Predictors of Functional Recovery in Patients With Mild Hemorrhagic Transformation Following Intravenous Thrombolysis for Acute Ischemic Stroke.

Abstract

Aims/background: Patients who develop mild hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) for acute ischemic stroke (AIS) exhibit substantial heterogeneity in functional recovery. However, a systematic evaluation of predictors of functional recovery in this specific population remains lacking. This study aimed to identify the clinical and nutritional factors associated with functional recovery in these patients.

Methods: This dual-center retrospective cohort study consecutively enrolled 204 patients with AIS who developed mild HT after IVT between March 2020 and March 2025. Based on the modified Rankin Scale (mRS) score at 3 months, patients were classified into a good functional recovery group (mRS ≤2, n = 153) and a poor functional recovery group (mRS ≥3, n = 51). Demographic, clinical, and laboratory data were collected. Nutritional status was evaluated using the Controlling Nutritional Status (CONUT) score and the Prognostic Nutritional Index (PNI). Univariate and multivariate logistic regression analyses were performed to identify independent predictors. The predictive performance of individual factors and a combined model was assessed using receiver operating characteristic (ROC) curve analysis.

Results: Univariate analysis demonstrated that age, baseline National Institutes of Health Stroke Scale (NIHSS) score, PNI, CONUT score, arrival-to-thrombolysis time, and history of diabetes mellitus (HD) were significantly associated with poor functional recovery (all p < 0.05). Multivariate analysis identified HD, older age, a higher baseline NIHSS score, and a higher CONUT score as independent risk factors for poor functional recovery (all p < 0.05). A combined model incorporating these four variables demonstrated the highest discriminative performance, with an area under the curve (AUC) of 0.840 (95% CI: 0.783-0.897). At the optimal probability cut-off of 0.156, the model achieved a specificity of 92.2% and a sensitivity of 64.5%.

Conclusion: In patients with AIS who develop mild HT after IVT, baseline neurological deficit severity, nutritional status, HD, and age are independent determinants of functional recovery. A model integrating these factors demonstrates superior discriminative potential and may facilitate early risk stratification and personalized management in this patient population.