Serum Lipid Profiles as Predictors of Hemorrhagic Transformation After Thrombolysis in Acute Cerebral Infarction: A Prospective Study.

Introduction: This study aims to investigate the effect of the serum Total Cholesterol (TC) to High-Density Lipoprotein cholesterol (HDL) ratio (T/H ratio) on Hemorrhagic Transformation (HT) after Intravenous Thrombolysis (IVT) in patients with Acute Cerebral Infarction (ACI).

Methods: Patients with ACI who received alteplase were enrolled. Subgroups were classified based on the occurrence of hemorrhagic transformation (HT) after intravenous thrombolysis (IVT), whether tirofiban was coadministered, and their 90-day prognosis. The primary observation indicators were HT and the 90-day prognosis. Single-factor and multi-factor analyses were performed to identify independent predictors of HT and prognosis.

Results: Age, TC, and HDL were identified as risk factors for ACI. The T/H ratio and HDL were statistically significant in relation to HT (p < 0.05). A correlation was observed between the T/H ratio and HT, with HT more likely to occur when the T/H ratio was greater than or equal to 3.25. The use of tirofiban after IVT did not increase the risk of HT. Significant differences were observed in HT, type of HT, age, hypertension, baseline National Institutes of Health Stroke Scale (NIHSS) score, platelet volume distribution width, TC, D-dimer, and fibrinogen degradation products between groups with different prognoses.

Discussion: The T/H ratio was statistically associated with HT-ACI and predicted HT-ACI to some extent. However, the study had two limitations: the small sample size and the assessment of prognosis through follow-up phone calls, which affected the final results.

Conclusion: Patients with ACI undergoing IVT who had higher baseline NIHSS scores, lower TC, higher HDL, and a higher T/H ratio were at increased risk of HT, which was also associated with long-term outcomes. The T/H ratio may be a valuable predictor of HT following IVT.