Glucose and platelet are two easily obtained clinical indicators; the present research aimed to demonstrate their association with hemorrhagic transformation (HT) in acute ischemic stroke (AIS) patients without thrombolytic or thrombectomy therapy. This was a single-center retrospective study. Patients who were diagnosed with HT after AIS were included in the HT group. Meanwhile, using the propensity score matching (PSM) approach, with a ratio of 1:2, matched patients without HT were included in the non-HT group. Serum G/P levels were measured on the first morning after admission (at least eight hours after the last meal). Characteristics were compared between the two groups. Multivariate logistic regression was used to determine the independent relationship between G/P and HT after AIS, with G/P being divided into quartiles. From January 2013 to March 2022, we consecutively included 643 AIS patients with HT (426/643 [66.25%] with HI and 217/643 [33.75%] with PH), and 1282 AIS patients without HT, at the First Affiliated Hospital of Wenzhou Medical University. The HT group had higher G/P levels than the non-HT group (0.04 ± 0.02 vs. 0.03 ± 0.02, p < 0.001). However, there was no difference in G/P levels between HI and PH subgroups (0.04 ± 0.02 vs. 0.04 ± 0.02, p > 0.05). Moreover, the G/P levels were divided into quartiles (Q1 ≤ 0.022; Q2 = 0.023–0.028; Q3 = 0.029–0.039; Q4 ≥ 0.040), with Q1 being settled as the reference layer. After controlling the confounders, multivariate regression analyses showed that the Q4 layer (Q4: G/P ≥ 0.040) was independently associated with elevated HT risk (odds ratio [OR] = 1.85, 95% CI = 1.31–2.63, p < 0.001). G/P levels on admission were independently associated with HT risk in AIS patients. In clinical practice, adequate attention should be paid to AIS patients with elevated G/P levels (G/P ≥ 0.040).

Background: Hemorrhagic transformation (HT) is a severe complication in patients with acute ischemic stroke (AIS). This study was performed to explore and validate the relation between bilirubin levels and spontaneous HT (sHT) and HT after mechanical thrombectomy (tHT). Methods: The study population consisted of 408 consecutive AIS patients with HT and age- and sex-matched patients without HT. All patients were divided into quartiles according to total bilirubin (TBIL) level. HT was classified as hemorrhagic infarction (HI) and parenchymal hematoma (PH) based on radiographic data. Results: In this study, the baseline TBIL levels were significantly higher in the HT than non-HT patients in both cohorts (p < 0.001). Furthermore, the severity of HT increased with increasing TBIL levels (p < 0.001) in sHT and tHT cohorts. The highest quartile of TBIL was associated with HT in sHT and tHT cohorts (sHT cohort: OR = 3.924 (2.051–7.505), p < 0.001; tHT cohort: OR = 3.557 (1.662–7.611), p = 0.006). Conclusions: Our results suggest that an increased TBIL is associated with a high risk of patients with sHT and tHT, and that TBIL is more suitable as a predictor for sHT than tHT. These findings may help to identify patients susceptible to different types and severity of HT.

Background and purpose: Multiple factors influence the efficacy of mechanical thrombectomy (MT) in patients with acute ischemic stroke. This study aimed to clarify the association between admission hyperglycemia (AH) and long-term functional outcome and to determine whether this association is mediated by postoperative renal function. Methods: A total of 397 patients with acute ischemic stroke who underwent MT between February 2018 and June 2024 and had available 6-month follow-up were included in this study. Functional outcome was assessed using the modified Rankin Scale (mRS), with scores of 0–2 indicating a good outcome. Multivariable regression models were constructed, adjusting for relevant covariates, including diabetes and the diabetes × AH interaction term. Mediation analysis was performed to explore the mediating effect of postoperative renal function. Results: Among the 397 patients, the median postoperative estimated glomerular filtration rate (post-eGFR) was 92.4 mL/min/1.73 m ² (IQR: 76.2–106.3), 198 (49.9%) patients had AH, and a good outcome at 6 months was achieved in 151 (38.0%) patients. After adjustment for confounding factors, multivariable regression analysis demonstrated that AH [OR (95% CI): 3.148 (1.672–5.925), p < 0.001] and lower post-eGFR [OR (95% CI): 0.978 (0.963–0.993), p = 0.004] were significantly associated with a lower likelihood of a good outcome at 6 months. Mediation analysis showed that post-eGFR mediated the association between AH and good prognosis, accounting for 25.57% of the total effect. Conclusion: Our study suggests that admission hyperglycemia is independently associated with long-term functional outcome after MT in patients with acute ischemic stroke, with or without diabetes. This association may be partly mediated by postoperative renal function.