Abstract: Objective To investigate the predictive value of stress hyperglycemia ratio (SHR) combined with glycosylated hemoglobin (HbA1c) on hemorrhagic transformation (HT) after intravenous thrombolysis in the elderly patients with acute ischemic stroke (AIS). Methods A total of 234 elderly AIS inpatients receiving intravenous thrombolytic therapy with recombinant tissue plasminogen activator (rt-PA) from the First People’s Hospital of Lianyungang and Affiliated Hospital of Jiangsu University from June 2018 to December 2020 were enrolled in this study. The patients were divided into HT group (n=50) and non-HT group (n=184)according to the results of computed tomography (CT) or magnetic resonance imaging (MRI) during the acute period. The clinical baseline data of the two groups were collected and compared. Multivariate Logistic regression analysis was used to analyze the risk factors for HT after rt-PA intravenous thrombolytic therapy in the elderly AIS patients. The receiver operating characteristic (ROC) curve was used to analyze the value of SHR, HbA1c and their combination in predicting HT after rt-PA intravenous thrombolytic therapy in the elderly AIS patients. Results There were statistically significant differences in age, pre-thrombolysis NIHSS score, the levels of fasting plasma glucose (FPG) and HbA1c, and the ratio of atrial fibrillation, TOAST classification and large infarct area between the two groups(P<0.05 or P<0.01). Multivariate Logistic regression analysis showed that high levels of SHR (OR=39.443, 95%CI:1.847-842.343) and HbA1c (OR=1.777, 95%CI:1.091-2.859), and large infarct area(OR=3.093, 95%CI:1.359-7.036) were the independent risk factors for HT after intravenous thrombolysis with rt-PA in the elderly AIS patients. The area under curve (AUC) of HbA1c, SHR and their combination to predict the risk of HT after intravenous thrombolysis with rt-PA in the elderly AIS patients was 0.631 (95%CI:0.541-0.721), 0.656 (95%CI:0.654-0.748) and 0.741 (95%CI:0.665-0.816), respectively. The AUC of HbA1c combined with SHR was significantly greater than that of the two indexes alone (P<0.05). Conclusions High levels of SHR and HbA1c are independent risk factors for HT after intravenous thrombolysis with rt-PA in the elderly AIS patients,and the combination of the two indexes shows significant value to predict the risk of HT after rt-PA intravenous thrombolytic therapy.

Key words: acute ischemic stroke, hemorrhagic transformation, stress hyperglycemia ratio, glycosylated hemoglobin, risk factor