Impacts of stress hyperglycemia ratio on functional outcomes of ischemic stroke patients treated with intravenous thrombolysis: a population-based study

Backgrounds Stress hyperglycemia ratio (SHR) has been associated with poor outcomes in acute ischemic stroke, but the impacts of SHR on functional outcomes in stroke patients with intravenous thrombolysis remain unclear. This study aimed to investigate the predictive value of SHR on functional outcomes in stroke patients with intravenous thrombolysis. Methods Ischemic stroke patients with intravenous thrombolysis were retrospectively enrolled in 36 centers. SHR is calculated by glucose/glycated hemoglobin. Favorable functional outcome was defined as a modified Rankin Scale score of 0–2 at 90 days after stroke onset. Multivariable logistic regression models evaluated the SHR–outcome relationship, adjusting for demographic, clinical, and laboratory parameters. Piecewise linear regression with a recursive algorithm identified potential threshold effects, and stratified analyses were performed based on key demographic and clinical factors. Sensitivity analyses were conducted in non-diabetic patients and in those with BMI < 25 kg/m 2 and HbA1c < 6.5%. Results A non-linear relationship was detected between SHR and functional outcomes, with an inflection point at SHR = 1.09. Below this threshold, each 0.1-unit increase in SHR was associated with a 33% increase in the odds of poor outcomes (OR = 1.33, 95% CI: 1.16–1.57, p < 0.001), whereas the association became non-significant above this threshold (OR = 0.91, 95% CI: 0.79–1.06, p = 0.201). Conclusion SHR exhibits a threshold effect on functional outcomes in acute ischemic stroke patients receiving thrombolysis, suggesting its potential prognostic value as a risk stratification indicator in this population. These findings warrant further validation in prospective studies before clinical application.