Association of remnant cholesterol and cholesterol, high-density lipoprotein, and glucose index with unfavorable outcomes after intravenous thrombolysis in acute ischemic stroke: a dual-center cohort study

Background and purpose: This study aimed to investigate the independent and joint effects of two novel lipid-derived biomarkers-Remnant cholesterol (RC) and Cholesterol, high-density lipoprotein, and glucose (CHG) index-with hemorrhagic transformation (HT) and poor prognosis in patients with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT). Methods: In this dual-center retrospective cohort study, 4403 AIS patients undergoing IVT were analyzed. RC and the CHG index were calculated from routine baseline biochemical measurements. The primary outcome was HT, and the secondary outcome was poor prognosis at 90 days (modified Rankin Scale [mRS] score > 2). Multivariable logistic regression and restricted cubic spline (RCS) models were used to assess linear and non-linear associations. Subgroup and receiver operating characteristic (ROC) analyses were conducted to evaluate robustness and discriminative ability. Mediation analysis explored the potential mediating role of the systemic immune-inflammation index (SII). Results: < 0.001) than alone. Mediation analysis further showed that SII partially mediated these associations. Conclusion: High RC and CHG levels were associated with a lower risk of HT and poor prognosis in AIS patients undergoing IVT. Integrating these biomarkers enhances predictive performance, supporting their potential utility in pre-thrombolysis risk stratification and personalized treatment decision-making.