Association of Admission Glucose‐to‐Lymphocyte Ratio With 90‐Day Functional Outcome in Patients With Acute Ischemic Stroke Treated With Intravenous Thrombolysis

BACKGROUND: The glucose-to-lymphocyte ratio (GLR), a composite biomarker reflecting metabolic and immune-inflammatory status, has shown prognostic value in several clinical settings. However, its relevance in patients with acute ischemic stroke (AIS) undergoing intravenous thrombolysis (IVT) remains unclear. We investigated the association between admission GLR and poor functional outcome at 90 days in this population. METHODS: In this retrospective single-center study, consecutive patients with AIS treated with IVT between May 2016 and December 2025 were included. The primary outcome was poor functional outcome at 90 days, defined as a modified Rankin Scale score of 3-6. GLR was analyzed as both a continuous and a categorical variable. Multivariable logistic regression, inverse probability weighting, restricted cubic spline analysis, subgroup analyses, and sensitivity analyses were performed after multiple imputation for missing data. RESULTS: Among 785 patients, 29.64% had poor functional outcome at 90 days. The optimal GLR cutoff was 4.137, with a pooled AUC of 0.623 (95% CI 0.578-0.665). In the fully adjusted model, GLR was independently associated with poor outcome both as a continuous variable (OR = 1.071, 95% CI 1.004-1.144, p = 0.038) and as a categorical variable (OR = 1.639, 95% CI 1.057-2.543, p = 0.027). The findings remained robust in an alternative lipid-adjusted model and IPW analyses. RCS analysis suggested an overall linear association, whereas sensitivity analyses using an alternative mRS dichotomization were not statistically significant. CONCLUSIONS: Elevated admission GLR was independently associated with an increased risk of poor functional outcome at 90 days in patients with AIS undergoing IVT. GLR may provide useful supplementary prognostic information for early risk stratification, although its standalone discriminatory performance was modest.