Predictive value of MLR and NHHR on hemorrhagic transformation after intravenous thrombolysis with tenecteplase in acute cerebral infarction

LAN Yue; ZHAO Sisi; ZHANG Suxia; ZHANG Yuanyuan; LI Jiaying; HOU Qian

doi:10.3969/j.issn.1671-2897.2025.06.014

Abstract：Objective To explore the predictive value of monocyte-to-lymphocyte ratio(MLR)and non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio(NHHR)on hemorrhagic transformation(HT)after intravenous thrombolysis with tenecteplase(TNK)in patients with ACI.Methods A total of 42 cases with ACI who received TNK intravenous thrombolysis and developed HT from January 2023 to January 2025 were included in the HT group,and 217 cases with ACI who received TNK intravenous thrombolysis and did not develop HT were included in the non-HT group.The predictive value of MLR and NHHR was evaluated by ROC curve.The influencing factors of HT after TNK intravenous thrombolysis were explored by multivariate logistic stepwise regression.Results The monocyte count,non-HDL-C,MLR,and NHHR in the HT group were higher compared with non-HT group,while the lymphocyte count and HDL-C were lower than those in the non-HT group(P<0.05).The area under the ROC curve(AUC)(95%CI)of MLR combined with NHHR for predicting HT after TNK intravenous thrombolysis in patients with acute cerebral infarction was 0.903(0.853～0.952),which was higher than that of MLR and NHHR alone,0.755(0.705～0.804)and 0.843(0.795～0.894),respectively(Z=9.567,8.347,P<0.001).The proportion of history of hypertension and atrial fibrillation in the HT group was higher compared with non-HT group,and the NIHSS score at admission,time from onset to thrombolysis,neutrophil count,D-dimer,fasting blood glucose,and aspartate aminotransferase were higher in the HT group than in the non-HT group(P<0.05).Multivariate analysis showed that atrial fibrillation(OR=3.080,95%CI:1.563～6.069),increased NIHSS score at admission(OR=2.793,95%CI:1.342～5.813),increased D-dimer(OR=1.962,95%CI:1.360～2.831),MLR≥0.23(OR=2.875,95%CI:1.523～5.425),and NHHR≥3.22(OR=3.360,95%CI:1.643～6.872)were independent risk factors for HT after TNK intravenous thrombolysis(P<0.05).Conclusions Elevated MLR and NHHR are closely related to HT after TNK intravenous thrombolysis in patients with ACI and can be used as predictive indicators for HT.The predictive efficacy of the combination of the two is better than that of a single indicator.