OBJECTIVE: To assess the prognostic value of the homocysteine-to-high-density lipoprotein cholesterol (Hcy/HDL-C) ratio and the high-sensitivity C-reactive protein-to-albumin (hs-CRP/Alb) ratio as biomarkers for predicting functional outcomes in acute cerebral infarction (ACI) patients treated with recombinant tissue plasminogen activator (rt-PA). METHODS: A retrospective analysis was conducted on 204 ACI patients who received rt-PA. Patients were classified into two groups based on their functional outcomes at 3 months poststroke: good (modified Rankin scale mRS ≤ 2) and poor (mRS > 2). Logistic regression and restricted cubic spline (RCS) analyses were performed to evaluate the association between Hcy/HDL-C and hs-CRP/Alb ratios with functional outcomes. A predictive nomogram was developed incorporating these biomarkers, baseline NIHSS scores, and atrial fibrillation. The performance of this nomogram was compared to traditional risk models. RESULTS: Elevated Hcy/HDL-C and hs-CRP/Alb ratios were identified as independent predictors of poor functional outcomes in ACI patients (p < 0.05). The nomogram, incorporating these biomarkers along with NIHSS scores and atrial fibrillation, demonstrated superior predictive performance with a C-index of 0.936 and an AUC of 0.935, outperforming traditional risk models (C-index = 0.782). Subgroup analysis revealed that Hcy/HDL-C was more predictive in patients with large-artery atherosclerosis (LAA), while hs-CRP/Alb showed stronger prognostic value in patients with cardioembolic strokes. CONCLUSION: The Hcy/HDL-C and hs-CRP/Alb ratios serve as independent and valuable biomarkers for predicting poor outcomes in ACI patients post-rt-PA treatment. The nomogram incorporating these biomarkers provides superior prognostic accuracy and could be a useful tool for personalized risk assessment and management in ACI patients following thrombolytic therapy.
Ding et al. (2026) studied this question.