Comorbidity Burden and Early In‐Hospital Outcomes After Intravenous Thrombolysis for Acute Ischemic Stroke

Background The prognostic relevance of comorbidity burden in patients with acute ischemic stroke (AIS) treated with intravenous thrombolysis (IVT) remains uncertain. This study examined the association between four comorbidity indices and early in‐hospital outcomes. Methods This single‐center retrospective study included 106 patients with AIS treated with IVT between January and December 2024. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI; 1987 and 2011 versions) and the Elixhauser Comorbidity Index (ECI; 2009 and 2017 versions). The primary outcome was unfavorable functional status at discharge, defined as a modified Rankin scale (mRS) score of 3–6. Multivariable logistic regression was used to identify factors associated with the primary outcome, and receiver operating characteristic (ROC) analyses assessed the discriminatory performance of the indices. Mortality comparisons were exploratory because only 10 in‐hospital deaths occurred. Results The median age was 68 years, and 60 patients (56.6%) were men. Unfavorable functional outcome (mRS 3–6) occurred in 73 patients (68.9%). Higher admission National Institutes of Health Stroke Scale (NIHSS) scores and glucose levels were independently associated with unfavorable functional status at discharge, whereas none of the four comorbidity indices remained significant after multivariable adjustment. The comorbidity indices showed limited to modest discriminatory performance, with an AUC of 0.645 (95% CI 0.531–0.760) for CCI 1987. Hemorrhagic transformation (HT) occurred exclusively in patients with an unfavorable outcome and was more frequent among nonsurvivors. Exploratory comparisons also showed higher prestroke mRS, admission NIHSS, CCI 1987, and CCI 2011 scores among nonsurvivors; no multivariable mortality analysis was performed. Conclusions None of the evaluated comorbidity indices was independently associated with functional status at hospital discharge. Their discriminatory performance was modest, whereas admission stroke severity and glucose level showed stronger associations with short‐term outcome. Given the retrospective single‐center design, modest sample size, and limited number of deaths, the findings should be considered exploratory and hypothesis‐generating and require confirmation in larger prospective studies.