{
  "abstract": "Background and objective\n\nUric acid and bilirubin are endogenous redox-related metabolites, but their joint association with hemorrhagic transformation (HT) after intravenous thrombolysis (IVT) remains uncertain. We examined whether relatively low uric acid and high total bilirubin define a cumulative biochemical profile associated with hemorrhagic risk.Methods\n\nIn this single-center retrospective cohort, we analyzed 733 patients with verifiable pretreatment uric acid and total bilirubin measurements from an IVT registry. Low uric acid (≤278 μmol/L) and high total bilirubin (≥12.67 μmol/L) contributed one point each to a 0-2 adverse-feature score. Any HT was the primary outcome; parenchymal hematoma (PH) and database-defined symptomatic intracranial hemorrhage (sICH) were secondary outcomes. Analyses used logistic regression, Firth bias-reduced regression, multiple imputation and restricted cubic splines.Results\n\nHT occurred in 79/733 patients (10.8%). Observed HT rates were 7.0%, 13.6% and 26.5% across zero, one and two adverse features. Each additional feature was associated with higher odds of HT after covariate adjustment (OR 1.76, 95% CI 1.19-2.60; P = 0.004). PH occurred in 30/733 patients (4.1%), and database-defined sICH occurred in 33/664 patients with observed status (5.0%). Continuous spline analyses in 731 patients showed evidence of an overall association for uric acid (P overall=0.044) and total bilirubin (P overall=0.040), without strong evidence of nonlinearity (P nonlinear=0.193 and P nonlinear=0.704, respectively). No multiplicative interaction between the continuous biomarker terms was detected (OR 0.99, 95% CI 0.77-1.28; P = 0.938).Conclusions\n\nRelatively low uric acid and high total bilirubin defined a cumulative biochemical profile associated with greater odds of HT after IVT. The association requires external validation and should not be interpreted as evidence of causality or as a clinical treatment threshold.",
  "abstract_shown": true,
  "affiliations": [
    "College of Acupuncture-Moxibustion, Tuina and Rehabilitation, Hunan University of Chinese Medicine , ,",
    "Teaching and Research Office of TCM Internal Medicine, Hunan Traditional Chinese Medical College , ,",
    "Changsha Central Hospital , , ,",
    "School of Physical Education, Hunan University of Arts and Science , ,"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 8,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Huan Liang"
    },
    {
      "affs": [
        1
      ],
      "name": "Baiyu Zeng"
    },
    {
      "affs": [
        2
      ],
      "name": "Jingquan Wang"
    },
    {
      "affs": [
        0
      ],
      "name": "Lizhen Yi"
    },
    {
      "affs": [
        3
      ],
      "name": "Linxing Huang"
    },
    {
      "affs": [
        0
      ],
      "name": "Ziyan Lin"
    },
    {
      "affs": [
        2
      ],
      "name": "Cai Zhou"
    },
    {
      "affs": [
        0
      ],
      "name": "Zenghui Yue"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/a3hm8qhkes5t4.bib",
  "cited_by": 0,
  "doi": "10.3389/fmed.2026.1977632",
  "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13716756/?tool=EBI",
  "id": "a3hm8qhkes5t4",
  "issns": [
    "2296-858X"
  ],
  "landing_url": "https://europepmc.org/article/PMC/PMC13716756",
  "language": "eng",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2713|Acute Ischemic Stroke Management"
    ]
  ],
  "openalex": "W7222003912",
  "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13716756/pdf/?tool=EBI",
  "pmcid": "PMC13716756",
  "pmid": "42959095",
  "published": "2026-10-15",
  "publisher": "Frontiers Media SA",
  "ris": "https://research.draconitic.com/paper/a3hm8qhkes5t4.ris",
  "sources": [
    {
      "first_seen": "2026-10-31T00:20:37Z",
      "native_id": "PMC:PMC13716756",
      "source": "europepmc",
      "url": "https://europepmc.org/article/PMC/PMC13716756"
    },
    {
      "first_seen": "2026-11-01T00:20:52Z",
      "native_id": "MED:42959095",
      "source": "europepmc",
      "url": "https://europepmc.org/article/MED/42959095"
    },
    {
      "first_seen": "2026-11-01T12:23:58Z",
      "native_id": "PMC13716756",
      "source": "pmc",
      "url": "https://doi.org/10.3389/fmed.2026.1977632"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2713|Acute Ischemic Stroke Management",
      "subfield": "epidemiology-public-health"
    }
  ],
  "title": "A cumulative biochemical profile of low uric acid and high total bilirubin is associated with hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke: a retrospective cohort study",
  "title_text": "A cumulative biochemical profile of low uric acid and high total bilirubin is associated with hemorrhagic transformation after intravenous thrombolysis in acute ischemic stroke: a retrospective cohort study",
  "type": "peer-reviewed",
  "updated_at": "2026-11-02T12:21:12Z",
  "url": "https://research.draconitic.com/paper/a3hm8qhkes5t4",
  "venue": "Frontiers in medicine",
  "versions": []
}