International Journal For Multidisciplinary Research

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Admission NIHSS Score as a Clinical Predictor of Hemorrhagic Transformation in Acute Ischemic Stroke

Author(s) Dr. Pranav Mallick, Dr. Pankaj Kaushal, Dr. Abhay Umesh Baraliya
Country India
Abstract Background: Hemorrhagic transformation (HT) is a common and clinically significant complication of acute ischemic stroke (AIS), contributing to neurological deterioration, prolonged hospitalization, and unfavorable functional outcomes. Early identification of patients at increased risk for HT is essential for optimizing acute stroke management. The National Institutes of Health Stroke Scale (NIHSS) score at admission reflects initial stroke severity and may serve as a readily available clinical predictor of HT.

Objective: To assess the association between admission NIHSS score and the occurrence of hemorrhagic transformation in patients with acute ischemic stroke.

Methods: This retrospective cross-sectional study included patients admitted with acute ischemic stroke to a tertiary care teaching hospital between January 2020 and December 2023. Adult patients (≥18 years) with radiologically confirmed ischemic stroke and a documented admission NIHSS score were included. Patients with primary intracranial hemorrhage, stroke mimics, or incomplete clinical or imaging data were excluded. Hemorrhagic transformation was identified on follow-up computed tomography or magnetic resonance imaging performed within 7 days of admission and classified according to the European Cooperative Acute Stroke Study (ECASS) criteria. Demographic characteristics, vascular risk factors, laboratory parameters, and acute stroke therapies were recorded. Multivariable logistic regression analysis was performed to identify independent predictors of HT. The predictive performance of admission NIHSS score was evaluated using receiver operating characteristic (ROC) curve analysis.

Results: A total of 186 patients were included in the final analysis (mean age 64.2 ± 12.1 years; 60.8% male). Hemorrhagic transformation occurred in 32 patients (17.2%), of whom 12 patients (6.5%) developed symptomatic HT. The median admission NIHSS score was significantly higher in patients who developed HT compared with those who did not (15 [IQR 11–19] vs 9 [IQR 6–13]; p < 0.001). On multivariable logistic regression analysis, admission NIHSS score remained an independent predictor of HT (adjusted odds ratio 1.21 per point increase; 95% CI 1.11–1.32; p < 0.001), after adjustment for age, atrial fibrillation, serum glucose levels, hypertension, and thrombolytic therapy. ROC curve analysis demonstrated good discriminative ability of admission NIHSS score for predicting HT, with an area under the curve of 0.83 (95% CI 0.76–0.89). An NIHSS cut-off value of ≥13 yielded a sensitivity of 75.0% and specificity of 72.4% for predicting HT. Higher admission NIHSS scores were also significantly associated with poor functional outcomes at 90 days (modified Rankin Scale ≥3; p < 0.001).

Conclusion: Admission NIHSS score is a robust and independent clinical predictor of hemorrhagic transformation in acute ischemic stroke. Early stroke severity assessment using NIHSS can facilitate risk stratification and guide clinical decision-making in routine practice. Incorporation of NIHSS into predictive models may improve identification of high-risk patients and optimize stroke care pathways.
Keywords Keywords: Acute ischemic stroke; hemorrhagic transformation; NIHSS score; clinical predictor; retrospective study.
Field Medical / Pharmacy
Published In Volume 8, Issue 1, January-February 2026
Published On 2026-01-21
DOI https://doi.org/10.36948/ijfmr.2026.v08i01.67192
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