Clinico-Biological Correlates of Admission Glasgow Coma Scale in Thrombolysis-Treated Older Adults with Acute Ischemic Stroke: A Retrospective Cohort Study with an Exploratory Oral-Systemic Perspective

Background and Objectives: Biological correlates of admission consciousness remain incompletely characterized in older adults with acute ischemic stroke treated with intravenous thrombolysis. We evaluated associations between admission Glasgow Coma Scale (GCS) and pre-thrombolysis hematologic, inflammatory, iron-status, and micronutrient parameters, while considering the oral-systemic relevance of the resulting biological pattern. Materials and Methods: This retrospective single-center cohort included 95 unique patients aged ≥65 years treated between 2020 and 2024. Spearman correlations used the original GCS scores (11–14). Proportional-odds models used ordered categories (11–12, 13, and 14), adjusted for age and sex, with additional National Institutes of Health Stroke Scale (NIHSS) adjustment; false discovery rate (FDR) correction was applied. Results: Admission GCS correlated most strongly with RDW-CV (rho = −0.843; 95% bootstrap CI, −0.892 to −0.774) and MCV (rho = 0.779; 95% CI, 0.668 to 0.866). In age- and sex-adjusted models, odds ratios per 1-SD increase were 5.15 for hemoglobin, 3.17 for log-transformed ferritin, 4.49 for serum iron, 4.90 for log-transformed vitamin B12, 0.18 for C-reactive protein, and 0.018 for RDW-CV (all FDR-adjusted p < 0.001). Directions remained consistent after NIHSS adjustment. MCV showed a nonlinear association, with a model-derived turning point at 86.6 fL. Biomarkers were associated with absolute GCS at 24 hours but not with the direction of 24-hour change after FDR correction. Conclusions: The pre-thrombolysis biological profile was associated with the restricted range of admission GCS observed in this cohort. The convergence of hematologic, micronutrient, and inflammatory associations provides an exploratory oral-systemic research perspective but does not establish oral disease or an oral source for the systemic findings.