Inflammatory Factors Affecting The Clinical Outcome Of Anterior Circulation Acute Ischemic Stroke After Endovascular Treatment

Part I:The correlation between neutrophil ratio and clinical outcome of anterior circulation acute ischemic stroke after endovascular treatmentBackground:Endovascular treatment(EVT)is proven to be safe and effective for acute large vessel occlusion stroke(LVOS).Neutrophil ratio reflects systematic inflammation which plays an important role in the process of ischemic stroke.This study aims to explore the relationship between baseline neutrophil ratio and the clinical outcomes of LVOS patients undergoing EVT.Method:A total of 658 patients from endovAsCular Treatment for acUte Anterior circulation ischemic stroke registry(ACTUAL)were enrolled in this study.The laboratory data before EVT were collected.Poor functional outcome was defined as modified Rankin Scale(mRS)of 3-6 at 90 days.Subjects were divided into two groups according to the median of baseline neutrophil ratio.Univariate analysis was performed on baseline variables,clinical variables and recanalization outcomes between two groups,statistically significant variables were included in the multivariate logistic regression model to analyze the predictive value of baseline neutrophil ratio for death and 90-day clinical outcomeResults:Of the 658 enrolled patients,56.8%(374/658)achieved an mRS of 3-6 at 90 days and the mortality at 90 days was 25.1%(165/658).Patients with a neutrophil ratio>0.83 had higher rates of poor functional outcome(67.5%vs 46.2%,p<0.001)and mortality(34%vs 16.1%,p<0.001).Multivariate logistic regression analysis showed that a higher neutrophil ratio was independently associated with 90-day poor clinical outcome(OR 1.652,95%CI 1.088-2.511,p=0.019);though not being an independent predictor for mortality at 90 days(OR 1.556,95%CI 0.944-2.567,p=0.083),it was associated with the trend of a higher mortality.Conclusion:Baseline neutrophil ratio independently predicts 90-day functional outcome but a trend association with mortality after EVT for acute anterior circulation LVOS patients.PART II:Serum Procalcitonin Predicts Functional and Safety Outcomes after Endovascular Treatment for Acute Ischemic StrokeBackground:Serum procalcitonin reflects systematic inflammation which plays an important role in the process of ischemic stroke.This study aims to explore the relationship between baseline procalcitonin and the clinical outcomes of LVOS patients undergoing EVT.Method:A total of 236 patients from the ACTUAL registry database were enrolled in this study.The laboratory data before EVT were collected.Poor functional outcome was defined as an mRS of 3-6 at 90 days.Subjects were divided into two groups according to the median of baseline procalcitonin.Univariate analysis was performed on baseline variables,clinical variables and recanalization outcomes between two groups,statistically significant variables were included in the multivariate logistic regression model to analyze the predictive value of baseline procalcitonin for 90-day clinical outcome.Results:Of the 236 enrolled patients,64.6%(170/263)achieved an mRS of 3-6 at90 days and the mortality at 90 days was 24.3%(64/263).Patients with a procalcitonin≥0.83 had higher rates of poor functional outcome(76%vs 53.7%,P<0.001).Multivariate logistic regression analysis showed that a higher level of procalcitonin was independently associated with 90-day poor clinical outcome(OR:2.158;95%Cl:1.213-3.840;P=0.009),while sICH(OR:9.39;95%CI:2.686-32.837;P<0.001)and SAP(OR:9.39;95%CI:2.686-32.837;P<0.001)proved to be risk factors to good clinical outcome.Conclusion:Baseline procalcitonin independently predicts 90-day functional outcome.