Prandin Gabriele, Foschi Matteo, Valente Mariarosaria, Zhang Liqun, Malhotra Paresh, Sacco Simona, Ornello Raffaele, Toraldo Francesco, Maisano Domenico, Del Regno Caterina, Komauli Filippo, Gartner Jarmillo Adelaida, Al-Karadsheh Hakam, Zahid Hamza, Klein Piers, Abdalkader Mohamad, Manganotti Paolo, Lobotesis Kyriakos, Nguyen Thanh N, Gigli Gian Luigi, Banerjee Soma, Merlino Giovanni, D'Anna Lucio
Department of Brain Sciences, Imperial College London, London, UK.
Clinical Unit of Neurology, Department of Medicine, Surgery and Health Sciences, University Hospital and Health Services of Trieste, ASUGI, University of Trieste, Trieste, Italy.
Ther Adv Neurol Disord. 2025 Jun 21;18:17562864251345719. doi: 10.1177/17562864251345719. eCollection 2025.
Inflammatory biomarkers, key predictors of ischemic stroke prognosis, may exhibit sex-specific predictive patterns.
This study investigates sex-based differences in inflammatory biomarkers as predictors of 90-day clinical outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy (MT).
Multicenter retrospective study.
This study included 970 patients consecutively treated with MT for anterior circulation large vessel occlusion between 2016 and 2023. Inflammatory indices, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio (MLR), C-reactive protein (CRP), systemic inflammation response index, and systemic immune-inflammation index, were measured on admission and 24-h post-MT. Inverse probability weighting was used to balance baseline characteristics between male and female patients. Least absolute shrinkage and selection operator regression and logistic regression were used to identify independent predictors of 90-day good functional outcomes (modified Rankin scale (mRS) score 0-2) and death, stratified by sex and age groups (<55 and ⩾55 years).
In the male weighted population (516 patients), multivariable analysis showed that MLR (odds ratio (OR): 0.37, 95% confidence interval (CI): 0.13-0.95, = 0.041), 24-h NLR (OR: 0.88, 95% CI: 0.83-0.94, < 0.001), and 24-h MLR (OR: 0.33, 95% CI: 0.12-0.94, < 0.001) were independent predictors of 90-day good functional outcome with age-specific differences noted. Twenty-four-hour MLR (OR: 5.05, 95% CI: 1.36-4.28, = 0.047) and erythrocyte sedimentation rate (OR: 1.02, 95% CI: 1.01-1.04, = 0.025) were independent predictors of death, respectively, for men <55 and men ⩾55 years. In the weighted female population (454 patients), 24-h NLR (OR: 0.89, 95% CI: 0.81-0.96, = 0.007) and 24-h CRP (OR: 0.98, 95% CI: 0.97-0.99, = 0.029) were independent predictors of good functional outcomes. Twenty-four-hour CRP was also an independent predictor of 90-day death (OR: 1.01, 95% CI: 1.00-1.02, = 0.017) in women with no age-specific differences noted. Interaction analysis revealed significant sex-specific relationships for MLR and CRP but not for NLR.
This study highlights sex-based differences in the predictive value of widely available inflammatory biomarkers for stroke outcomes. MLR was a distinct predictor in men, while CRP was uniquely associated with outcomes in women. These findings underscore the need for sex-stratified approaches in stroke management and research.
炎症生物标志物是缺血性中风预后的关键预测指标，可能呈现出性别特异性的预测模式。
本研究调查了炎症生物标志物在接受机械取栓（MT）的急性缺血性中风患者中作为90天临床结局预测指标的性别差异。
多中心回顾性研究。
本研究纳入了2016年至2023年间连续接受MT治疗的970例前循环大血管闭塞患者。在入院时和MT后24小时测量炎症指标，包括中性粒细胞与淋巴细胞比值（NLR）、血小板与淋巴细胞比值、单核细胞与淋巴细胞比值（MLR）、C反应蛋白（CRP）、全身炎症反应指数和全身免疫炎症指数。采用逆概率加权法平衡男性和女性患者的基线特征。使用最小绝对收缩和选择算子回归及逻辑回归来确定90天良好功能结局（改良Rankin量表（mRS）评分0 - 2）和死亡的独立预测因素，并按性别和年龄组（<55岁和⩾55岁）进行分层。
在男性加权人群（516例患者）中，多变量分析显示，MLR（比值比（OR）：0.37，95%置信区间（CI）：0.13 - 0.95，P = 0.041）、24小时NLR（OR：0.88，95% CI：0.83 - 0.94，P < 0.001）和24小时MLR（OR：0.33，95% CI：0.12 - 0.94，P < 0.001）是90天良好功能结局的独立预测因素，且存在年龄特异性差异。24小时MLR（OR：5.05，95% CI：1.36 - 4.28，P = 0.047）和红细胞沉降率（OR：1.02，95% CI：1.01 - 1.04，P = 0.025）分别是<55岁和⩾55岁男性死亡的独立预测因素。在女性加权人群（454例患者）中，24小时NLR（OR：0.89，95% CI：0.81 - 0.96）和24小时CRP（OR：0.98，95% CI：0.97 - 0.99，P = 0.029）是良好功能结局的独立预测因素。24小时CRP也是90天死亡的独立预测因素（OR：1.01，95% CI：1.00 - 1.02，P = 0.017），在女性中未观察到年龄特异性差异。交互分析显示MLR和CRP存在显著的性别特异性关系，但NLR不存在。
本研究强调了广泛可用的炎症生物标志物对中风结局预测价值的性别差异。MLR是男性的独特预测指标，而CRP与女性结局有独特关联。这些发现强调了在中风管理和研究中采用性别分层方法的必要性。
