Bao Li, Wang Yuhang, He Shuang
Department of Stroke Center, Affiliated Hospital of Nantong University, Nantong, China.
Front Neurol. 2025 Jun 13;16:1606563. doi: 10.3389/fneur.2025.1606563. eCollection 2025.
Hemorrhagic transformation (HT) and symptomatic intracranial hemorrhage (sICH) are common complications of endovascular thrombectomy (EVT) in acute ischemic stroke (AIS) patients. The role of peripheral immune inflammation in HT after EVT is unclear. This study aimed to evaluate the relationship between immune inflammatory factor levels and HT and sICH occurrence, and to develop predictive models.
We included 81 AIS patients who underwent EVT. Peripheral blood samples were collected immediately post-EVT to measure immunoinflammatory markers. Least absolute shrinkage and selection operator (LASSO) regression was used to select variables, and backward stepwise multivariable logistic regression identified independent predictors and predictive models for HT and sICH. The models' discrimination was assessed using the area under the receiver operating characteristic curve (AUC), and calibration was evaluated using the Hosmer-Lemeshow test. Logistic regression models were used to evaluate the impact of HT or sICH on 90-day functional outcomes and mortality.
The HT rate was 39.51% (32/81), and the sICH rate was 17.07% (14/81). Multivariate analysis revealed that HT after EVT was significantly associated with collateral score [OR 0.27 (95% CI 0.13-0.52), < 0.001], arteriosclerosis etiology [OR 0.11 (95% CI 0.02-0.46), = 0.006], puncture to recanalization time [OR 3.72 (95% CI 1.07-14.59), = 0.04], and levels of IL-6 [OR 7.33 (95% CI 2.1-31.07), = 0.003; AUC 0.696 (95% CI 0.593-0.799)]. sICH was independently related to direct aspiration (DA) techniques [OR 0.07 (95% CI 0.09-0.35), = 0.004] and neutrophil-to-albumin ratio (NAR) values [OR 5.69 (95% CI 1.16-37.24), = 0.044; 0.676 (95% CI 0.550-0.803)]. Both predictive models for HT [AUC 0.898 (95% CI 0.831-0.965)] and sICH [AUC 0.925 (0.853-0.997)] exhibited good discrimination and calibration.
IL-6 and NAR are potential biomarkers for predicting HT and sICH in AIS patients after EVT. This study developed simple and effective predictive models for HT and sICH based on immunoinflammatory factors. Future research should explore the spatiotemporal effects of immune inflammation on prognosis in AIS patients undergoing EVT.
出血性转化（HT）和症状性颅内出血（sICH）是急性缺血性卒中（AIS）患者血管内血栓切除术（EVT）的常见并发症。外周免疫炎症在EVT后HT中的作用尚不清楚。本研究旨在评估免疫炎症因子水平与HT及sICH发生之间的关系，并建立预测模型。
我们纳入了81例行EVT的AIS患者。EVT后立即采集外周血样本以检测免疫炎症标志物。采用最小绝对收缩和选择算子（LASSO）回归进行变量选择，向后逐步多变量逻辑回归确定HT和sICH的独立预测因素及预测模型。使用受试者操作特征曲线（ROC）下面积评估模型的辨别力，使用Hosmer-Lemeshow检验评估校准情况。采用逻辑回归模型评估HT或sICH对90天功能结局和死亡率 的影响。
HT发生率为39.51%（32/81），sICH发生率为17.07%（14/81）。多变量分析显示，EVT后HT与侧支循环评分显著相关[比值比（OR）0.27（95%置信区间[CI]0.13 - 0.52），P < 0.001]、动脉硬化病因[OR 0.11（95% CI 0.02 - 0.46），P = 0.006]、穿刺至再通时间[OR 3.72（95% CI 1.07 - 14.59），P = 0.04]以及白细胞介素-6（IL-6）水平[OR 7.33（95% CI 2.1 - 31.07），P = 0.003；ROC下面积0.696（95% CI 0.593 - 0.799）]。sICH与直接抽吸（DA）技术[OR 0.07（95% CI 0.09 - 0.35），P = 0.004]和中性粒细胞与白蛋白比值（NAR）值独立相关[OR 5.69（95% CI 1.16 - 37.24），P = 0.044；ROC下面积为0.676（95% CI 0.550 - 0.803）]。HT [ROC下面积0.898（95% CI 0.831 - 0.965）]和sICH [ROC下面积为0.925（0.853 - 0.997）]的预测模型均显示出良好的辨别力和校准情况。
IL-6和NAR是预测AIS患者EVT后HT和sICH的潜在生物标志物。本研究基于免疫炎症因子建立了简单有效的HT和sICH预测模型。未来研究应探索免疫炎症对接受EVT的AIS患者预后的时空效应。
