High-Mobility Group Box-1 as a Predictor for Malignant Brain Edema Following Mechanical Thrombectomy in Acute Ischemic Stroke Patients.

BACKGROUND AND PURPOSE

Emerging experimental evidence has established that high-mobility group box 1 (HMGB-1) plays a pivotal role in cerebral ischemia pathogenesis, primarily through mediating neuroinflammatory cascades following ischemic injury. This study sought to investigate the potential association between circulating HMGB-1 levels and the risk of malignant brain edema (MBE) in patients undergoing mechanical thrombectomy (MT).

METHODS

This study prospectively recruited patients presenting with large vessel occlusive stroke in the anterior circulation and receiving MT treatment. Serum HMGB-1 levels were quantitatively assessed for all participants upon hospital admission. MBE was defined as defined as a midline shift of ≥5 mm observed on follow-up neuroimaging after MT. Multivariate logistic regression analyses were conducted to investigate the potential correlation between serum HMGB-1 concentrations and MBE development.

RESULTS

Among the cohort of 261 eligible patients (mean age: 69.7 years; male: 166 [63.6%]), 59 individuals (22.6%; 95% confidence interval [CI]: 17.6%-28.3%) developed MBE. After adjusted for demographic characteristics and other potential confounders, multivariate logistic regression demonstrated that higher serum HMGB-1 levels were associated with an increased risk of MBE (odds ratios [OR], highest vs lowest quartile: 3.130; 95% CI, 1.077-9.098; = 0.036). In addition, restricted cubic spline analysis revealed a dose-response relationship between elevated serum HMGB-1 levels and MBE risk ( for non-linearity=0.764).

CONCLUSION

This study confirmed that elevated circulating HMGB-1 levels were significantly associated with MBE after MT. These findings suggested that HMGB-1 could serve as a predictive biomarker for post-MT MBE risk, potentially enabling early identification of high-risk patients who may benefit from intensified monitoring or targeted therapeutic interventions.