Admission Inflammatory-Metabolic Biomarker Profiles and Outcome-Specific Prognostic Patterns After Endovascular Therapy for Acute Ischemic Stroke: A Multicenter Cohort Study
Abstract
Background Clinical outcomes after endovascular therapy (EVT) for acute ischemic stroke (AIS) remain heterogeneous despite advances in reperfusion care. Whether admission inflammatory-metabolic biomarker profiles provide complementary and outcome-specific prognostic information beyond established clinical and imaging variables remains uncertain. Methods This multicenter retrospective cohort included consecutive adults with anterior-circulation large-vessel occlusion AIS treated with EVT at three centers between 2020 and 2025. The primary outcome was unfavorable 90-day functional outcome (modified Rankin Scale score 3–6); secondary outcomes were early neurological deterioration (END) and hemorrhagic transformation (HT). Multivariable logistic regression, restricted cubic splines, interaction analyses, and internally validated prediction models were used. Results Among 740 patients, 424 (57.3%) had an unfavorable 90-day functional outcome. Per 1-SD increase, the C-reactive protein–triglyceride glucose index (CTI) was independently associated with unfavorable outcome (adjusted odds ratio [aOR] 2.07, 95% CI 1.65–2.61) and END (aOR 1.74, 95% CI 1.46–2.08), but not with HT. Several cell-derived inflammatory indices were independently associated with HT, including the neutrophil-to-lymphocyte ratio (NLR; aOR 1.47, 95% CI 1.25–1.74) and systemic immune-inflammation index (SII; aOR 1.35, 95% CI 1.15–1.58). The association between CTI and unfavorable outcome was stronger in patients with poor collateral circulation (P for interaction = 0.011). Adding CTI and NLR increased the baseline model AUC from 0.792 to 0.836 (ΔAUC 0.044, 95% CI 0.025–0.065; cross-validated AUC 0.818). Conclusion Admission inflammatory–metabolic biomarkers showed complementary, outcome-specific associations after EVT. CTI was most consistently associated with END and unfavorable 90-day functional outcome, whereas cell-derived inflammatory indices were more strongly associated with HT. Combining CTI and NLR may refine early risk stratification after EVT, although prospective external validation is required before clinical application.