Liver fibrosis indices predict malignant cerebral edema after endovascular therapy for anterior circulation large vessel occlusion stroke: a retrospective cohort study
ObjectiveTo investigate the association between liver fibrosis indices and malignant cerebral edema (MCE) following endovascular therapy (EVT) for anterior circulation large vessel occlusion (LVO) stroke.MethodsThis single-center, retrospective cohort study consecutively enrolled 340 anterior circul...
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Frontiers Media S.A.
2025-07-01
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| Series: | Frontiers in Neurology |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fneur.2025.1569698/full |
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| author | Weiwei Gao Weiwei Gao Weiwei Gao Yanan Zhao Jingjing She Jingjing She Jingjing She Jingjing She Ziwei Wu Lijuan Cai Lijuan Cai Lijuan Cai Jianzhong Lin Xingyu Chen Xingyu Chen Xingyu Chen Renjing Zhu Renjing Zhu Renjing Zhu Renjing Zhu Renjing Zhu |
| author_facet | Weiwei Gao Weiwei Gao Weiwei Gao Yanan Zhao Jingjing She Jingjing She Jingjing She Jingjing She Ziwei Wu Lijuan Cai Lijuan Cai Lijuan Cai Jianzhong Lin Xingyu Chen Xingyu Chen Xingyu Chen Renjing Zhu Renjing Zhu Renjing Zhu Renjing Zhu Renjing Zhu |
| author_sort | Weiwei Gao |
| collection | DOAJ |
| description | ObjectiveTo investigate the association between liver fibrosis indices and malignant cerebral edema (MCE) following endovascular therapy (EVT) for anterior circulation large vessel occlusion (LVO) stroke.MethodsThis single-center, retrospective cohort study consecutively enrolled 340 anterior circulation LVO stroke patients who underwent EVT between January 2018 and December 2024. The primary outcome was MCE, defined as a midline shift >5 mm at the level of the septum pellucidum or pineal gland, accompanied by the disappearance of the perimesencephalic cistern or the need for decompressive craniectomy. Multivariable logistic regression models were used to assess the independent associations of eight liver fibrosis indices with MCE, and restricted cubic spline regression analysis (RCS) was employed to explore their nonlinear relationships. The predictive performance was evaluated using receiver operating characteristic curves.ResultsMCE occurred in 69 patients (20.3%). After adjusting for multiple confounders, elevated fibrosis-4 index (FIB-4) (OR = 1.41, 95% CI: 1.09–1.82), modified FIB-4 (OR = 1.14, 95% CI: 1.05–1.23), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (ARR) (OR = 2.35, 95% CI: 1.57–3.52), and AST/ALT-platelet ratio index (AARPRI) (OR = 2.63, 95% CI: 1.69–4.10) were independently associated with an increased risk of MCE, while FIB-5 index showed a negative association (OR = 0.89, 95% CI: 0.83–0.94). These liver fibrosis indices demonstrated moderate predictive performance (AUC: 0.65–0.68). RCS analysis revealed that most liver fibrosis indices exhibited an overall increasing dose–response relationship with MCE risk (both P-overall<0.05).ConclusionNon-invasive liver fibrosis indices could serve as novel biomarkers for risk stratification of MCE following EVT for stroke. These readily available tools may help identify high-risk patients who might benefit from early preventive interventions. |
| format | Article |
| id | doaj-art-1fc822b64a004657af291c6e998dbffa |
| institution | DOAJ |
| issn | 1664-2295 |
| language | English |
| publishDate | 2025-07-01 |
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| spelling | doaj-art-1fc822b64a004657af291c6e998dbffa2025-08-20T02:45:46ZengFrontiers Media S.A.Frontiers in Neurology1664-22952025-07-011610.3389/fneur.2025.15696981569698Liver fibrosis indices predict malignant cerebral edema after endovascular therapy for anterior circulation large vessel occlusion stroke: a retrospective cohort studyWeiwei Gao0Weiwei Gao1Weiwei Gao2Yanan Zhao3Jingjing She4Jingjing She5Jingjing She6Jingjing She7Ziwei Wu8Lijuan Cai9Lijuan Cai10Lijuan Cai11Jianzhong Lin12Xingyu Chen13Xingyu Chen14Xingyu Chen15Renjing Zhu16Renjing Zhu17Renjing Zhu18Renjing Zhu19Renjing Zhu20Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, ChinaXiamen Clinical Research Center for Cerebrovascular Diseases, Xiamen, ChinaXiamen Quality Control Center for Stroke, Xiamen, ChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, ChinaDepartment of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, ChinaXiamen Clinical Research Center for Cerebrovascular Diseases, Xiamen, ChinaXiamen Quality Control Center for Stroke, Xiamen, ChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, ChinaSchool of Medicine, Xiamen University, Xiamen, ChinaDepartment of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, ChinaXiamen Clinical Research Center for Cerebrovascular Diseases, Xiamen, ChinaXiamen Quality Control Center for Stroke, Xiamen, ChinaDepartment of MRI, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, ChinaDepartment of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, ChinaXiamen Clinical Research Center for Cerebrovascular Diseases, Xiamen, ChinaXiamen Quality Control Center for Stroke, Xiamen, ChinaDepartment of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, ChinaXiamen Clinical Research Center for Cerebrovascular Diseases, Xiamen, ChinaXiamen Quality Control Center for Stroke, Xiamen, ChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, ChinaSchool of Medicine, Xiamen University, Xiamen, ChinaObjectiveTo investigate the association between liver fibrosis indices and malignant cerebral edema (MCE) following endovascular therapy (EVT) for anterior circulation large vessel occlusion (LVO) stroke.MethodsThis single-center, retrospective cohort study consecutively enrolled 340 anterior circulation LVO stroke patients who underwent EVT between January 2018 and December 2024. The primary outcome was MCE, defined as a midline shift >5 mm at the level of the septum pellucidum or pineal gland, accompanied by the disappearance of the perimesencephalic cistern or the need for decompressive craniectomy. Multivariable logistic regression models were used to assess the independent associations of eight liver fibrosis indices with MCE, and restricted cubic spline regression analysis (RCS) was employed to explore their nonlinear relationships. The predictive performance was evaluated using receiver operating characteristic curves.ResultsMCE occurred in 69 patients (20.3%). After adjusting for multiple confounders, elevated fibrosis-4 index (FIB-4) (OR = 1.41, 95% CI: 1.09–1.82), modified FIB-4 (OR = 1.14, 95% CI: 1.05–1.23), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (ARR) (OR = 2.35, 95% CI: 1.57–3.52), and AST/ALT-platelet ratio index (AARPRI) (OR = 2.63, 95% CI: 1.69–4.10) were independently associated with an increased risk of MCE, while FIB-5 index showed a negative association (OR = 0.89, 95% CI: 0.83–0.94). These liver fibrosis indices demonstrated moderate predictive performance (AUC: 0.65–0.68). RCS analysis revealed that most liver fibrosis indices exhibited an overall increasing dose–response relationship with MCE risk (both P-overall<0.05).ConclusionNon-invasive liver fibrosis indices could serve as novel biomarkers for risk stratification of MCE following EVT for stroke. These readily available tools may help identify high-risk patients who might benefit from early preventive interventions.https://www.frontiersin.org/articles/10.3389/fneur.2025.1569698/fulllarge vessel occlusionmalignant cerebral edemaendovascular therapyliver fibrosis indicesanterior circulation |
| spellingShingle | Weiwei Gao Weiwei Gao Weiwei Gao Yanan Zhao Jingjing She Jingjing She Jingjing She Jingjing She Ziwei Wu Lijuan Cai Lijuan Cai Lijuan Cai Jianzhong Lin Xingyu Chen Xingyu Chen Xingyu Chen Renjing Zhu Renjing Zhu Renjing Zhu Renjing Zhu Renjing Zhu Liver fibrosis indices predict malignant cerebral edema after endovascular therapy for anterior circulation large vessel occlusion stroke: a retrospective cohort study Frontiers in Neurology large vessel occlusion malignant cerebral edema endovascular therapy liver fibrosis indices anterior circulation |
| title | Liver fibrosis indices predict malignant cerebral edema after endovascular therapy for anterior circulation large vessel occlusion stroke: a retrospective cohort study |
| title_full | Liver fibrosis indices predict malignant cerebral edema after endovascular therapy for anterior circulation large vessel occlusion stroke: a retrospective cohort study |
| title_fullStr | Liver fibrosis indices predict malignant cerebral edema after endovascular therapy for anterior circulation large vessel occlusion stroke: a retrospective cohort study |
| title_full_unstemmed | Liver fibrosis indices predict malignant cerebral edema after endovascular therapy for anterior circulation large vessel occlusion stroke: a retrospective cohort study |
| title_short | Liver fibrosis indices predict malignant cerebral edema after endovascular therapy for anterior circulation large vessel occlusion stroke: a retrospective cohort study |
| title_sort | liver fibrosis indices predict malignant cerebral edema after endovascular therapy for anterior circulation large vessel occlusion stroke a retrospective cohort study |
| topic | large vessel occlusion malignant cerebral edema endovascular therapy liver fibrosis indices anterior circulation |
| url | https://www.frontiersin.org/articles/10.3389/fneur.2025.1569698/full |
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