Distinct trajectory patterns of neutrophil-to-albumin ratio predict clinical outcomes after endovascular therapy in large vessel occlusion stroke
ObjectiveTo investigate the dynamic characteristics and prognostic value of neutrophil-to-albumin ratio (NAR) in patients with acute large vessel occlusion ischemic stroke (LVO-AIS) undergoing endovascular therapy (EVT).MethodsIn this retrospective cohort study, we consecutively enrolled 299 patient...
Saved in:
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Frontiers Media S.A.
2025-06-01
|
| Series: | Frontiers in Aging Neuroscience |
| Subjects: | |
| Online Access: | https://www.frontiersin.org/articles/10.3389/fnagi.2025.1570662/full |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1849736188927148032 |
|---|---|
| author | Weiwei Gao Junxuan Sun Lingfeng Yu Jingjing She Yanan Zhao Lijuan Cai Xingyu Chen Xingyu Chen Renjing Zhu Renjing Zhu Renjing Zhu |
| author_facet | Weiwei Gao Junxuan Sun Lingfeng Yu Jingjing She Yanan Zhao Lijuan Cai Xingyu Chen Xingyu Chen Renjing Zhu Renjing Zhu Renjing Zhu |
| author_sort | Weiwei Gao |
| collection | DOAJ |
| description | ObjectiveTo investigate the dynamic characteristics and prognostic value of neutrophil-to-albumin ratio (NAR) in patients with acute large vessel occlusion ischemic stroke (LVO-AIS) undergoing endovascular therapy (EVT).MethodsIn this retrospective cohort study, we consecutively enrolled 299 patients with anterior circulation LVO-AIS who underwent EVT between January 2018 and February 2024. NAR was measured at admission, day 1, and day 3 after EVT. The primary outcome was poor functional outcome at 90 days (modified Rankin Scale score 3–6). Secondary outcomes included symptomatic intracranial hemorrhage (sICH), malignant cerebral edema (MCE), and in-hospital mortality (IHM). Multivariable logistic regression and restricted cubic spline regression were used to analyze the association between NAR and functional outcomes. Latent class trajectory modeling (LCTM) was applied to identify NAR evolution patterns, and propensity score matching (PSM) was performed to balance baseline characteristics between different trajectory groups, followed by conditional logistic regression to assess their association with clinical outcomes.ResultsAt 90-day follow-up, 197 patients (65.9%) had poor outcomes. The predictive value of NAR increased over time, with day 3 NAR showing the best predictive performance (poor outcome: AUC = 0.79; sICH: AUC = 0.70; MCE: AUC = 0.75; IHM: AUC = 0.81). Multivariable analysis showed that for each unit increase in day 3 NAR, the risk of 90-day poor outcome increased 2.81-fold (95% CI: 1.96–4.03, p < 0.001). LCTM analysis identified two distinct NAR evolution patterns: continuously increasing (31.1%) and peak-then-decline (68.7%). After PSM (63 patients per group), compared with the continuously increasing trajectory, the peak-then-decline trajectory was associated with significantly lower risks of poor functional outcome (OR = 0.38, 95% CI: 0.17–0.86, p = 0.020), sICH (OR = 0.38, 95% CI: 0.17–0.86, p = 0.020), MCE (OR = 0.25, 95% CI: 0.10–0.61, p = 0.002), and IHM (OR = 0.13, 95% CI: 0.04–0.42, p < 0.001).ConclusionNAR trajectory patterns independently predict clinical outcomes after EVT for LVO-AIS. Dynamic monitoring of NAR, particularly on day 3 post-procedure, may facilitate early risk stratification and development of targeted intervention strategies, providing a new biomarker tool for precision stroke management. |
| format | Article |
| id | doaj-art-76bf6e226ae544909433bfa274740f79 |
| institution | DOAJ |
| issn | 1663-4365 |
| language | English |
| publishDate | 2025-06-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Aging Neuroscience |
| spelling | doaj-art-76bf6e226ae544909433bfa274740f792025-08-20T03:07:21ZengFrontiers Media S.A.Frontiers in Aging Neuroscience1663-43652025-06-011710.3389/fnagi.2025.15706621570662Distinct trajectory patterns of neutrophil-to-albumin ratio predict clinical outcomes after endovascular therapy in large vessel occlusion strokeWeiwei Gao0Junxuan Sun1Lingfeng Yu2Jingjing She3Yanan Zhao4Lijuan Cai5Xingyu Chen6Xingyu Chen7Renjing Zhu8Renjing Zhu9Renjing Zhu10Department of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, ChinaDepartment of Emergency, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, ChinaSchool of Medicine, Xiamen University, Xiamen, ChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, ChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, ChinaDepartment of Neurology, 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, ChinaDepartment of Neurology, Zhongshan Hospital of Xiamen University, School of Medicine, Xiamen University, Xiamen, ChinaThe School of Clinical Medicine, Fujian Medical University, Fuzhou, Fujian, ChinaXiamen Clinical Research Center for Cerebrovascular Diseases, Xiamen, ChinaObjectiveTo investigate the dynamic characteristics and prognostic value of neutrophil-to-albumin ratio (NAR) in patients with acute large vessel occlusion ischemic stroke (LVO-AIS) undergoing endovascular therapy (EVT).MethodsIn this retrospective cohort study, we consecutively enrolled 299 patients with anterior circulation LVO-AIS who underwent EVT between January 2018 and February 2024. NAR was measured at admission, day 1, and day 3 after EVT. The primary outcome was poor functional outcome at 90 days (modified Rankin Scale score 3–6). Secondary outcomes included symptomatic intracranial hemorrhage (sICH), malignant cerebral edema (MCE), and in-hospital mortality (IHM). Multivariable logistic regression and restricted cubic spline regression were used to analyze the association between NAR and functional outcomes. Latent class trajectory modeling (LCTM) was applied to identify NAR evolution patterns, and propensity score matching (PSM) was performed to balance baseline characteristics between different trajectory groups, followed by conditional logistic regression to assess their association with clinical outcomes.ResultsAt 90-day follow-up, 197 patients (65.9%) had poor outcomes. The predictive value of NAR increased over time, with day 3 NAR showing the best predictive performance (poor outcome: AUC = 0.79; sICH: AUC = 0.70; MCE: AUC = 0.75; IHM: AUC = 0.81). Multivariable analysis showed that for each unit increase in day 3 NAR, the risk of 90-day poor outcome increased 2.81-fold (95% CI: 1.96–4.03, p < 0.001). LCTM analysis identified two distinct NAR evolution patterns: continuously increasing (31.1%) and peak-then-decline (68.7%). After PSM (63 patients per group), compared with the continuously increasing trajectory, the peak-then-decline trajectory was associated with significantly lower risks of poor functional outcome (OR = 0.38, 95% CI: 0.17–0.86, p = 0.020), sICH (OR = 0.38, 95% CI: 0.17–0.86, p = 0.020), MCE (OR = 0.25, 95% CI: 0.10–0.61, p = 0.002), and IHM (OR = 0.13, 95% CI: 0.04–0.42, p < 0.001).ConclusionNAR trajectory patterns independently predict clinical outcomes after EVT for LVO-AIS. Dynamic monitoring of NAR, particularly on day 3 post-procedure, may facilitate early risk stratification and development of targeted intervention strategies, providing a new biomarker tool for precision stroke management.https://www.frontiersin.org/articles/10.3389/fnagi.2025.1570662/fullacute ischemic strokelarge vessel occlusion strokeendovascular therapyneutrophil-to-albumin ratioclinical outcomeslatent class trajectory modeling |
| spellingShingle | Weiwei Gao Junxuan Sun Lingfeng Yu Jingjing She Yanan Zhao Lijuan Cai Xingyu Chen Xingyu Chen Renjing Zhu Renjing Zhu Renjing Zhu Distinct trajectory patterns of neutrophil-to-albumin ratio predict clinical outcomes after endovascular therapy in large vessel occlusion stroke Frontiers in Aging Neuroscience acute ischemic stroke large vessel occlusion stroke endovascular therapy neutrophil-to-albumin ratio clinical outcomes latent class trajectory modeling |
| title | Distinct trajectory patterns of neutrophil-to-albumin ratio predict clinical outcomes after endovascular therapy in large vessel occlusion stroke |
| title_full | Distinct trajectory patterns of neutrophil-to-albumin ratio predict clinical outcomes after endovascular therapy in large vessel occlusion stroke |
| title_fullStr | Distinct trajectory patterns of neutrophil-to-albumin ratio predict clinical outcomes after endovascular therapy in large vessel occlusion stroke |
| title_full_unstemmed | Distinct trajectory patterns of neutrophil-to-albumin ratio predict clinical outcomes after endovascular therapy in large vessel occlusion stroke |
| title_short | Distinct trajectory patterns of neutrophil-to-albumin ratio predict clinical outcomes after endovascular therapy in large vessel occlusion stroke |
| title_sort | distinct trajectory patterns of neutrophil to albumin ratio predict clinical outcomes after endovascular therapy in large vessel occlusion stroke |
| topic | acute ischemic stroke large vessel occlusion stroke endovascular therapy neutrophil-to-albumin ratio clinical outcomes latent class trajectory modeling |
| url | https://www.frontiersin.org/articles/10.3389/fnagi.2025.1570662/full |
| work_keys_str_mv | AT weiweigao distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke AT junxuansun distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke AT lingfengyu distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke AT jingjingshe distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke AT yananzhao distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke AT lijuancai distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke AT xingyuchen distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke AT xingyuchen distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke AT renjingzhu distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke AT renjingzhu distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke AT renjingzhu distincttrajectorypatternsofneutrophiltoalbuminratiopredictclinicaloutcomesafterendovasculartherapyinlargevesselocclusionstroke |