ArticleFrontiers in neurology
Systemic immune-inflammation index predicts post-thrombectomy outcomes and reveals a mediating role in the association between neurocardiac stress and prognosis: a multicenter study.
Article in Frontiers in neurology. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Systemic inflammation and neurocardiac stress are key determinants of poor outcomes after endovascular thrombectomy (EVT), yet their interplay remains poorly quantified. Existing models often rely on static factors and overlook the dynamic interaction between these two pathways. This study investigates whether the Systemic Immune-Inflammation Index (SII) statistically accounts for a portion of the association between atrial fibrillation with rapid ventricular response (AF-RVR)-a clinical marker of neurocardiac stress-and poor outcome in stroke patients undergoing EVT. Methods: In this multicenter retrospective study, 678 EVT patients were screened, yielding a derivation cohort of 515. Using LASSO and multivariable logistic regression, we developed a model incorporating AF-RVR, SII, and key clinical/procedural variables to predict poor 3-month functional outcome (mRS 3-6). Mediation analysis was employed to quantify the indirect effect of AF-RVR on outcome via SII. External validation was performed in 181 independent patients. The model was implemented as an online risk calculator. Results: Poor outcome occurred in 56.1% (289/515) of the derivation cohort. AF-RVR correlated with elevated SII. Patients with both AF-RVR and high SII had a significantly increased risk of poor outcome (adjusted OR 9.80; 95% CI, 3.46-31.43), with a graded risk across subgroups. Mediation analysis revealed that the indirect effect of AF-RVR through SII was significant (absolute risk difference 4.6 percentage points; 95% CI, 1.1-8.4). The model demonstrated good discrimination (AUC 0.789 derivation, 0.710 validation), calibration, and clinical utility on decision curve analysis. Conclusion: We developed and externally validated a nomogram integrating AF-RVR and SII to predict post-EVT outcomes. The prognostic association of AF-RVR was partially statistically accounted for by systemic inflammation. This tool supports early individualized risk stratification and underscores the importance of jointly assessing neurocardiac stress and systemic inflammation in post-thrombectomy care.
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