Abstract / Summary
Purpose Inflammation and dyslipidemia are critical in post-stroke prognosis. We conducted a comprehensive analysis of six common inflammatory-lipid indices to evaluate the associations between these indices and four clinical outcomes after mechanical thrombectomy (MT) for acute ischemic stroke (AIS), and to identify generalizable consistently associated markers for all four clinical outcomes. Methods In this retrospective studyassociations between inflammatory-lipid indices, namely monocyte-to-high-density lipoprotein cholesterol ratio (MHR), platelet-to-HDL-C ratio (PHR), neutrophil-to-HDL-C (NHR), lymphocyte-to-HDL-C ratio (LHR), fibrinogen-to-HDL-C ratio (FHR), and C-reactive protein-to-HDL-C ratio (CRP/HDL-C), and four post-MT clinical outcomes comprised hemorrhagic transformation (HT), malignant cerebral edema (MCE) 90-day unfavorable outcome and all-cause mortality were evaluated using multivariable analyses. False discovery rate (FDR) correction was applied for multiple comparisons. NHR, which demonstrated consistent significance for all four clinical outcomes, was subjected to further analyses. Results A total of 513 patients were included., demonstrated The incidences of HT, MCE, unfavorable outcome, and all-cause mortality were 30.6% (157), 22.6% (116), 54.8% (281), and 25.9% (133), respectively. The NHR was significantly associated with all four clinical outcomes (HT: odds ratio [OR] 1.079, 95% confidence interval [CI] 1.023–1.142, p-FDR = 0.034; MCE: OR 1.089, 95% CI 1.031–1.154, p-FDR = 0.008; unfavorable outcome: OR 1.177, 95% CI 1.098–1.269, p-FDR < 0.001; all-cause mortality: hazard ratio [HR] 1.047, 95% CI 1.012–1.084, p-FDR = 0.022). In the subgroup analysis for all-cause mortality, an interaction between NHR and TOAST classification was observed ( p for interaction = 0.023), indicating that the association with all-cause mortality was pronounced in patients with cardioembolic stroke (HR 1.109, 95% CI 1.055–1.165). Mediation analysis showed that HT (23.9%, p < 0.001) and MCE (23.8%, p < 0.001) statistically accounted for part of the associations between NHR and unfavorable outcome. The relationship between NHR and unfavorable outcome may be partially mediated by HT (23.9%, p < 0.001) and MCE (23.8%, p < 0.001). Conclusion NHR may serve as a potentially useful complementary marker of post-MT HT, MCE, unfavorable outcome, and all-cause mortality. Its association with all-cause mortality appears stronger in patients with cardioembolic stroke. HT and MCE may act as mediators linking NHR to unfavorable outcomes. External validation is required to verify these findings.