Early eGFR fluctuation and 180-day outcome after thrombectomy for large-artery atherosclerotic stroke

Background To investigate whether early estimated glomerular filtration rate (eGFR) fluctuation is associated with 180-day functional outcome in patients with large-artery atherosclerotic stroke undergoing endovascular thrombectomy. Methods We conducted a multicenter retrospective cohort study of consecutive patients with acute ischemic stroke attributed to large-artery atherosclerosis who underwent endovascular thrombectomy between January 1, 2024 and December 31, 2024. Among 108 patients with 180-day follow-up, 93 had at least two actual eGFR measurements within the first 7 days and comprised the primary complete-case cohort; the full 108-patient cohort after multiple imputation was examined in a sensitivity analysis. Early eGFR fluctuation was defined as the absolute difference between the maximum and minimum eGFR values within 7 days after admission. Poor functional outcome was defined as a modified Rankin Scale score of 3–6 at 180 days. Results In the primary cohort of 93 patients, 54 had poor functional outcomes. Greater early eGFR fluctuation was associated with poor 180-day functional outcome (adjusted OR per 1 mL/min/1.73 m2 increase, 1.078; 95% CI, 1.019–1.139; p = 0.008). The association was consistent in Firth penalized regression (OR, 1.068; 95% CI, 1.020–1.134; p = 0.002) and bootstrap internal validation. It remained significant after adjustment for the number of eGFR measurements (adjusted OR, 1.065; 95% CI, 1.006–1.127; p = 0.029) and in the 108-patient post-imputation sensitivity cohort (adjusted OR, 1.089; 95% CI, 1.030–1.151; p = 0.003). Restricted cubic spline analysis showed an overall association ( p = 0.012) without evidence of nonlinearity ( p = 0.471). Conclusion Greater early eGFR fluctuation was associated with poor 180-day functional outcome after thrombectomy in patients with large-artery atherosclerotic stroke. Early eGFR fluctuation may represent an exploratory prognostic marker that requires prospective external validation.