Sex-based differences in inflammatory predictors of outcomes in patients undergoing mechanical thrombectomy: an inverse probability weighting analysis
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Type
Journal Article
Abstract
Background. Inflammatory biomarkers, key predictors of ischemic stroke prognosis, may exhibit sex-specific predictive patterns. This study investigates sex-based differences in
inflammatory biomarkers as predictors of 90-day clinical outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy (MT).
Methods. This multicentre retrospective study included 970 patients consecutively treated with MT for anterior circulation large vessel occlusion (LVO) between 2016 and 2023. Inflammatory indices, including NLR, PLR, MLR, CRP, SIRI, and SII, were measured on admission and 24-hour post-MT. Inverse probability weighting (IPW) was used to balance baseline characteristics between male and female patients. LASSO regression and logistic regression were used to identify independent predictors of 90-day good functional outcomes(modified Rankin scale score mRS 0-2) and death, stratified by sex and agegroups (<55 and ≥55years).
Results. In the male weighted population (516 patients), multivariable analysis showed that MLR (OR:0.37, 95% CI: 0.13–0.95, p=0.041), 24-hour NLR (OR:0.88, 95%CI:0.83–0.94, p<0.001) and 24-hour MLR (OR:0.33, 95%CI:0.12–0.94, p<0.001) were independent predictors of 90-day good functional outcome with age-specific differences noted.24-hour MLR (OR:5.05, 95%CI:1.36–4.28, p=0.047) and ESR (OR:1.02, 95%CI:1.01–1.04, p=0.025) were independent predictors of death, respectively for men < 55 and men ³ 55years.
In the weighted female population (454 patients), 24-hour NLR (OR:0.89, 95%CI:0.81–0.96, p=0.007) and 24-hour CRP (OR:0.98, 95%CI:0.97–0.99, p=0.029) were independent predictors of good functional outcomes. 24-hour CRP was also an independent predictor of 90- day death (OR:1.01, 95%CI:1.00–1.02, p=0.017) in women with no age-specific differences noted. Interaction analysis revealed significant sex-specific relationships for MLR and CRP but not for NLR.
Conclusions. This study highlights sex-based differences in the predictive value of widely available inflammatory biomarkers for stroke outcomes. MLR was a distinct predictor in men, while CRP was uniquely associated with outcomes in women. These findings underscore the need for sex-stratified approaches in stroke management and research.
inflammatory biomarkers as predictors of 90-day clinical outcomes in acute ischemic stroke patients undergoing mechanical thrombectomy (MT).
Methods. This multicentre retrospective study included 970 patients consecutively treated with MT for anterior circulation large vessel occlusion (LVO) between 2016 and 2023. Inflammatory indices, including NLR, PLR, MLR, CRP, SIRI, and SII, were measured on admission and 24-hour post-MT. Inverse probability weighting (IPW) was used to balance baseline characteristics between male and female patients. LASSO regression and logistic regression were used to identify independent predictors of 90-day good functional outcomes(modified Rankin scale score mRS 0-2) and death, stratified by sex and agegroups (<55 and ≥55years).
Results. In the male weighted population (516 patients), multivariable analysis showed that MLR (OR:0.37, 95% CI: 0.13–0.95, p=0.041), 24-hour NLR (OR:0.88, 95%CI:0.83–0.94, p<0.001) and 24-hour MLR (OR:0.33, 95%CI:0.12–0.94, p<0.001) were independent predictors of 90-day good functional outcome with age-specific differences noted.24-hour MLR (OR:5.05, 95%CI:1.36–4.28, p=0.047) and ESR (OR:1.02, 95%CI:1.01–1.04, p=0.025) were independent predictors of death, respectively for men < 55 and men ³ 55years.
In the weighted female population (454 patients), 24-hour NLR (OR:0.89, 95%CI:0.81–0.96, p=0.007) and 24-hour CRP (OR:0.98, 95%CI:0.97–0.99, p=0.029) were independent predictors of good functional outcomes. 24-hour CRP was also an independent predictor of 90- day death (OR:1.01, 95%CI:1.00–1.02, p=0.017) in women with no age-specific differences noted. Interaction analysis revealed significant sex-specific relationships for MLR and CRP but not for NLR.
Conclusions. This study highlights sex-based differences in the predictive value of widely available inflammatory biomarkers for stroke outcomes. MLR was a distinct predictor in men, while CRP was uniquely associated with outcomes in women. These findings underscore the need for sex-stratified approaches in stroke management and research.
Date Acceptance
2025-05-13
Citation
Therapeutic Advances in Neurological Disorders
ISSN
1756-2856
Publisher
SAGE Publishing
Journal / Book Title
Therapeutic Advances in Neurological Disorders
Copyright Statement
Copyright This paper is embargoed until publication. Once published the Version of Record (VoR) will be available on immediate open access.
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Publication Status
Accepted