Inflammatory Markers Mediate the Prognosis of Baseline Mismatch Volume and 90-Day Outcomes in Acute Ischemic Stroke Patients.

BACKGROUND: While previous studies link larger ischemic penumbra volumes to worse AIS outcomes, clinical results are inconsistent. This study seeks to explore how baseline mismatch volume (a proxy for ischemic penumbra) relates to 90-day AIS prognosis and the mediating role of inflammatory markers herein. METHODS: This study conducted a retrospective analysis of 473 patients with AIS. Logistic regression and restricted cubic spline (RCS) analysis were used to evaluate the relationship between baseline mismatch volume and poor 90-day outcomes. The mediating role of inflammatory markers was assessed using the bootstrap method. Participants were divided into four groups based on baseline mismatch volume and outcome to further explore the role of inflammation in ischemic penumbra volume and poor outcome. RESULTS: Logistic regression analysis showed that baseline mismatch volume was significantly associated with poor outcomes at 90 days (OR = 1.04 [95% CI, 1.01-1.06]; p < 0.01), and RCS curve analysis showed a linear relationship between the two (p > 0.05). Inflammatory markers partially mediated the relationship between the two (NLR: 22.9%, MLR: 17.5%, PNR: 27.4%). In addition, a small number of patients with large mismatch volumes had good outcomes, while patients with small mismatch volumes had poor outcomes, which was significantly related to the severity of their inflammatory response (p < 0.001). CONCLUSION: Larger baseline mismatch volume, higher NLR and MLR, and lower PNR were significantly associated with poor outcomes in patients with 90-day AIS. It is worth noting that in some cases with smaller mismatch volume, patients with high NLR and MLR and low PNR still had poor outcomes. Some patients with low NLR and MLR, and high PNR still experienced favorable outcomes, even with larger mismatch volumes. These findings suggest that AIS prognosis is not solely determined by baseline mismatch volume but is also significantly influenced by systemic inflammatory responses.