Prognostic Value of Abnormal Liver Function Tests After Mechanical Thrombectomy for Acute Ischemic Stroke

Area of Science:

• Neurology
• Hepatology
• Clinical Outcomes Research

Background:

• Mechanical thrombectomy (MT) is a key treatment for acute ischemic stroke (AIS).
• The impact of post-procedural abnormal liver function tests (ALFT) on functional outcomes following MT for AIS is not well understood.
• Assessing ALFT may provide crucial prognostic information.

Purpose of the Study:

• To investigate the clinical significance of post-procedural ALFT on 90-day functional outcomes in AIS patients treated with MT.
• To determine if post-procedural ALFT is an independent predictor of outcomes after MT.

Main Methods:

• Retrospective observational study including AIS patients undergoing MT from the Nanjing Stroke Registry Program and Captor trial.
• Favorable outcome defined as modified Rankin Scale score 0-2 at 90 days.
• Multivariable logistic regression, continuous net reclassification improvement (NRI), integrated discrimination improvement (IDI), and restricted cubic splines were used for analysis.

Main Results:

• Post-procedural ALFT was diagnosed in 55.7% of 420 patients.
• Patients with post-procedural ALFT had higher admission NIH Stroke Scale scores and increased rates of pneumonia.
• Post-procedural ALFT, not pre-procedural, independently predicted favorable outcomes (aOR, 0.48; 95% CI 0.28-0.81; P=0.006), significantly improving predictive models (NRI=0.401, P<0.001; IDI=0.013, P<0.001).

Conclusions:

• Post-procedural ALFT in AIS patients treated with MT is associated with more severe strokes.
• Post-procedural ALFT serves as an independent predictor of worse 90-day functional prognosis.
• No dose-response relationship was found between ALFT severity and prognosis.