Progression of Neuroinflammation Is Associated With Clinical Prognosis of Patients Undergoing Intravenous...

Recent research has shown that neuroinflammation progresses rapidly within a few hours after stroke; however, the relationship between its progression and clinical outcomes remains unclear. Therefore, this study aimed to investigate the effect of neuroinflammation, measured by serum GFAP (glial fibrillary acidic protein), on patient outcomes, as well as the influence of baseline peripheral inflammation on the progression of neuroinflammation.

This prospective cohort study enrolled patients with acute ischemic stroke who received intravenous thrombolysis (IVT) between September 2016 and April 2023 across 16 centers in China. Serum GFAP levels were measured before (baseline, within 4.5 hours of onset) and at 24 hours after IVT. GFAP changes were determined by subtracting baseline levels from those measured 24 hours post-IVT. Outcome measures included final infarct volume during hospitalization, National Institutes of Health Stroke Scale scores at 24 hours and 7 days post-IVT, early neurological deterioration within 24 hours, delayed neurological deterioration within 7 days, and 3-month modified Rankin Scale scores. A modified Rankin Scale score of ≥2 was classified as an unfavorable outcome. Peripheral inflammation indicators were measured at baseline. Binary logistic and linear regressions were used as the main statistical methods.

Overall, 743 patients were included. A significant increase in GFAP levels was observed, indicating progression of neuroinflammation. Regression analyses revealed that increased GFAP after IVT was independently associated with larger infarct volume (β, 30.965 [95% CI, 19.185-42.745]; P<0.001), higher 24-hour and 7-day National Institutes of Health Stroke Scale scores (24-hour: β, 2.632 [95% CI, 1.644-3.620]; P<0.001; 7-day: β, 3.298 [95% CI, 2.179-4.417]; P<0.001), and unfavorable outcomes (odds ratio, 3.631, [95% CI, 2.159-6.106]; P<0.001). Furthermore, baseline peripheral inflammation, assessed using peripheral inflammation indicators, was significantly associated with elevated GFAP levels.

The increase in GFAP levels over the first 24 hours after IVT is independently associated with clinical outcomes, with higher baseline peripheral inflammation correlating with greater GFAP elevation during that period.