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Introduction <p>Acute ischemic stroke (AIS) remains a major cause of disability and death despite effective reperfusion therapies, intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). Systemic inflammation critically shapes ischemic injury and recovery, but the prognostic value of inflammatory biomarkers in reperfused patients is unclear, and previous reviews have not consistently addressed pre-treatment inflammatory markers in patients treated with IVT or MT.</p> Methods <p>We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane Library, Web of Science, and Scopus were searched through November 30, 2024, for studies assessing associations between circulating inflammatory biomarkers measured before IVT or MT and 3-month functional outcome (modified Rankin Scale, mRS). Data were pooled using random-effects models, with odds ratios (OR) and 95% confidence intervals (CI) calculated for poor outcome (mRS 3–6).</p> Results <p>Thirty-seven studies (8780 patients) met inclusion criteria; ten contributed to meta-analysis. Four biomarkers were evaluable in IVT-treated cohorts. Higher pre-treatment interleukin-6 (IL-6) predicted poor outcome (pooled OR 1.80, 95% CI 1.42–2.28), as did osteopontin (pooled OR 3.36, 95% CI 1.95–5.80). Tumor necrosis factor-α (TNF-α) showed a borderline association (pooled OR 1.05, 95% CI 1.00–1.10), whereas C-reactive protein (CRP) was not predictive (pooled OR 1.02, 95% CI 0.99–1.06). Evidence in MT cohorts was limited and heterogeneous.</p> Conclusion <p>Among patients with AIS treated with IVT, pre-treatment IL-6 showed the most consistent association with poor 3-month functional outcome, whereas CRP showed no reliable prognostic association. Osteopontin emerged as a promising but preliminary candidate biomarker based on limited evidence, and TNF-α showed only modest prognostic relevance. Evidence in patients undergoing MT remains insufficient for quantitative conclusions. Larger standardized prospective studies are needed to validate inflammatory biomarkers and determine their added prognostic value beyond established clinical and imaging predictors.</p>

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Pre-Treatment Levels of Inflammatory Biomarkers as Predictors of Reperfusion Outcomes in Acute Ischemic Stroke: A Systematic Review and Meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月17日

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  • István Szegedi,
  • Zsolt Barnabás Éles,
  • Attila Nagy,
  • Zsuzsa Bagoly

摘要

Introduction

Acute ischemic stroke (AIS) remains a major cause of disability and death despite effective reperfusion therapies, intravenous thrombolysis (IVT) and mechanical thrombectomy (MT). Systemic inflammation critically shapes ischemic injury and recovery, but the prognostic value of inflammatory biomarkers in reperfused patients is unclear, and previous reviews have not consistently addressed pre-treatment inflammatory markers in patients treated with IVT or MT.

Methods

We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Cochrane Library, Web of Science, and Scopus were searched through November 30, 2024, for studies assessing associations between circulating inflammatory biomarkers measured before IVT or MT and 3-month functional outcome (modified Rankin Scale, mRS). Data were pooled using random-effects models, with odds ratios (OR) and 95% confidence intervals (CI) calculated for poor outcome (mRS 3–6).

Results

Thirty-seven studies (8780 patients) met inclusion criteria; ten contributed to meta-analysis. Four biomarkers were evaluable in IVT-treated cohorts. Higher pre-treatment interleukin-6 (IL-6) predicted poor outcome (pooled OR 1.80, 95% CI 1.42–2.28), as did osteopontin (pooled OR 3.36, 95% CI 1.95–5.80). Tumor necrosis factor-α (TNF-α) showed a borderline association (pooled OR 1.05, 95% CI 1.00–1.10), whereas C-reactive protein (CRP) was not predictive (pooled OR 1.02, 95% CI 0.99–1.06). Evidence in MT cohorts was limited and heterogeneous.

Conclusion

Among patients with AIS treated with IVT, pre-treatment IL-6 showed the most consistent association with poor 3-month functional outcome, whereas CRP showed no reliable prognostic association. Osteopontin emerged as a promising but preliminary candidate biomarker based on limited evidence, and TNF-α showed only modest prognostic relevance. Evidence in patients undergoing MT remains insufficient for quantitative conclusions. Larger standardized prospective studies are needed to validate inflammatory biomarkers and determine their added prognostic value beyond established clinical and imaging predictors.