Inflammatory Response Indices in Patients with Acute Ischemic Stroke Treated with and Without Reperfusion Therapy

Sep 30, 2026

Ischemic stroke is a major cause of death and long-term disability, and reperfusion therapies can restore cerebral blood flow while also triggering ischemia–reperfusion injury and systemic inflammation. A retrospective analysis of 8833 acute ischemic stroke patients (January 2014 to May 2025) compared 2242 treated with reperfusion therapy versus 6591 managed conservatively. Admission leukocyte count, CRP, albumin, and composite inflammatory indices (NLR, SII, SIRI, NPAR) were linked to in-hospital mortality and functional outcomes. Reperfusion patients showed higher inflammatory indices, but multivariable analysis indicated severity measures (GCS, mRS) explained inflammatory response more than therapy type.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages15

Reading Time38 min

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Abstract

Methods

Results

Conclusions

1. Introduction

Article Inflammatory Response Indices in Patients with Acute Ischemic Stroke Treated with and Without Reperfusion Therapy Milena ´Swito ´nska 1,2,†, Agnieszka Rogalska 2,†, Natalia Mysiak 2,3, Agata Staniewska 2,3, Alicja Szulc 1, Oliwia Jarosz 3, Magdalena Konieczna-Brazis 1,2, Magdalena Grigorief 2,4, Daria Fra˛ckowska 2,3 and Jacek Budzy ´nski 2,4, * Academic Editor: Angelika Alonso Received: 30 October 2025 Revised: 14 December 2025 Accepted: 18 December 2025 Published: 21 December 2025 Copyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Department of Neurology and Clinical Neurophysiology, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru ´n, No 2, 85-168 Bydgoszcz, Poland; [m.switonska@cm.umk.pl](m.switonska@cm.umk.pl) (M.´S .); alicja.szulc@cm.umk.pl (A.S.); magda.brazis@cm.umk.pl (M.K.-B.) 2 Jan Biziel University Hospital No. 2 in Bydgoszcz, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru ´n, 85-168 Bydgoszcz, Poland; [agnieszka.rogalska@biziel.pl](agnieszka.rogalska@biziel.pl) (A.R.); [503585@doktorant.umk.pl](503585@doktorant.umk.pl) (N.M.); [agata.staniewska@cm.umk.pl](agata.staniewska@cm.umk.pl) (A.S.); [magdalena.grigorief@cm.umk.pl](magdalena.grigorief@cm.umk.pl) (M.G.); [daria.frackowska@doktorant.umk.pl](daria.frackowska@doktorant.umk.pl) (D.F.) 3 Doctoral School of Medical and Health Sciences, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru ´n, 85-067 Bydgoszcz, Poland; [503671@doktorant.umk.pl](503671@doktorant.umk.pl) 4 Department of Vascular and Internal Medicine, Ludwik Rydygier Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toru ´n, 85-067 Bydgoszcz, Poland * [Correspondence: jb112233@cm.umk.pl](Correspondence: jb112233@cm.umk.pl); Tel.: +48-52-36-55-162; Fax: +48-52-36-55-163 † These authors contributed equally to this work. Abstract Background: Ischemic stroke remains a leading cause of mortality and long-term disability worldwide. Reperfusion therapies, such as intravenous thrombolysis and mechanical thrombectomy, are crucial for restoring cerebral blood flow but may also trigger ischemia– reperfusion injury and systemic inflammatory activation, associated with poorer clinical outcomes. Methods: We retrospectively analyzed medical records of 8833 patients hospitalized for acute ischemic stroke between January 2014 and May 2025 . Of these, 2242 (25.38%) underwent reperfusion therapy (mechanical thrombectomy ± intravenous thrombolysis), and 6591 (74.62%) were treated conservatively. Laboratory parameters, including leukocyte count, C-reactive protein (CRP), and albumin, and composite inflammatory indices (e.g., neutrophil-to-lymphocyte ratio (NLR), systemic immune–inflammation index (SII), systemic-inflammation response index (SIRI), and neutrophil percentage-to-albumin ratio (NPAR)), were assessed at admission. Clinical outcomes included in-hospital mortality and functional scale results (e.g., National Institutes of Health Stroke Scale, modified Rankin score (mRS), Barthel scale, and Glasgow Coma Scale (GCS)) . Results: Patients treated with reperfusion therapy had higher inflammatory indices (white blood cells, CRP, NLR, SII, and NPAR) compared to patients treated conservatively. In multiple regression analysis, these indices were significantly determined only by GCS and mRS scores, but age, gender, comorbidities, biochemical determinations, and type of ischemic stroke treatment (reperfusion or conservative) remained non-statistically significant. Conclusions: Patients with acute ischemic stroke undergoing reperfusion therapy exhibited a stronger inflammatory response and higher in-hospital mortality than those treated conservatively. However, multivariate analysis showed that a stronger

FAQs

What clinical problem does the study address?

The study addresses how reperfusion therapies for acute ischemic stroke may provoke ischemia–reperfusion injury and systemic inflammatory activation, potentially worsening outcomes.

Which patient groups were compared in the analysis?

The study retrospectively compared 2242 patients who received reperfusion therapy (mechanical thrombectomy ± intravenous thrombolysis) with 6591 patients treated conservatively.

What inflammatory markers and indices were evaluated at admission?

Leukocyte count, CRP, albumin, and composite inflammatory indices including NLR, SII, SIRI, and NPAR were assessed at admission.

Do the results suggest the inflammatory response depends more on therapy or on patient severity?

Although reperfusion-treated patients had higher inflammatory indices and higher in-hospital mortality, multivariate analysis showed the stronger inflammatory response was driven more by the patients’ condition severity (GCS and mRS) than by the type of therapy.

Sep 30, 2026

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