PREDICTIVE VALUE OF INFLAMMATORY HEMATOLOGICAL INDICES, REPRODUCTIVE AND PREGNANCY-RELATED FACTORS, AND BASELINE NEUROIMAGING FOR SHORT-TERM NEUROLOGICAL AND VISUAL OUTCOMES IN PATIENTS WITH ACUTE ISCHEMIC STROKE

Abstract

Background: Acute ischemic stroke (AIS) is a heterogeneous neurological emergency influenced by systemic inflammatory cascades, biological sex, reproductive dynamics, and baseline vascular-neuroimaging markers. While individual risk markers have been studied, the integrated predictive capacity of inflammatory hematological indices, reproductive and pregnancy-related variables, and baseline neuroimaging parameters for short-term functional and visual outcomes remains to be fully elucidated.

Objective: To evaluate the predictive value of admission inflammatory hematological indices, reproductive/pregnancy-related factors, and baseline neuroimaging markers for short-term (90-day) neurological and visual outcomes in patients presenting with acute ischemic stroke.

Methods: This prospective cohort study evaluated 160 adult patients with acute ischemic stroke admitted at Liaquat University of Medical and Health Sciences. Admission inflammatory hematological indices—including the Systemic Immune-Inflammation Index (SII), Neutrophil-to-Lymphocyte Ratio (NLR), and Platelet-to-Lymphocyte Ratio (PLR)—were derived from baseline complete blood counts. A detailed reproductive and pregnancy-related history (parity, gravidity, history of preeclampsia/gestational hypertension, age at menarche, and oral contraceptive or hormone replacement therapy exposure) was compiled for female participants. Baseline non-contrast computed tomography (NCCT) and CT angiography (CTA) parameters were recorded, including Alberta Stroke Program Early CT Score (ASPECTS), presence of dense vessel sign, clot burden score (CBS), and presence of posterior circulation or occipital lobe infarcts. The primary endpoint was 90-day favorable neurological outcome, defined as a modified Rankin Scale (mRS) score of 0–2. The secondary endpoint was persistent visual deficit (visual field defects, cortical blindness, or diplopia) evaluated at 90 days. Multivariable logistic regression models were developed to evaluate independent predictive factors.

Results: Among 160 patients (mean age 58.4 ± 11.2 years; 52.5% female, n=84), 98 patients (61.3%) achieved a favorable 90-day neurological outcome (mRS≤2), while 62 patients (38.8%) experienced poor functional outcomes or mortality (mRS≥3). Persistent visual deficits were identified in 31 patients (19.4%). Baseline SII was significantly elevated in patients with poor 90-day functional outcomes (1342.8±482.1 vs. 628.4±214.6×109/L, p<0.001). Among female participants (n=84), a history of preeclampsia or gestational hypertension was significantly more prevalent in the poor outcome group (32.4% vs. 10.2%, p=0.012). Low baseline ASPECTS (≤7) (p<0.001) and posterior circulation/occipital infarct location (p<0.001) strongly correlated with adverse functional and visual recovery. Multivariable logistic regression revealed that admission SII>920×109/L (adjusted OR = 3.68, 95% CI: 1.72–7.88, p=0.001), baseline ASPECTS ≤7 (adjusted OR = 4.12, 95% CI: 1.88–9.03, p<0.001), history of hypertensive pregnancy disorders in females (adjusted OR = 3.15, 95% CI: 1.18–8.42, p=0.022), and occipital/posterior visual pathway involvement (adjusted OR = 5.84, 95% CI: 2.24–15.22, p<0.001) were independent predictors of adverse 90-day neurological and visual outcomes.

Conclusion: Integrated evaluation of admission systemic inflammatory indices (SII), reproductive history (preeclampsia/gestational hypertension), and baseline neuroimaging scores (ASPECTS, lesion topography) provides high predictive accuracy for 90-day functional recovery and persistent visual deficits in acute ischemic stroke. Incorporating these multi-domain parameters into acute stroke triage enables early risk stratification and personalized rehabilitation planning.