The predictive value of circulating inflammatory and immune biomarkers for stroke-associated pneumonia following endovascular therapy in patients with acute anterior circulation large vessel occlusion infarction: a prospective cohort study

Objective To investigate the changes in circulating biomarkers of patients with acute anterior circulation large vessel occlusive cerebral infarction (ACLVO) following endovascular therapy (EVT), and to explore their potential utility as early predictors for the development of stroke-associated pneumonia (SAP). Methods Peripheral blood samples were collected from ACLVO patients on days 1, 3, and 7 following EVT. Samples were analyzed to detect monocyte human leukocyte antigen-DR (mHLA-DR) expression level, along with plasma levels of interleukin-6 (IL-6), C-reactive protein (CRP), and procalcitonin (PCT). Results Multivariate binary logistic regression analysis adjusted for clinical confounders identified decreased mHLA DR expression at day 1 and dysphagia as independent SAP predictors ( P 0.001). Compared to the non-SAP group, the SAP group showed significantly lower expression of mHLA-DR on days 1, 3, and 7 ( P 0.001), plasma IL-6 and CRP levels were significantly higher on days 3 and 7 ( P 0.05), as was the plasma PCT level on day 7 ( P 0.05). Infarct volume was significantly larger in the SAP group ( P 0.001). In predictive modeling, expression of mHLA-DR on days 1 alone yielded an AUC of 0.914 (optimal cutoff: 55.75%). Decision curve analysis showed that expression of mHLA-DR on days 1 offered greater net benefit than other clinical scores, and that combining it with the A2DS2 score provided a superior, stable net benefit for SAP prediction. Conclusion In this exploratory study, our findings suggest that mHLA-DR expression levels may indicate some predictive value for SAP development after EVT in ACLVO patients, with the predictive performance appearing enhanced when combined with the A2DS2 score. Dysphagia and a large infarct volume emerged as potential risk factors for SAP. Conversely, within the context of our cohort, plasma levels of IL-6, CRP, and PCT did not demonstrate clear utility for the early prediction of SAP.