The endothelial activation and stress index (EASIX) predicts hazards of short- and long-term mortality in acute ischemic stroke: a retrospective cohort study

Q: What are the key findings of this study?

Higher EASIX levels were independently associated with an increased risk of all-cause mortality in acute ischemic stroke patients, with a 20% increased hazard of death per log2 increase (HR 1.20).

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ischemic stroke (n=6461). Intervention: Endothelial activation and stress index (EASIX) vs. Lower EASIX levels. Primary outcome: All-cause mortality (HR 1.20, 95% CI 1.12-1.28, p=<0.001).

Q: What does this research mean for the field?

Higher endothelial activation and stress index (EASIX) independently predicts increased risk of short- and long-term all-cause mortality in acute ischemic stroke patients. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To investigate the prognostic value of the endothelial activation and stress index (EASIX) for short- and long-term mortality risk in patients with acute ischemic stroke.

Antonia Kleeberg; Thomas Luft; Peter A. Ringleb; Julian Hotz; Lisa Kaindl; Marek Sykora; Daniel Golkowski; Jan Purrucker

doi:10.1007/s00415-026-13941-8

June 22, 2026Journal of NeurologyOpen Access

The endothelial activation and stress index (EASIX) predicts hazards of short- and long-term mortality in acute ischemic stroke: a retrospective cohort study

View Full Paper

Ask AI

Bookmark

Share

Key result

Higher EASIX linked to ~20% greater mortality per log2 increase in acute ischemic stroke.

HR 1.20
95% CI 1.12-1.28
P<0.001
n=6,461

Figures

Why the study?

Does the endothelial activation and stress index (EASIX) predict mortality in acute ischemic stroke patients?

Key Points

To investigate the prognostic value of the endothelial activation and stress index (EASIX) for short- and long-term mortality risk in patients with acute ischemic stroke.
Analyzed a retrospective derivation cohort of acute ischemic stroke patients treated with recanalization therapies (n=4,188) and an external validation cohort from Vienna (n=2,273).
Determined an optimal EASIX cut-off value using the maximal Youden index in the derivation cohort.
Assessed mortality outcomes using multivariable Cox proportional hazards regression and multivariable binary logistic regression, evaluating model performance via Brier score and C-statistics.
In the derivation cohort, higher log2(EASIX) was independently associated with all-cause mortality in multivariable Cox regression (HR per log2 increase: 1.20, 95% CI 1.12-1.28, p < 0.001).
An EASIX cut-off value of 1.211 was established in the derivation cohort and independently predicted 3-month mortality in the external validation cohort (OR 1.86, 95% CI 1.28-2.70, p < 0.01).
Observed 3-month mortality was 22.0% (n=907/4131) in the derivation cohort and 16.6% in the validation cohort, with EASIX improving discriminative performance across Brier score and C-statistics.

Study Design

Type

Cohort (n=6,461)

Multicenter

Yes

Structured PICO

Does the endothelial activation and stress index (EASIX) predict mortality in acute ischemic stroke patients?

P

Population

6,461 adult patients with acute ischemic stroke from two European registries, followed for up to 25 months, to evaluate the prognostic value of the EASIX biomarker for mortality.

E

Exposure

Endothelial activation and stress index (EASIX) assessment

O

Outcome

All-cause mortality and 3-month mortalityhard clinical

Main Result

Hazard Ratio: 1.2 (95% CI 1.12–1.28)

p-value: p=<0.001

Limitations

Retrospective design introduces potential documentation bias
Exclusion of patients due to missing survival data may have introduced attrition bias
Individual components of EASIX can be influenced by factors unrelated to endothelial dysfunction
Long-term outcome data were unavailable for the external validation cohort

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

EASIX is a valid prognostic biomarker that improves risk stratification for short- and long-term mortality in patients with acute ischemic stroke.

Abstract

INTRODUCTION: Endothelial activation and stress index (EASIX) is a biomarker of endothelial dysfunction and has been validated previously as a prognostic score for mortality in various diseases, including oncologic diseases, sepsis, and cardiac disease. Since endothelial dysfunction is an established mediator of adverse outcomes in acute ischemic stroke, this study investigates the prognostic value of EASIX for risk of mortality in these patients. PATIENTS AND METHODS: /L]. An EASIX cut-off was established using maximal Youden index. Validation was performed using Brier score and C-statistics. RESULTS: Higher EASIX was associated with higher risk of mortality in the training cohort in a multivariable Cox regression (HR of all-cause mortality per log2 increase: 1.20 (95% CI 1.12-1.28), p < 0.001). An optimal EASIX cut-off value of 1.211 was identified in the derivation cohort. In the independent validation cohort, this cut-off was associated with risk of 3-month mortality in a multivariable binary logistic regression model (OR 1.86 (1.28-2.70), p < 0.01). Brier score and C-statistics validated the superior predictive performance of EASIX in the multivariable model. DISCUSSION AND CONCLUSION: EASIX predicts mortality in acute ischemic stroke patients and retained prognostic validity across two heterogeneous European cohorts. Incorporation of EASIX improved risk stratification beyond established clinical scores. EASIX may serve as a useful tool for risk stratification and outcome prediction in acute ischemic stroke patients.

Discussion

No takes yet. Share an insight, caveat, or question.

Cite This Study

Kleeberg et al. (2026) conducted a cohort in Acute ischemic stroke (n=6,461). Endothelial activation and stress index (EASIX) vs. Lower EASIX levels was evaluated on All-cause mortality (HR 1.20, 95% CI 1.12-1.28, p=<0.001). Higher EASIX levels were independently associated with an increased risk of all-cause mortality in acute ischemic stroke patients, with a 20% increased hazard of death per log2 increase (HR 1.20).

synapsesocial.com/papers/6a3c2323d15afadd906f9d44 https://doi.org/10.1007/s00415-026-13941-8

View Full Paper

Ask AI

Bookmark

Share

The endothelial activation and stress index (EASIX) predicts hazards of short- and long-term mortality in acute ischemic stroke: a retrospective cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

The endothelial activation and stress index (EASIX) predicts hazards of short- and long-term mortality in acute ischemic stroke: a retrospective cohort study

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Keep reading

Keep reading