Dynamic perioperative thrombo-inflammatory biomarkers correlate with early functional outcomes after mechanical thrombectomy for acute ischemic stroke

Background Inflammatory and coagulation responses continue to evolve after mechanical thrombectomy for acute ischaemic stroke. A single admission measurement may therefore miss clinically relevant perioperative biology. We examined whether longitudinal thrombo-inflammatory biomarker profiles were associated with early functional and neurological outcomes after thrombectomy. Methods This single-centre retrospective cohort study grouped routine laboratory measurements into baseline (−3 to 0 days), postoperative days 1–3, 4–7, and 8–14. The primary endpoint was an unfavourable discharge modified Rankin Scale (mRS) score of 3–6. Failure of in-hospital early neurological improvement, defined as an admission-to-discharge NIHSS reduction of <4 points without a discharge NIHSS of 0–1, was examined as a secondary dynamic neurological endpoint. Biomarker associations were estimated using logistic regression adjusted for age, sex, and admission NIHSS. The clinical and combined models were compared in the same 586-patient complete-case subset. Results Amongst 963 registry patients, 801 had discharge mRS data; 428 had favourable and 373 had unfavourable outcomes. Higher baseline NLR (OR 1.30, 95% CI 1.08–1.58), peak first-week NLR (OR 1.26, 95% CI 1.08–1.48), peak 1st-week D-dimer (OR 1.07, 95% CI 1.01–1.14), and lower baseline fibrinogen (OR 0.78, 95% CI 0.63–0.97) and minimum first-week lymphocyte count (OR 0.67, 95% CI 0.54–0.84) were independently associated with an unfavourable discharge outcome. Baseline platelet-to-lymphocyte ratio and white blood cell count on postoperative days 4–7 and 8–14 were also associated after adjustment. The principal biomarker signals were directionally consistent for failure of in-hospital early neurological improvement. In the matched subset, the clinical model had an AUC of 0.709 and the combined model an AUC of 0.726; the paired AUC difference was 0.017 (95% bootstrap CI −0.003 to 0.037). Conclusion Dynamic perioperative thrombo-inflammatory profiles were associated with early disability and neurological recovery after thrombectomy. Their incremental discrimination beyond basic clinical variables was small and statistically uncertain. These findings are exploratory and require prospective, multicentre validation with standardised sampling before clinical implementation.