Aims/Background: Early neurological deterioration (END) after thrombolysis is a serious complication in acute ischemic stroke (AIS); however, its early identification remains challenging. This study aimed to investigate the value of amplitude-integrated electroencephalography (aEEG) combined with CD4+/CD8+ ratio in assessing END in patients with AIS. Methods: The study enrolled 210 AIS patients who underwent thrombolysis at Shangyu People’s Hospital of Shaoxing, China, between May 2020 and May 2025. Based on whether the National Institutes of Health Stroke Scale (NIHSS) score at 24 hours post-thrombolysis increased by ≥4 points compared to the score at admission, patients were divided into an END group (score increase ≥4, n = 61) and a non-END group (score increase <4, n = 149). Clinical data were compared between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of the aEEG score and CD4+/CD8+ ratio, both individually and in combination, for END after thrombolysis. Multivariate logistic regression analysis was performed to identify factors influencing END post-thrombolysis. Furthermore, two predictive models were constructed and their predictive efficacy evaluated: Model 1 (excluding aEEG score and CD4+/CD8+ ratio) and Model 2 (including aEEG score and CD4+/CD8+ ratio). Results: The onset-to-needle time in the END group was significantly longer than in the non-END group. NIHSS score at admission, white blood cell count (WBC), Systemic Inflammation Response Index (SIRI), and aEEG score were significantly higher in the END group, while the CD4+/CD8+ ratio was significantly lower (p < 0.001). The area under the ROC curve (AUC) was 0.755 for the aEEG score, 0.776 for the CD4+/CD8+ ratio alone, and 0.862 for their combination. Multivariate logistic regression analysis showed that prolonged onset-to-needle time, higher NIHSS score at admission, increased WBC count, elevated SIRI, and higher aEEG score were independent risk factors for END after thrombolysis, with an increased CD4+/CD8+ ratio serving as a protective factor (p < 0.05). Both Model 1 and Model 2 demonstrated good goodness-of-fit (p = 0.856 and 0.997, respectively), with AUCs of 0.944 and 0.991. In Model 2, the variance inflation factor (VIF) for all six influencing factors ranged from 1.070 to 1.383. Conclusion: The aEEG score and the CD4+/CD8+ ratio have a significant influence on the occurrence of END in AIS patients after thrombolysis, and their combination improves predictive performance.
Ruan et al. (2026) studied this question.