CNS neuroscience & therapeutics · 2026
Adjunctive Methylprednisolone After Thrombectomy: A Secondary Analysis Stratified by Admission White Blood Cell Count.
СтатьяРандомизированное исследованиеНазвание и аннотация: Перевод в очереди
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Yue Chengsong, Yang Jie, Yang Dahong, Heng Guanting, Li Linyu, Yang Shihai, Chen Xuanyu, Lin Yi, Lin Kunxin, Zi Wenjie
Аннотация
BACKGROUND: Leukocyte-driven inflammation may contribute to reperfusion-outcome mismatch after thrombectomy. We tested whether admission white blood cell (WBC) count may identify reperfused patients more likely to benefit from adjunctive methylprednisolone.
METHODS: This post hoc secondary analysis of the MARVEL randomized, placebo-controlled trial was conducted with a prospectively finalized statistical analysis plan. We included patients with anterior-circulation large-vessel occlusion stroke who achieved successful reperfusion after thrombectomy and received intravenous methylprednisolone or placebo. The analysis included 1201 patients stratified by admission WBC count (< 10 × 109/L, n = 808; ≥ 10 × 109/L, n = 393). The primary outcome was 90-day modified Rankin Scale (mRS 0-6) using covariate-adjusted ordinal logistic regression. Secondary outcomes included mRS 0-3 and 0-4, early NIHSS, mortality, symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage, pneumonia, and gastrointestinal bleeding.
RESULTS: The treatment × WBC interaction reached nominal statistical significance (p = 0.04). In patients with WBC ≥ 10 × 109/L, methylprednisolone was associated with a more favorable 90-day ordinal mRS distribution (adjusted common OR, 1.59; 95% CI, 1.11-2.28), higher odds of mRS 0-3 and 0-4, and lower mortality (aOR, 0.60; 95% CI, 0.37-0.96) and pneumonia (aOR, 0.61; 95% CI, 0.40-0.93), without an apparent increase in hemorrhage or gastrointestinal bleeding. No clear benefit was observed in patients with WBC < 10 × 109/L.
CONCLUSIONS: Higher admission WBC was associated with more favorable estimated treatment effects from adjunctive methylprednisolone after thrombectomy, warranting prospective validation.
TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR.org.cn); ChiCTR2100051729; https://www.chictr.org.cn/.
METHODS: This post hoc secondary analysis of the MARVEL randomized, placebo-controlled trial was conducted with a prospectively finalized statistical analysis plan. We included patients with anterior-circulation large-vessel occlusion stroke who achieved successful reperfusion after thrombectomy and received intravenous methylprednisolone or placebo. The analysis included 1201 patients stratified by admission WBC count (< 10 × 109/L, n = 808; ≥ 10 × 109/L, n = 393). The primary outcome was 90-day modified Rankin Scale (mRS 0-6) using covariate-adjusted ordinal logistic regression. Secondary outcomes included mRS 0-3 and 0-4, early NIHSS, mortality, symptomatic intracranial hemorrhage (sICH), any intracranial hemorrhage, pneumonia, and gastrointestinal bleeding.
RESULTS: The treatment × WBC interaction reached nominal statistical significance (p = 0.04). In patients with WBC ≥ 10 × 109/L, methylprednisolone was associated with a more favorable 90-day ordinal mRS distribution (adjusted common OR, 1.59; 95% CI, 1.11-2.28), higher odds of mRS 0-3 and 0-4, and lower mortality (aOR, 0.60; 95% CI, 0.37-0.96) and pneumonia (aOR, 0.61; 95% CI, 0.40-0.93), without an apparent increase in hemorrhage or gastrointestinal bleeding. No clear benefit was observed in patients with WBC < 10 × 109/L.
CONCLUSIONS: Higher admission WBC was associated with more favorable estimated treatment effects from adjunctive methylprednisolone after thrombectomy, warranting prospective validation.
TRIAL REGISTRATION: Chinese Clinical Trial Registry (ChiCTR.org.cn); ChiCTR2100051729; https://www.chictr.org.cn/.