A prognostic model incorporating MCP-1 and IL-8 for early risk stratification in acute ischemic stroke patients receiving intravenous thrombolysis: a retrospective development with temporal validation.

OBJECTIVE

To investigate the expression characteristics of monocyte chemoattractant protein-1 (MCP-1) and interleukin-8 (IL-8) in patients with acute ischemic stroke (AIS) who received intravenous thrombolysis and their relationship with clinical prognosis.

METHODS

This retrospective study included 300 patients with AIS who received intravenous thrombolysis. Patients were chronologically divided into a development cohort (n = 200) and a temporal validation cohort (n = 100). A dynamic substudy cohort (n = 150) underwent serial sampling at 24 and 72 h. Patients were stratified by 90-day mRS score into a good outcome group (mRS ≤ 2, n = 192) and a poor outcome group (mRS > 2, n = 108). A separate healthy control group (n = 100) was included for reference. Multivariate logistic regression was performed using only variables available at admission (age, NIHSS score, infarct volume, MCP-1, IL-8) to build a prognostic nomogram for early risk stratification. Internal bootstrap validation and temporal validation were conducted, and decision curve analysis (DCA) assessed the net clinical benefit of adding biomarkers to a clinical baseline model.

RESULTS

Within the AIS cohort, MCP-1 and IL-8 levels were significantly higher in the poor outcome group compared with the good outcome group (both p < 0.001). Dynamic analysis revealed sustained elevation at 72 h only in the poor outcome group (interaction p < 0.001). Multivariate analysis in the development cohort identified age, NIHSS, infarct volume, MCP-1, and IL-8 as independent predictors. The nomogram showed a C-index of 0.872 in the development cohort and 0.842 in the temporal validation cohort, with good calibration. Decision curve analysis confirmed net clinical benefit in both cohorts. The AUC for predicting poor prognosis was 0.773 for MCP-1, 0.742 for IL-8, and 0.839 for the combination of both markers. Decision curve analysis confirmed the added clinical net benefit of the biomarker-enhanced model.

CONCLUSION

MCP-1 and IL-8 are independent prognostic biomarkers in AIS patients treated with intravenous thrombolysis. Their sustained elevation and combined use in a clinical prediction nomogram significantly enhance early risk stratification, offering a potential tool for personalized management.