Stroke-induced immunosuppression is associated with brain injury and poor outcomes in patients receiving intravenous thrombolysis: A multicenter prospective cohort study.

Following a stroke, a local inflammatory cascade is triggered, resulting in the systemic diminishment of immune function, known as stroke-induced immunosuppression. The association of stroke-induced immunosuppression with brain injury and stroke prognosis after intravenous thrombolysis remains unclear. In this cohort study, we prospectively enrolled 1023 patients across 16 centers. Lymphocyte counts and the neutrophil-to-lymphocyte ratio were used as indicators of the severity of stroke-induced immunosuppression. The primary outcomes were the 90-day functional outcome, assessed using the modified Rankin Scale, and the severity of brain injury, evaluated by serum biomarkers (glial fibrillary acidic protein, S100β, ubiquitin c-terminal hydrolase L1, and neuron-specific enolase). Key secondary outcomes included infarct volume, 24 h and 7-day National Institutes of Health Stroke Scale, early neurological deterioration, hemorrhagic transformation, and 3-month mortality. Our results demonstrated that stroke-induced immunosuppression was independently associated with functional outcomes at 3 months and the severity of brain injury. In addition, patients with severe stroke-induced immunosuppression had increased infarct volume, higher National Institutes of Health Stroke Scale scores, increased risk of hemorrhagic transformation, and higher 3-month mortality. These results suggest that stroke-induced immunosuppression is independently associated with brain injury and poor outcomes in patients with acute ischemic stroke undergoing intravenous thrombolysis.