Abstract
BACKGROUND: To investigate the effect of eosinophils on early (END) and delayed neurological deterioration (DND) after mechanical thrombectomy (MT) in patients with acute ischemic stroke (AIS). METHODS: A total of 442 consecutive AIS patients experiencing MT between May 2017 and January 2023 were analyzed. END and DND were defined as a rise of ≥ 2 points on the National Institutes of Health Stroke Scale (NIHSS) or a fall of ≥ 1 point on the Glasgow Coma Scale or death from baseline to 24 h and from 24 to 72 h, respectively. Multivariate regression analysis, generalize additive models and mediation analysis were used to assess the effect of eosinophils on END and DND and the underlying mechanisms. RESULTS: 113 (25.17%) and 47 (10.63%) patients had END and DND, respectively. Eosinophils was independently associated with END after adjusting potential confounders (odds ratio, 0.00; 95% CI, 0.00-0.80; P = 0.0441), which is consistent with the result of eosinophils (dichotomous) as a categorical variable (odds ratio, 0.40; 95% CI, 0.24-0.68; P = 0.0006). In assessing the relationship between eosinophils and DND, the inflection point was found to be 0.02, and eosinophils were independently correlated with DND at less than 0.02 (odds ratio, 0.00, 95% CI: 0.00-0.00, P = 0.0038); however, eosinophils ceased to be independently correlated with DND after exceeding 0.02 (P = 0.3519). Mediation analyses confirmed that eosinophils contribute to END in patients through symptomatic intracranial hemorrhage (indirect effect: -0.463; 95%CI: -0.902-0.19; P < 0.001). CONCLUSIONS: The effects of eosinophils on END and DND are not identical.