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Calculated plasma volume status is associated with poor outcomes in acute ischemic stroke treated with endovascular treatment
Dixia Zhang 
Guangzong Li- Department of Neurology, The Sixth People's Hospital of Chengdu, Chengdu, China
Background and purpose: The impact of calculated plasma volume status (PVS) on the prognosis of acute ischemic stroke treated with endovascular treatment (EVT) remains undetermined. This study aimed to investigate the association between PVS and 90 days functional outcomes after EVT.
Methods: We enrolled patients treated with EVT in the anterior circulation from a prospective registry. The endpoint was a modified Rankin scale score of ≥3 points at 90 days after EVT. We used multivariable logistic regression models to investigate the association between PVS and poor outcomes. We used the restricted cubic spline to present the linearity between PVS and poor outcomes.
Results: Among the 187 enrolled patients (median age, 65 years; 35.8% women), a total of 81 patients (43.3%) experienced poor outcomes at 90 days. In multivariable analyses, PVS was associated with poor outcomes despite increasing confounding factors (odds ratio, 3.157; 95% confidence interval, 1.942–5.534; P < 0.001). The restricted cubic spline revealed a positive correlation between PVS and the risk of poor outcomes after EVT (P for nonlinearity = 0.021).
Conclusion: Our study found that an elevated PVS value was associated with poor outcomes after EVT. Further prospective cohorts were warranted to evaluate the utility of PVS in AIS treated with EVT.
Introduction
Ischemic stroke is the most common cause of death and long-term disability in China (1, 2). Randomized controlled trials have shown that endovascular treatment (EVT) is associated with improved functional independence and can extend the time window for acute ischemic stroke (AIS) patients with large-vessel occlusions in the anterior circulation (3–6). Despite the higher rates of successful recanalization, approximately 50% of AIS patients treated with EVT could not achieve functional independence during the process of rehabilitation (7). Previous studies suggested that the benefits from EVT could be attenuated by the stroke severity, pre-stroke disability, and major complications caused by EVT such as symptomatic intracranial hemorrhage (SICH) (8–10). Hence, it is warranted to have a better understanding of potential predictors to help physicians identify AIS patients with high risks of poor outcomes at the early stage after EVT.
Heart failure is an important risk factor for the short- and long-term prognosis of ischemic stroke. Previous studies have revealed that heart failure was associated with a 2-fold increased risk of mortality (11) and poor functional outcomes at 90 days in patients with ischemic stroke (12). Plasma volume (PV) is a marker of systemic congestion, which is a major complication of heart failure (13). However, accurate measurement of the PV could be challenging in clinical practice due to the technical difficulty and the requirement of invasive tools (14, 15). Notably, plasma volume status (PVS), which is calculated from non-invasive biomarkers of hematocrit and body weight, has been shown to be moderately correlated with gold-standard measurements using radioisotope assays (16). Previous studies have revealed that PVS was associated with clinical outcomes of heart failure (17), transcatheter aortic valve implantation (18), and cardiovascular diseases (19). However, few research studies have investigated the association between PVS and the risk of poor outcomes in AIS patients treated with EVT.
Hence, we performed the current study to investigate the potential association between PVS and poor outcomes in AIS patients treated with EVT.
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