Shifu Sun,1,2,* Yongqing Cheng,2,* Lei Li,2 Honghong Zhu,3 Changxia Liu,2 Yongjun Cao1 

1Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, People’s Republic of China; 2Department of Neurology, the Yancheng Clinical College of Xuzhou Medical University, the First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, 224000, People’s Republic of China; 3Department of Rheumatology and Immunology, the Yancheng Clinical College of Xuzhou Medical University, the First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, 224000, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Yongjun Cao, Department of Neurology, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215004, People’s Republic of China, Tel +86-18361077906, Email yongjuncao@126.com Yongqing Cheng, Department of Neurology, the Yancheng Clinical College of Xuzhou Medical University, the First People’s Hospital of Yancheng, Yancheng, Jiangsu Province, People’s Republic of China, Tel +86-13851190252, Email chengyq1990@163.com

Purpose: The fibrinogen-to-albumin ratio (FAR) is a novel inflammation marker associated with various diseases. This study aimed to investigate the correlation between FAR and early neurological deterioration (END) after intravenous thrombolysis (IVT) in patients with acute ischemic stroke (AIS).
Patients and Methods: From September 1, 2021, to March 31, 2023, continuously recruited AIS patients who received IVT within 4.5 hours were included in the study. Blood samples were collected in the emergency room before IVT. The National Institutes of Health Stroke Scale (NIHSS) score was assessed upon admission and after thrombolysis within the first 24 hours. END was defined as an increase in the NIHSS score by ≥ 4 points within 24 hours after thrombolysis. Multivariate logistic regression analysis was conducted to explore the relationship between FAR and END, and a receiver operating characteristic (ROC) curve was used to evaluate the predictive ability of FAR for END.
Results: 343 participants were recruited, and 59 (17.2%) experienced END. Patients with END had higher FAR levels than those without END (P< 0.001). Multivariate logistic regression analysis showed that FAR was independently associated with END, both as a continuous variable and as a tertile variable (P< 0.005). After excluding patients with hemorrhagic transformation (HT), FAR remained independently associated with END (P< 0.005). The area under the curve (AUC) of FAR for predicting END was 0.650 (95% CI=0.571– 0.729, P< 0.001), with an optimal cutoff of 72.367 mg/g, a sensitivity of 61.6%, and a specificity of 62.6%.
Conclusion: FAR upon admission was independently associated with END after IVT and can be an effective predictor.

Keywords: fibrinogen-to-albumin ratio, early neurological deterioration, intravenous thrombolysis, acute ischemic stroke, inflammation marker