A nomogram prediction model for malignant brain edema after mechanical thrombectomy in patients with acute is-chemic stroke was constructed based on serum levels of NLRP3,sE-selectin and ICAM-1

Gao Zhongsheng; Bi Tingting; Wu Xing; Han Xuefei; Liu Hongying; Yue Liying

doi:10.3969/j.issn.1671-6450.2025.01.005

Abstract：Objective To construct a nomogram prediction model for malignant brain edema(MBE)after mechani-cal thrombectomy in patients with acute ischemic stroke(AACIS)based on serum NOD-like receptor hot protein domain-re-lated protein 3(NLRP3),sE-selectin(sE-selectin)and intercellular adhesion molecule-1(ICAM-1)levels.Methods Patients with acute anterior circulation ischemic stroke(receiving mechanical thrombus removal,n=368)admitted to the Second De-partment of Neurology,Zhangjiakou First Hospital from January 2020 to December 2023 were selected as the study objects.According to whether MBE occurred 72 h after surgery,the patients were divided into 73 cases in the MBE group and 295 cases in the non-MBE group.Serum NLRP3,sE-selectin and ICAM-1 levels were compared between the two groups.Multi-variate Logistic regression was used to analyze the risk factors of MBE after mechanical thrombectomy in AACIS patients,and the risk nomogram prediction model was constructed.Receiver operating characteristic(ROC)curve analysis of the model predicted the efficacy of MBE after mechanical thrombectomy in AACIS patients.Results Serum NLRP3,sE-selectin,ICAM-1 levels in the MBE group were significantly higher than those in the non-MBE group(t=13.570,11.773,8.366,all P＜0.001).High NLRP3,sE-selectin,ICAM-1 levels and high NIHSS score at admission were independent risk factors for MBE in AACIS patients after mechanical thrombectomy[OR(95％CI)=14.391(1.575-131.481),1.455(1.110-1.909),1.062(1.004-1.123),1.705(1.039-2.800)];ROC curve analysis showed that the area under the curve(AUC)of the risk nomogram prediction model based on serum NLRP3,sE-selectin,ICAM-1 levels and NIHSS score was 0.980.The consistency index(C-index)of the model is 0.960,which indicates that the model has good prediction ability.The decision curve shows that the threshold probability of this model ranges from 0.01 to 0.97,and its net return rate is＞0,which is higher than the two inva-lid lines.Conclusion High serum NLRP3,sE-selectin,ICAM-1 levels and high NIHSS score at admission are independent risk factors for MBE after mechanical thrombectomy in AACIS patients,and the nomogram prediction model base on the above risk factors has good predictive value for MBE after mechanical thrombectomy in AACIS patients.