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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, S100\u03b2, 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.<\/jats:p>","DOI":"10.1177\/0271678x261462716","type":"journal-article","created":{"date-parts":[[2026,6,15]],"date-time":"2026-06-15T10:00:15Z","timestamp":1781517615000},"page":"2577-2588","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Stroke-induced immunosuppression is associated with brain injury and poor outcomes in patients receiving intravenous thrombolysis: A multicenter prospective cohort study"],"prefix":"10.1177","volume":"46","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5845-661X","authenticated-orcid":false,"given":"Zhong-Yu","family":"Cao","sequence":"first","affiliation":[{"name":"Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, 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