{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T18:02:22Z","timestamp":1780077742599,"version":"3.54.0"},"reference-count":58,"publisher":"Akademiai Kiado Zrt.","issue":"2","license":[{"start":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T00:00:00Z","timestamp":1780012800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Department of neurology, People's Hospital of Longhua"}],"content-domain":{"domain":["www.akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMICR"],"published-print":{"date-parts":[[2026,5,29]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The prognostic utility of plasma endotoxemia, marked by elevated lipopolysaccharide (LPS) and often associated with gut barrier dysfunction, remains undefined in acute ischemic stroke (AIS) patients with type 2 diabetes. In this single-center prospective cohort of 300 AIS patients with diabetes, we measured early admission plasma LPS and assessed its correlation with stroke severity and inflammatory markers, and its independent association with 90-day unfavorable functional outcome (modified Rankin Scale 3\u20136). Compared to the good outcome group, patients with poor outcomes had significantly higher LPS\u00a0levels. Log-transformed LPS levels positively correlated with baseline NIHSS score, high-sensitivity C-reactive protein, and white blood cell count. After multivariable adjustment for age, NIHSS, HbA1c, atrial fibrillation, estimated glomerular filtration rate, and other covariates, each standard deviation increase in log-LPS was independently associated with an increased risk of 90-day unfavorable outcome (odds ratio 1.86, 95% CI 1.39\u20132.48). A clear dose-response relationship was observed, with the risk of poor outcome and mortality rising across LPS quartiles. Adding LPS to a basic clinical prediction model improved the area under the curve from 0.79 to 0.83, enhanced risk reclassification, and provided greater net clinical benefit across a range of decision thresholds. In conclusion, early admission plasma endotoxemia is an independent predictor of 90-day functional outcome in AIS patients with diabetes and improves conventional risk stratification. This finding positions LPS as a clinically accessible biomarker that is associated with poor recovery in acute ischemic stroke.<\/jats:p>","DOI":"10.1556\/030.2026.02887","type":"journal-article","created":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T12:31:37Z","timestamp":1775046697000},"page":"245-254","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":0,"title":["Plasma endotoxin level independently predicts unfavorable 90-day outcome in acute ischemic stroke patients with type 2 diabetes mellitus"],"prefix":"10.1556","volume":"73","author":[{"given":"Xiaoquan","family":"Li","sequence":"first","affiliation":[{"name":"Department of Neurology, People's Hospital of Longhua, Shenzhen city, 518109, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jia","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, Ganzhou People's Hospital, Ganzhou, 341001, Jiangxi Province, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"425","reference":[{"issue":"10","key":"B1","series-title":"Lancet Neurol","first-page":"795","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: a systematic analysis for the global burden of disease study 2019","volume":"20","author":"Collaborators GBDS","year":"2021","unstructured":"Collaborators GBDS. Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: a systematic analysis for the global burden of disease study 2019. Lancet Neurol 2021; 20(10): 795\u2013820."},{"issue":"3","key":"B2","series-title":"J Diabetes Investig","first-page":"780","article-title":"Prevalence of diabetes and its effects on stroke outcomes: a meta-analysis and literature review","volume":"10","author":"Lau LH","year":"2019","unstructured":"Lau LH, Lew J, Borschmann K, Thijs V, Ekinci EI. Prevalence of diabetes and its effects on stroke outcomes: a meta-analysis and literature review. J Diabetes Investig 2019; 10(3): 780\u201392."},{"key":"B3","series-title":"Front Neurol","first-page":"889","article-title":"Functional outcome prediction in ischemic stroke: a comparison of machine learning algorithms and regression models","volume":"11","author":"Alaka SA","year":"2020","unstructured":"Alaka SA, Menon BK, Brobbey A, Williamson T, Goyal M, Demchuk AM, et\u00a0al. 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J Endocr Soc 2020; 4(2): bvz039."},{"issue":"6","key":"B8","series-title":"Clin Exp Pharmacol Physiol","first-page":"927","article-title":"Metabolic endotoxemia and cardiovascular disease: a\u00a0systematic review about potential roles of prebiotics and probiotics","volume":"47","author":"Moludi J","year":"2020","unstructured":"Moludi J, Maleki V, Jafari-Vayghyan H, Vaghef-Mehrabany E, Alizadeh M. Metabolic endotoxemia and cardiovascular disease: a\u00a0systematic review about potential roles of prebiotics and probiotics. Clin Exp Pharmacol Physiol 2020; 47(6): 927\u201339."},{"issue":"12","key":"B9","series-title":"Biomedicines","first-page":"2781","article-title":"Gut microbiota, bacterial translocation, and stroke: current knowledge and future directions","volume":"12","author":"Granados-Martinez C","year":"2024","unstructured":"Granados-Martinez C, Alfageme-Lopez N, Navarro-Oviedo M, Nieto-Vaquero C, Cuartero MI, Diaz-Benito B, et\u00a0al. 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J Am Heart Assoc 2019; 8(21): e013628."},{"issue":"8","key":"B27","series-title":"Int J Mol Sci","first-page":"4305","article-title":"The effect of enteric-derived lipopolysaccharides on obesity","volume":"25","author":"Wang K","year":"2024","unstructured":"Wang K, Lai W, Min T, Wei J, Bai Y, Cao H, et\u00a0al. The effect of enteric-derived lipopolysaccharides on obesity. Int J Mol Sci 2024; 25(8): 4305."},{"issue":"21","key":"B28","series-title":"J Clin Med","first-page":"7748","article-title":"Serum biomarkers in acute ischemic stroke: clinical applications and emerging insights","volume":"14","author":"Tsogka A","year":"2025","unstructured":"Tsogka A, Ellul J, Chroni E, Safouris A, Psychogios K, Veltsista D, et\u00a0al. Serum biomarkers in acute ischemic stroke: clinical applications and emerging insights. J Clin Med 2025; 14(21): 7748."},{"issue":"2","key":"B29","series-title":"Clin Nutr","first-page":"529","article-title":"Postprandial endotoxemia may influence the development of type 2 diabetes mellitus: from the CORDIOPREV study","volume":"38","author":"Camargo A","year":"2019","unstructured":"Camargo A, Jimenez-Lucena R, Alcala-Diaz JF, Rangel-Zuniga OA, Garcia-Carpintero S, Lopez-Moreno J, et\u00a0al. Postprandial endotoxemia may influence the development of type 2 diabetes mellitus: from the CORDIOPREV study. Clin Nutr 2019; 38(2): 529\u201338."},{"issue":"10","key":"B1","series-title":"Lancet Neurol","first-page":"795","article-title":"Global, regional, and national burden of stroke and its risk factors, 1990\u20132019: a systematic analysis for the global burden of disease study 2019","volume":"20","author":"Collaborators GBDS","year":"2021","unstructured":"Collaborators GBDS. 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Gut microbiota, bacterial translocation, and stroke: current knowledge and future directions. Biomedicines 2024; 12(12): 2781."},{"issue":"5","key":"B10","series-title":"Stroke","first-page":"604","article-title":"Interobserver agreement for the assessment of handicap in stroke patients","volume":"19","author":"van Swieten JC","year":"1988","unstructured":"van Swieten JC, Koudstaal PJ, Visser MC, Schouten HJ, van Gijn J. Interobserver agreement for the assessment of handicap in stroke patients. Stroke 1988; 19(5): 604\u20137."},{"issue":"7","key":"B11","series-title":"Stroke","first-page":"864","article-title":"Measurements of acute cerebral infarction: a clinical examination scale","volume":"20","author":"Brott T","year":"1989","unstructured":"Brott T, Adams HP Jr., Olinger CP, Marler JR, Barsan WG, Biller J, et\u00a0al. Measurements of acute cerebral infarction: a clinical examination scale. 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Stroke 2020; 51(11): 3215\u201323."},{"issue":"3","key":"B15","series-title":"Neurol Sci","first-page":"989","article-title":"Metformin treatment and acute ischemic stroke outcomes in patients with type 2 diabetes: a retrospective cohort study","volume":"44","author":"Jian Y","year":"2023","unstructured":"Jian Y, Wang H, Zhao L, Li T, Zhang L, Wang X, et\u00a0al. Metformin treatment and acute ischemic stroke outcomes in patients with type 2 diabetes: a retrospective cohort study. Neurol Sci 2023; 44(3): 989\u201397."},{"issue":"1","key":"B16","series-title":"Discov Oncol","first-page":"1551","article-title":"AKR1B10 as a novel prognostic biomarker linking methylation and immune escape in hepatocellular carcinoma","volume":"16","author":"Khan MN","year":"2025","unstructured":"Khan MN, Binli M, Juan H, Mengjia S, Shunyao W, Li X. AKR1B10 as a novel prognostic biomarker linking methylation and immune escape in hepatocellular carcinoma. Discov Oncol 2025; 16(1): 1551."},{"key":"B17","series-title":"EBioMedicine","article-title":"Role of gut microbiota in type 2 diabetes pathophysiology","volume":"51","author":"Gurung M","year":"2020","unstructured":"Gurung M, Li Z, You H, Rodrigues R, Jump DB, Morgun A, et\u00a0al. Role of gut microbiota in type 2 diabetes pathophysiology. EBioMedicine 2020; 51: 102590."},{"key":"B18","series-title":"Front Immunol","article-title":"Tumor-associated macrophages and CD8+ T cells: dual players in the pathogenesis of HBV-related HCC","volume":"15","author":"Khan MN","year":"2024","unstructured":"Khan MN, Mao B, Hu J, Shi M, Wang S, Rehman AU, et\u00a0al. Tumor-associated macrophages and CD8+ T cells: dual players in the pathogenesis of HBV-related HCC. Front Immunol 2024; 15: 1472430."},{"key":"B19","series-title":"Front Immunol","article-title":"The gastrointestinal-brain-microbiota axis: a promising therapeutic target for ischemic stroke","volume":"14","author":"Wei YH","year":"2023","unstructured":"Wei YH, Bi RT, Qiu YM, Zhang CL, Li JZ, Li YN, et\u00a0al. The gastrointestinal-brain-microbiota axis: a promising therapeutic target for ischemic stroke. Front Immunol 2023; 14: 1141387."},{"key":"B20","series-title":"Front Cell Infect Microbiol","article-title":"Blood-brain barrier disruption by lipopolysaccharide and sepsis-associated encephalopathy","volume":"11","author":"Peng X","year":"2021","unstructured":"Peng X, Luo Z, He S, Zhang L, Li Y. Blood-brain barrier disruption by lipopolysaccharide and sepsis-associated encephalopathy. 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