{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T09:01:08Z","timestamp":1780131668058,"version":"3.54.0"},"reference-count":30,"publisher":"IMR Press","issue":"5","license":[{"start":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T00:00:00Z","timestamp":1779235200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Shaoxing Health Commission Science and Technology Plan Project","award":["2024SKY110"],"award-info":[{"award-number":["2024SKY110"]}]},{"name":"2024 District-Level Social Development Science and Technology Project of Shangyu District, Shaoxing City","award":["2024-10"],"award-info":[{"award-number":["2024-10"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Br. J. Hosp. Med. (Lond)"],"abstract":"<jats:p>Aims\/Background: Early neurological deterioration (END) after thrombolysis is a serious complication in acute ischemic stroke (AIS); however, its early identification remains challenging. This study aimed to investigate the value of amplitude-integrated electroencephalography (aEEG) combined with CD4+\/CD8+ ratio in assessing END in patients with AIS. Methods: The study enrolled 210 AIS patients who underwent thrombolysis at Shangyu People\u2019s Hospital of Shaoxing, China, between May 2020 and May 2025. Based on whether the National Institutes of Health Stroke Scale (NIHSS) score at 24 hours post-thrombolysis increased by \u22654 points compared to the score at admission, patients were divided into an END group (score increase \u22654, n = 61) and a non-END group (score increase &lt;4, n = 149). Clinical data were compared between the two groups. The receiver operating characteristic (ROC) curve was used to analyze the diagnostic value of the aEEG score and CD4+\/CD8+ ratio, both individually and in combination, for END after thrombolysis. Multivariate logistic regression analysis was performed to identify factors influencing END post-thrombolysis. Furthermore, two predictive models were constructed and their predictive efficacy evaluated: Model 1 (excluding aEEG score and CD4+\/CD8+ ratio) and Model 2 (including aEEG score and CD4+\/CD8+ ratio). Results: The onset-to-needle time in the END group was significantly longer than in the non-END group. NIHSS score at admission, white blood cell count (WBC), Systemic Inflammation Response Index (SIRI), and aEEG score were significantly higher in the END group, while the CD4+\/CD8+ ratio was significantly lower (p &lt; 0.001). The area under the ROC curve (AUC) was 0.755 for the aEEG score, 0.776 for the CD4+\/CD8+ ratio alone, and 0.862 for their combination. Multivariate logistic regression analysis showed that prolonged onset-to-needle time, higher NIHSS score at admission, increased WBC count, elevated SIRI, and higher aEEG score were independent risk factors for END after thrombolysis, with an increased CD4+\/CD8+ ratio serving as a protective factor (p &lt; 0.05). Both Model 1 and Model 2 demonstrated good goodness-of-fit (p = 0.856 and 0.997, respectively), with AUCs of 0.944 and 0.991. In Model 2, the variance inflation factor (VIF) for all six influencing factors ranged from 1.070 to 1.383. Conclusion: The aEEG score and the CD4+\/CD8+ ratio have a significant influence on the occurrence of END in AIS patients after thrombolysis, and their combination improves predictive performance.<\/jats:p>","DOI":"10.31083\/bjhm54061","type":"journal-article","created":{"date-parts":[[2026,5,30]],"date-time":"2026-05-30T08:09:42Z","timestamp":1780128582000},"source":"Crossref","is-referenced-by-count":0,"title":["The Diagnostic Value of Amplitude-Integrated Electroencephalography Combined With CD4+\/CD8+ Ratio for Early Neurological Deterioration in Patients With Acute Ischemic Stroke"],"prefix":"10.31083","volume":"87","author":[{"given":"Qiqi","family":"Ruan","sequence":"first","affiliation":[{"name":"Department of Neurology, Shangyu People\u2019s Hospital of Shaoxing, 312300 Shaoxing, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haojie","family":"Wu","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shangyu People\u2019s Hospital of Shaoxing, 312300 Shaoxing, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liming","family":"Ye","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shangyu People\u2019s Hospital of Shaoxing, 312300 Shaoxing, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Siye","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shangyu People\u2019s Hospital of Shaoxing, 312300 Shaoxing, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-4145-6925","authenticated-orcid":true,"given":"Jianhua","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Neurology, Shangyu People\u2019s Hospital of Shaoxing, 312300 Shaoxing, Zhejiang, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"16242","published-online":{"date-parts":[[2026,5,20]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Saceleanu VM, Toader C, Ples H, Covache-Busuioc RA, Costin HP, Bratu BG, et al. Integrative Approaches in Acute Ischemic Stroke: From Symptom Recognition to Future Innovations. Biomedicines. 2023; 11: 2617.","DOI":"10.3390\/biomedicines11102617"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Al-Ajlan FS, Alkhiri A, Alamri AF, Alghamdi BA, Almaghrabi AA, Alharbi AR, et al. Golden Hour Intravenous Thrombolysis for Acute Ischemic Stroke: A Systematic Review and Meta-Analysis. Annals of Neurology. 2024; 96: 582\u2013590.","DOI":"10.1002\/ana.27007"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Tian T, Wang L, Xu J, Jia Y, Xue K, Huang S, et al. Prediction of early neurological deterioration in acute ischemic stroke patients treated with intravenous thrombolysis. Journal of Cerebral Blood Flow and Metabolism. 2023; 43: 2049\u20132059.","DOI":"10.1177\/0271678X231200117"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Luo B, Yuan M, Kuang W, Wang Y, Chen L, Zhang Y, et al. A novel nomogram predicting early neurological deterioration after intravenous thrombolysis for acute ischemic stroke. Heliyon. 2023; 10: e23341.","DOI":"10.1016\/j.heliyon.2023.e23341"},{"key":"ref5","doi-asserted-by":"publisher","unstructured":"Sun S, Cheng Y, Li L, Zhu H, Liu C, Cao Y. A High Fibrinogen-to-Albumin Ratio on Admission is Associated with Early Neurological Deterioration Following Intravenous Thrombolysis in Patients with Acute Ischemic Stroke. Journal of Inflammation Research. 2024; 17: 4151\u20134161.","DOI":"10.2147\/JIR.S459161"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Jin R, Yang G, Li G. Inflammatory mechanisms in ischemic stroke: role of inflammatory cells. Journal of Leukocyte Biology. 2010; 87: 779\u2013789.","DOI":"10.1189\/jlb.1109766"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Wang YP, Cheng YQ, Wang H, Wang H, Liu WX, Jiang Y, et al. Quantitative Electroencephalography for Predication of Neurological Dysfunction in Type A Aortic Dissection: A Prospective Observational Study. Journal of the American Heart Association. 2024; 13: e034351.","DOI":"10.1161\/JAHA.124.034351"},{"key":"ref8","doi-asserted-by":"publisher","unstructured":"Zhu C, Li W, Zhang Y, Qianqian Li, Wang H. Association of cerebrospinal fluid CD4+\/CD8+Ratio with 60-day functional outcome after intracerebral hemorrhage. International Journal of Immunopathology and Pharmacology. 2023; 37: 3946320231207350.","DOI":"10.1177\/03946320231207350"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Telec M, Frydrychowicz M, Kazmierski R, Wojtasz I, Dworacki G, Kozubski W, et al. Circulating CD4+, CD8+, and double-negative T cells in ischemic stroke and stroke-associated infection: a prospective case-control study. Frontiers in Cellular Neuroscience. 2025; 19: 1547905.","DOI":"10.3389\/fncel.2025.1547905"},{"key":"ref10","doi-asserted-by":"publisher","unstructured":"Yan Y, An X, Ma Y, Jiang Z, Di Y, Li T, et al. Detection of early neurological deterioration using a quantitative electroencephalography system in patients with large vessel occlusion stroke after endovascular treatment. Journal of Neurointerventional Surgery. 2025; 17: 883\u2013889.","DOI":"10.1136\/jnis-2024-022011"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Liesz A, Suri-Payer E, Veltkamp C, Doerr H, Sommer C, Rivest S, et al. Regulatory T cells are key cerebroprotective immunomodulators in acute experimental stroke. Nature Medicine. 2009; 15: 192\u2013199.","DOI":"10.1038\/nm.1927"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Zhang J, Luo Z, Zeng Y. Predictive Modeling of Early Neurological Deterioration in Patients with Acute Ischemic Stroke. World Neurosurgery. 2024; 191: 58\u201367.","DOI":"10.1016\/j.wneu.2024.08.017"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Feng X, Taiwakuli M, Du J, Zhu W, Xu S. Clinical and imaging risk factors for early neurological deterioration and long-term neurological disability in patients with single subcortical small infarction. BMC Neurology. 2025; 25: 66.","DOI":"10.1186\/s12883-025-04067-x"},{"key":"ref14","doi-asserted-by":"publisher","unstructured":"Wang Y, Zhang Z, Hang X, Wang W. Associations of Inflammatory Markers With Neurological Dysfunction and Prognosis in Patients With Progressive Stroke. European Journal of Neurology. 2025; 32: e70080.","DOI":"10.1111\/ene.70080"},{"key":"ref15","doi-asserted-by":"publisher","unstructured":"Warner JJ, Harrington RA, Sacco RL, Elkind MSV. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke. Stroke. 2019; 50: 3331\u20133332.","DOI":"10.1161\/STROKEAHA.119.027708"},{"key":"ref16","doi-asserted-by":"publisher","unstructured":"Peduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR. A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology. 1996; 49: 1373\u20131379.","DOI":"10.1016\/s0895-4356(96)00236-3"},{"key":"ref17","doi-asserted-by":"publisher","unstructured":"Brott T, Adams HP Jr, Olinger CP, Marler JR, Barsan WG, Biller J, et al. Measurements of acute cerebral infarction: a clinical examination scale. Stroke. 1989; 20: 864\u2013870.","DOI":"10.1161\/01.str.20.7.864"},{"key":"ref18","doi-asserted-by":"publisher","unstructured":"Maynard D, Prior PF, Scott DF. Device for continuous monitoring of cerebral activity in resuscitated patients. British Medical Journal. 1969; 4: 545\u2013546.","DOI":"10.1136\/bmj.4.5682.545-a"},{"key":"ref19","doi-asserted-by":"publisher","unstructured":"Seners P, Turc G, Tisserand M, Legrand L, Labeyrie MA, Calvet D, et al. Unexplained early neurological deterioration after intravenous thrombolysis: incidence, predictors, and associated factors. Stroke. 2014; 45: 2004\u20132009.","DOI":"10.1161\/STROKEAHA.114.005426"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Shi HX, Li C, Zhang YQ, Li X, Liu AF, Liu YE, et al. Predictors of Early Neurological Deterioration Occurring within 24 h in Acute Ischemic Stroke following Reperfusion Therapy: A Systematic Review and Meta-Analysis. Journal of Integrative Neuroscience. 2023; 22: 52.","DOI":"10.31083\/j.jin2202052"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Zhou Y, Luo Y, Liang H, Zhong P, Wu D. Applicability of the low-grade inflammation score in predicting 90-day functional outcomes after acute ischemic stroke. BMC Neurology. 2023; 23: 320.","DOI":"10.1186\/s12883-023-03365-6"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Zhang Y, Li X, Peng Y. Value of omentin-1 level in evaluating early neurological deterioration in patients with acute cerebral infarction after thrombolysis. Chinese Journal of Geriatric Heart Brain and Vessel Diseases. 2024; 26: 409\u2013412.  (In Chinese)","DOI":"10.3969\/j.issn.1009-0126.2024.04.012"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Hu B, Hua J. Impact of Onset-to-Needle Time on the Risk of Early Neurological Deterioration in Patients with Acute Ischemic Stroke Receiving Intravenous Thrombolysis. Therapeutics and Clinical Risk Management. 2025; 21: 917\u2013927.","DOI":"10.2147\/TCRM.S515542"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"McInerney A, McDowell M, Glowacki N, Fifer K, Roels C, Lomotan N, et al. From clock to outcomes: Time to thrombolytics and functional outcomes in acute ischemic stroke. The American Journal of Emergency Medicine. 2025; 96: 161\u2013165.","DOI":"10.1016\/j.ajem.2025.06.047"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Liu H, Liu K, Zhang K, Zong C, Yang H, Li Y, et al. Early neurological deterioration in patients with acute ischemic stroke: a prospective multicenter cohort study. Therapeutic Advances in Neurological Disorders. 2023; 16: 17562864221147743.","DOI":"10.1177\/17562864221147743"},{"key":"ref26","doi-asserted-by":"publisher","unstructured":"Zhu W, Zhou J, Ma B, Fan C. Predictors of early neurological deterioration in patients with intracerebral hemorrhage: a systematic review and meta-analysis. Journal of Neurology. 2024; 271: 2980\u20132991.","DOI":"10.1007\/s00415-024-12230-6"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Tan C, Zhao L, Dai C, Liang Y, Liu H, Zhong Y, et al. Risk factors related to early neurological deterioration in lacunar stroke and its influence on functional outcome. International Journal of Stroke. 2023; 18: 681\u2013688.","DOI":"10.1177\/17474930221145259"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Han Y, Lin N. Systemic Inflammatory Response Index and the Short-Term Functional Outcome of Patients with Acute Ischemic Stroke: A Meta-analysis. Neurology and Therapy. 2024; 13: 1431\u20131451.","DOI":"10.1007\/s40120-024-00645-2"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Li J, Zhang P, Chen H, Wang Y, Han Y, Wang C, et al. Elevated systemic inflammation response index is associated with poor outcomes in minor ischemic stroke. Frontiers in Neurology. 2024; 15: 1492224.","DOI":"10.3389\/fneur.2024.1492224"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"Wang N, Wang L, Zhang M, Deng B, Wu T. Correlations of 2 Novel Inflammation Indexes With the Risk for Early Neurological Deterioration in Acute Ischemic Stroke Patients After Intravenous Thrombolytic Therapy. 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