{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T03:08:00Z","timestamp":1790392080029,"version":"4.1.0"},"reference-count":31,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T00:00:00Z","timestamp":1627430400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p><jats:bold>Objective:<\/jats:bold> To determine the clinical significance of post-procedural abnormal liver function test (ALFT) on the functional outcomes at 90 days in acute ischemic stroke (AIS) treated with mechanical thrombectomy (MT).<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> In this retrospective observational study, patients with AIS undergoing MT were enrolled from the Nanjing Stroke Registry Program and the multicenter Captor trial. A favorable outcome was defined as a modified Rankin Scale score 0\u20132 at 90 days. Predictive models were established by multivariable logistic regression. Improved predictive value of models was assessed by continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI). In addition, multivariable logistic regression and restricted cubic spline were used to analyze dose\u2013response correlations between the severity of ALFT and prognosis.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Among 420 patients enrolled, 234 (55.7%) patients were diagnosed as post-procedural ALFT after MT. Patients with post-procedural ALFT had higher National Institute of Health Stroke Scale score on admission (median, 18 vs. 15, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) and more pneumonia (65.4 vs. 38.2%, <jats:italic>p<\/jats:italic> &amp;lt; 0.001) than those without post-procedural ALFT. Post-procedural ALFT, rather than preprocedural ALFT, was independently associated with favorable outcome (adjusted odds ratio, 0.48; 95% CI 0.28\u20130.81; <jats:italic>p<\/jats:italic> = 0.006). The improvement of predictive model after adding post-procedural ALFT was significant [continuous NRI (value, 0.401; <jats:italic>p<\/jats:italic> &amp;lt; 0.001), IDI (value, 0.013; <jats:italic>p<\/jats:italic> &amp;lt; 0.001)]. However, the restricted cubic spline indicated no evidence of a dose\u2013response relationship between the severity of post-procedural ALFT and prognosis.<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> In AIS patients treated by MT, post-procedural ALFT was associated with more severe stroke and served as an independent predictor of worse prognosis at 90 days.<\/jats:p>","DOI":"10.3389\/fneur.2021.670387","type":"journal-article","created":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T05:13:10Z","timestamp":1627449190000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":4,"title":["Prognostic Value of Abnormal Liver Function Tests After Mechanical Thrombectomy for Acute Ischemic Stroke"],"prefix":"10.3389","volume":"12","author":[{"given":"Kangmo","family":"Huang","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingming","family":"Zha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lulu","family":"Xiao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie","family":"Gao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Du","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Wu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qingwen","family":"Yang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinfeng","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,7,28]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1832","DOI":"10.1001\/jama.2015.13767","article-title":"Endovascular thrombectomy for acute ischemic stroke: a meta-analysis","volume":"314","author":"Badhiwala","year":"2015","journal-title":"Jama."},{"key":"B2","doi-asserted-by":"publisher","first-page":"1981","DOI":"10.1056\/NEJMoa2001123","article-title":"Endovascular thrombectomy with or without intravenous alteplase in acute stroke","volume":"382","author":"Yang","year":"2020","journal-title":"N Engl J Med."},{"key":"B3","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1177\/1747493018799979","article-title":"Factors that may contribute to poor outcome despite good reperfusion after acute endovascular stroke therapy","volume":"14","author":"Rabinstein","year":"2019","journal-title":"Int J Stroke."},{"key":"B4","doi-asserted-by":"publisher","first-page":"2742","DOI":"10.1161\/STROKEAHA.120.030895","article-title":"Cortical microinfarcts associated with worse outcomes in patients with acute ischemic stroke receiving endovascular treatment","volume":"51","author":"Wei","year":"2020","journal-title":"Stroke."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1138","DOI":"10.1016\/S1474-4422(16)30177-6","article-title":"Mechanical thrombectomy after intravenous alteplase versus alteplase alone after stroke (THRACE): a randomised controlled trial","volume":"15","author":"Bracard","year":"2016","journal-title":"Lancet Neurol."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1514","DOI":"10.1161\/STROKEAHA.119.028511","article-title":"Brain atrophy and the risk of futile endovascular reperfusion in acute ischemic stroke","volume":"51","author":"Pedraza","year":"2020","journal-title":"Stroke."},{"key":"B7","doi-asserted-by":"publisher","first-page":"127","DOI":"10.1161\/STROKEAHA.118.023084","article-title":"Impact of microbleeds on outcome following recanalization in patients with acute ischemic stroke","volume":"50","author":"Choi","year":"2019","journal-title":"Stroke."},{"key":"B8","doi-asserted-by":"publisher","first-page":"1756286419873264","DOI":"10.1177\/1756286419873264","article-title":"Stroke-related complications in large hemisphere infarction: incidence and influence on unfavorable outcome","volume":"12","author":"Li","year":"2019","journal-title":"Ther Adv Neurol Disord."},{"key":"B9","doi-asserted-by":"publisher","first-page":"220","DOI":"10.1016\/j.jinf.2019.06.012","article-title":"Pneumonia in acute ischemic stroke patients requiring invasive ventilation: impact on short and long-term outcomes","volume":"79","author":"de Montmollin","year":"2019","journal-title":"J Infect."},{"key":"B10","doi-asserted-by":"publisher","first-page":"e464","DOI":"10.1212\/WNL.0000000000008748","article-title":"Renal impairment on clinical outcomes following endovascular recanalization","volume":"94","author":"Xiao","year":"2020","journal-title":"Neurology."},{"key":"B11","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1097\/01.CCM.0000259462.97164.A0","article-title":"Incidence and prognosis of early hepatic dysfunction in critically ill patients\u2014a prospective multicenter study","volume":"35","author":"Kramer","year":"2007","journal-title":"Crit Care Med."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1397","DOI":"10.1007\/s00134-009-1508-2","article-title":"Hypoxic hepatitis: underlying conditions and risk factors for mortality in critically ill patients","volume":"35","author":"Fuhrmann","year":"2009","journal-title":"Intensive Care Med."},{"key":"B13","doi-asserted-by":"publisher","first-page":"1090","DOI":"10.1016\/j.amjcard.2017.06.049","article-title":"Frequency and prognostic significance of abnormal liver function tests in patients with cardiogenic shock","volume":"120","author":"J\u00e4ntti","year":"2017","journal-title":"Am J Cardiol."},{"key":"B14","doi-asserted-by":"publisher","first-page":"341","DOI":"10.1007\/s00392-016-1060-3","article-title":"Incidence, laboratory detection and prognostic relevance of hypoxic hepatitis in cardiogenic shock","volume":"106","author":"Jung","year":"2017","journal-title":"Clin Res Cardiol."},{"key":"B15","doi-asserted-by":"publisher","first-page":"915","DOI":"10.1016\/j.jacl.2017.04.115","article-title":"Nonalcoholic fatty liver disease in patients with acute ischemic stroke is associated with more severe stroke and worse outcome","volume":"11","author":"Abdeldyem","year":"2017","journal-title":"J Clin Lipidol."},{"key":"B16","first-page":"144","article-title":"Association between non-alcoholic fatty liver disease and ischemic stroke","volume":"13","author":"Moshayedi","year":"2014","journal-title":"Iran J Neurol."},{"key":"B17","first-page":"104","article-title":"Prognostic significance of serum bilirubin in stroke","volume":"23","author":"Arsalan","year":"2011","journal-title":"J Ayub Med Coll Abbottabad."},{"key":"B18","doi-asserted-by":"publisher","first-page":"577","DOI":"10.1111\/ene.13556","article-title":"Non-alcoholic fatty liver disease is associated with stroke severity and progression of brainstem infarctions","volume":"25","author":"Li","year":"2018","journal-title":"Eur J Neurol."},{"key":"B19","doi-asserted-by":"publisher","first-page":"130","DOI":"10.1159\/000093241","article-title":"Subtypes and one-year survival of first-ever stroke in Chinese patients: the Nanjing stroke registry","volume":"22","author":"Liu","year":"2006","journal-title":"Cerebrovasc Dis."},{"key":"B20","doi-asserted-by":"publisher","first-page":"2650","DOI":"10.1161\/STROKEAHA.113.001972","article-title":"Recommendations on angiographic revascularization grading standards for acute ischemic stroke: a consensus statement","volume":"44","author":"Zaidat","year":"2013","journal-title":"Stroke."},{"key":"B21","doi-asserted-by":"publisher","first-page":"18","DOI":"10.1038\/ajg.2016.517","article-title":"ACG clinical guideline: evaluation of abnormal liver chemistries","volume":"112","author":"Kwo","year":"2017","journal-title":"Am J Gastroenterol."},{"key":"B22","doi-asserted-by":"publisher","first-page":"157","DOI":"10.1002\/sim.2929","article-title":"Evaluating the added predictive ability of a new marker: from area under the ROC curve to reclassification and beyond","volume":"27","author":"Pencina","year":"2008","journal-title":"Stat Med."},{"key":"B23","doi-asserted-by":"publisher","first-page":"159","DOI":"10.5853\/jos.2019.02978","article-title":"Beyond the brain: the systemic pathophysiological response to acute ischemic stroke","volume":"22","author":"Balch","year":"2020","journal-title":"J Stroke."},{"key":"B24","doi-asserted-by":"publisher","first-page":"512","DOI":"10.1038\/jcbfm.2008.140","article-title":"Vagus nerve mediates the protective effects of melanocortins against cerebral and systemic damage after ischemic stroke","volume":"29","author":"Ottani","year":"2009","journal-title":"J Cereb Blood Flow Metab."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1235","DOI":"10.1210\/en.2013-1593","article-title":"Activation of hepatic inflammatory pathways by catecholamines is associated with hepatic insulin resistance in male ischemic stroke rats","volume":"155","author":"Wang","year":"2014","journal-title":"Endocrinology."},{"key":"B26","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1038\/s41569-018-0098-5","article-title":"Safety and efficacy of statin therapy","volume":"15","author":"Adhyaru","year":"2018","journal-title":"Nat Rev Cardiol."},{"key":"B27","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1186\/1471-2377-14-122","article-title":"Changes of liver enzymes and bilirubin during ischemic stroke: mechanisms and possible significance","volume":"14","author":"Muscari","year":"2014","journal-title":"BMC Neurol."},{"key":"B28","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1111\/j.1365-2036.2011.04718.x","article-title":"Abnormal liver tests in people aged 75 and above: prevalence and association with mortality","volume":"34","author":"Fleming","year":"2011","journal-title":"Aliment Pharmacol Therap."},{"key":"B29","doi-asserted-by":"publisher","first-page":"88","DOI":"10.1038\/nrgastro.2015.200","article-title":"Immunology in the liver\u2014from homeostasis to disease","volume":"13","author":"Heymann","year":"2016","journal-title":"Nat Rev Gastroenterol Hepatol."},{"key":"B30","doi-asserted-by":"publisher","first-page":"775","DOI":"10.1038\/nrn1765","article-title":"Central nervous system injury-induced immune deficiency syndrome","volume":"6","author":"Meisel","year":"2005","journal-title":"Nat Rev Neurosci."},{"key":"B31","doi-asserted-by":"publisher","first-page":"414","DOI":"10.1007\/s13311-020-00844-3","article-title":"The local and peripheral immune responses to stroke: implications for therapeutic development","volume":"17","author":"Zera","year":"2020","journal-title":"Neurotherapeutics."}],"container-title":["Frontiers in Neurology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2021.670387\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,28]],"date-time":"2021-07-28T05:13:14Z","timestamp":1627449194000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fneur.2021.670387\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,7,28]]},"references-count":31,"alternative-id":["10.3389\/fneur.2021.670387"],"URL":"https:\/\/doi.org\/10.3389\/fneur.2021.670387","relation":{},"ISSN":["1664-2295"],"issn-type":[{"value":"1664-2295","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,28]]},"article-number":"670387"}}