Dynamic decline in estimated glomerular filtration rate associated with in-hospital mortality risk in acute ischemic stroke patients after endovascular therapy: evidence from a Chinese stroke center.

Objectives: To investigate the association between dynamic changes in estimated glomerular filtration rate (eGFR) and in-hospital mortality risk in patients with acute ischemic stroke due to large vessel occlusion (LVO-AIS) undergoing endovascular therapy (EVT). Methods: This retrospective cohort study consecutively enrolled 329 patients with anterior circulation LVO-AIS who underwent EVT between January 2018 and January 2025. The eGFR was calculated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) 2009 equation at admission (baseline), and on days 1 and 3 post-EVT. The primary outcome was all-cause in-hospital mortality. Multivariable logistic regression models and restricted cubic spline regression were employed to assess the association between eGFR and outcomes. Subgroup analyses with interaction testing were conducted to evaluate the consistency of this association across different patient populations. Results: Of the 329 patients, 49 (14.9%) died during hospitalization. Baseline eGFR was not significantly associated with mortality ( Conclusion: Dynamic decline in eGFR, particularly the level on day 3 post-EVT, is independently associated with in-hospital mortality in LVO-AIS patients undergoing EVT, exhibiting a clear dose-response relationship.