The endothelial activation and stress index as a key prognostic marker in severe ischemic stroke.

backgroundSevere ischemic stroke (SIS) is a life-threatening condition associated with high mortality rates. Endothelial dysfunction plays a critical role in its progression, leading to further neurovascular damage. The endothelial activation and stress index (EASIX) is a simple and easily accessible biomarker and may serve as a potential prognostic indicator for SIS. This study investigates the relationship between EASIX levels and 28-day all-cause mortality (ACM) in patients with SIS.

methodsThe study utilized data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Patients were stratified into three cohorts based on log

resultsA total of 786 patients with SIS were included in the study. The patients were stratified into tertiles based on their log₂(EASIX) values. Elevated EASIX levels were associated with prolonged hospital and ICU stays as well as an increased risk of 28-day ACM. Kaplan-Meier survival analysis revealed that higher EASIX levels significantly correlated with reduced survival probability. Cox regression analysis indicated that each unit increase in log₂(EASIX) was associated with a 17% higher mortality risk. Moreover, patients in the highest EASIX tertile exhibited a significantly greater mortality risk. RCS regression further identified a nonlinear increase in mortality risk beyond an EASIX threshold of 0.58. ROC analysis demonstrated that log₂(EASIX) had superior predictive accuracy for 28-day ACM (AUC = 0.765), outperforming both the SOFA and SIRS scores. Subgroup analyses confirmed the robustness of this association across various patient characteristics, with no significant interactions.

conclusionEASIX is a simple and accessible biomarker that provides early warning for identifying high-risk patients. Elevated EASIX levels are strongly associated with an increased risk of 28-day ACM in SIS patients.