Serial immune-inflammatory recovery trajectories after acute ischemic stroke: associations with early neurological deterioration and 90-day functional outcome in a retrospective cohort.

Background: Systemic inflammation after acute ischemic stroke is usually assessed using admission biomarkers, which may not distinguish transient stress from sustained immune-inflammatory activation. We examined whether serial immune-inflammatory recovery trajectories were associated with early neurological deterioration (END) and 90-day functional outcome. Methods: This single-center retrospective cohort included 760 adults with acute ischemic stroke identified from a hospital stroke database. NLR, SII, SIRI, and hs-CRP measured at admission, 24 h, 72 h, and day 7 were log-transformed and standardized, and equally weighted values were averaged at each observed time point. Latent class mixed models with 2-5 classes were compared without using outcome information, and a five-class solution was selected before association and prediction analyses. The primary outcome was 90-day mRS 3-6. END was defined as an NIHSS increase of ≥2 points within 72 h; the landmark END analysis excluded END within 24 h and tested 0-24 h immune change for END from 24 to 72 h. Results: The five LCMM classes comprised 182 low-stable, 223 transient moderate, 161 delayed recovery, 122 persistent high, and 72 extreme persistent high patients. Among 751 patients with 90-day outcome data, the observed rate of mRS 3-6 increased from 21.5 to 30.6%, 44.2, 71.9, and 98.6% across these classes. After adjustment, persistent high (OR 2.46, 95% CI 1.31-4.61; Conclusion: Longitudinal classification identified five immune-inflammatory recovery trajectories with a marked gradient in 90-day disability. Persistent-high and extreme persistent-high classes retained independent associations with poor functional outcome.