Clinical Neurology and Neurosurgery最新文献

{"title":"Systemic Microvasculature Frailty: Brain frailty score predicts contrast-associated acute kidney injury after thrombectomy for stroke","authors":"Thiago Oscar Goulart ,&nbsp;Amanda Sanae Esaki ,&nbsp;João Brainer Clares de Andrade ,&nbsp;Millene Rodrigues Camilo ,&nbsp;Daniel Giansante Abud ,&nbsp;Octávio Marques Pontes-Neto","doi":"10.1016/j.clineuro.2026.109323","DOIUrl":"10.1016/j.clineuro.2026.109323","url":null,"abstract":"<div><h3>Background</h3><div>Contrast-associated acute kidney injury (CA-AKI) is a frequent complication after mechanical thrombectomy (MT). Cerebral small vessel disease (CSVD) reflects cerebral microvascular dysfunction driven by systemic vascular risk factors that also affect renal integrity, and may therefore serve as a surrogate marker of renal vulnerability.</div></div><div><h3>Methods</h3><div>We prospectively included 351 patients with anterior circulation large-vessel occlusion who underwent MT. Baseline non-contrast CT was used to derive the modified small vessel disease (mSVD) score and the Brain Frailty Score (BFS). CA-AKI was defined as ≥ 0.5 mg/dL or ≥ 25 % increase in serum creatinine within 48–72 h after MT. Multivariable logistic regression, Firth penalized models, and XGBoost machine learning identified independent predictors.</div></div><div><h3>Results</h3><div>CA-AKI occurred in 42 patients (12.0 %). Affected patients were older (68 vs. 62 years), had higher glucose (143 vs. 118 mg/dL), elevated systolic pressure, and more pronounced CSVD features. Severe BFS (score=3) independently predicted CA-AKI (OR=5.13; 95 % CI 1.46–91.28; p = 0.039) after adjustment for age, glucose, and recanalization, whereas mSVD and individual imaging markers were not significant. The final model showed good discrimination and calibration (AUC=0.73; Brier=0.08) and remained stable in sensitivity analyses. In Firth regression, BFS remained significant (OR=4.26; 95 % CI 1.23–22.54). XGBoost achieved an AUC= 0.84, confirming the consistent predictive relevance of vascular, metabolic, and imaging factors across models.</div></div><div><h3>Conclusions</h3><div>BFS predicts CA-AKI after thrombectomy, outperforming both conventional CSVD scoring and individual imaging markers. These findings support the concept of <strong>Systemic Microvasculature Frailty</strong>,</div><div>in which cerebral microangiopathy reflects global endothelial vulnerability with acute renal implications.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109323"},"PeriodicalIF":1.6,"publicationDate":"2026-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146036637","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal strategy for mechanical thrombectomy based on the preoperative imaging features of the thrombus","authors":"Hiroyuki Sakata ,&nbsp;Masayuki Ezura ,&nbsp;Ryosuke Tashiro ,&nbsp;Shunsuke Omodaka ,&nbsp;Kenichi Sato ,&nbsp;Kuniyasu Niizuma ,&nbsp;Hidenori Endo","doi":"10.1016/j.clineuro.2026.109322","DOIUrl":"10.1016/j.clineuro.2026.109322","url":null,"abstract":"<div><h3>Objective</h3><div>Successful recanalization is not achieved in approximately 20 % of stroke patients who underwent mechanical thrombectomy, possibly due to the characteristics of the underlying thrombus. This study aimed to identify the most appropriate thrombectomy strategy based on the preoperative imaging features of the thrombus.</div></div><div><h3>Methods</h3><div>We retrospectively evaluated the data of 70 patients who underwent mechanical thrombectomy. Thrombus density was assessed using non-contrast computed tomography (ΔCT values) and CT angiography (thrombus permeability). Difficult-to-retrieve thrombi were categorized based on the cutoff values (ΔCT &lt;10 Hounsfield units and/or thrombus permeability &lt;9 Hounsfield units). Favorable outcomes (modified Rankin scale score of 0–2) and successful recanalization (Thrombolysis in Cerebral Infarction grade 2b or 3) were evaluated. We also analyzed the interaction between thrombus imaging features and thrombectomy strategy (stent retriever (SR) alone vs. combined strategy) and its effect on recanalization.</div></div><div><h3>Results</h3><div>Patients with favorable outcomes and successful recanalization had statistically higher ΔCT values and thrombus permeability. Multiple logistic analyses identified difficult-to-retrieve thrombi as independently associated with fewer favorable outcome (odds ratio: 0.12 [0.03–0.36], p &lt; 0.001). The combined strategy demonstrated significantly greater effectiveness in achieving successful recanalization for difficult-to-retrieve thrombi compared with the SR-alone strategy (84.2 % vs. 50 %, odds ratio: 5.33, 95 % CI: 1.14–24.90, p = 0.038). However, normal thrombi demonstrated comparable responses with both strategies (92.3 % vs. 100 %, p = 0.394).</div></div><div><h3>Conclusion</h3><div>Given its procedural simplicity and cost-effectiveness, the SR-alone strategy may be effective for normal thrombi, whereas the combined strategy may be preferable for difficult-to-retrieve thrombi.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109322"},"PeriodicalIF":1.6,"publicationDate":"2026-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017332","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between bone mineral density and spondylolisthesis: A matched case-control study using DXA","authors":"Elif Dilara Topcuoglu ,&nbsp;Nursima Aydın ,&nbsp;Mihrimah Kan ,&nbsp;Burcu Narin ,&nbsp;Ahmet Nedim Kahraman ,&nbsp;Esin Derin Cicek","doi":"10.1016/j.clineuro.2026.109318","DOIUrl":"10.1016/j.clineuro.2026.109318","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the association between dual-energy X-ray absorptiometry (DXA) T-scores (lumbar spine, total femur and femoral neck) and the presence of spondylolisthesis (SL) in a matched case-control design.</div></div><div><h3>Materials and Methods</h3><div>Between January 2020 and November 2024, patients who underwent lumbar magnetic resonance imaging (MRI) and DXA in the same year were retrospectively reviewed. Patients with SL were identified and matched 1:1 with controls by age, sex, and body mass index category. Group differences were assessed using t-tests and logistic regression.</div></div><div><h3>Results</h3><div>Of 1573 lumbar MRI scans, 173 patients with SL (mean age 69.3 ± 9.9 years, 158 women) were matched with 173 controls. Osteoporosis and osteopenia were significantly more prevalent in the SL group (p &lt; 0.001 for both). Patients with SL had significantly lower lumbar spine (−0.85 ± 1.60 vs. −0.15 ± 1.68), femoral neck (−1.23 ± 1.08 vs. −0.84 ± 1.03), and total femur (−0.91 ± 1.16 vs. −0.40 ± 1.23) T-scores (all p &lt; 0.001). Multivariable logistic regression confirmed that lumbar spine T-scores were independently associated with SL (OR 0.76, 95 % CI 0.58–1.00, p = 0.047), with a stronger effect in women (OR 0.61, 95 % CI 0.45–0.82, p = 0.001). Obesity was associated with higher T-scores but did not protect against SL.</div></div><div><h3>Conclusion</h3><div>Reduced lumbar spine T-scores are independently associated with SL, particularly in postmenopausal women, indicating that lumbar bone mineral density may be clinically relevant in this population. These findings support consideration of DXA assessment as part of preoperative evaluation in patients with SL.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"263 ","pages":"Article 109318"},"PeriodicalIF":1.6,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146017350","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward clarity in antiseizure medication withdrawal decisions: Clinical challenges and machine learning-based scoring systems","authors":"Gül Yücel ,&nbsp;Nur Yücel Ekici","doi":"10.1016/j.clineuro.2026.109317","DOIUrl":"10.1016/j.clineuro.2026.109317","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109317"},"PeriodicalIF":1.6,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145973596","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Red cell distribution width and in-hospital mortality in intensive care unit patients with non-traumatic subarachnoid hemorrhage: A cohort study","authors":"Dong Wang ,&nbsp;Kaiwu Meng ,&nbsp;Xinyan He","doi":"10.1016/j.clineuro.2026.109315","DOIUrl":"10.1016/j.clineuro.2026.109315","url":null,"abstract":"<div><h3>Objective</h3><div>Non-traumatic subarachnoid hemorrhage (SAH) is the predominant form of SAH and is associated with substantial in-hospital mortality. Red cell distribution width (RDW) is a novel prognostic indicator for numerous diseases. However, its association with outcomes after SAH remains uncertain. This study aimed to investigate the association between RDW and in-hospital mortality among patients with severe non-traumatic SAH and to determine the pivotal threshold for the impact of RDW on in-hospital mortality in these patients.</div></div><div><h3>Methods</h3><div>In total, 877 patients aged ≥ 18 years with non-traumatic SAH were identified in the MIMIC-IV (v2.2) database. The primary exposure factor was the initial RDW documented after admission. The outcome measure was the in-hospital mortality rate among patients in the intensive care unit (ICU). To evaluate the link between RDW and in-hospital mortality, a multivariate logistic regression analysis was conducted, considering possible confounding variables.</div></div><div><h3>Results</h3><div>An elevated RDW was associated with increased in-hospital mortality among ICU patients with non-traumatic SAH (odds ratio [OR]: 1.36, 95 % confidence interval [CI]: 1.25–1.49). After adjustment for potential confounders, this association remained (OR = 1.22, 95 % CI: 1.09–1.37, P = 0.015). Furthermore, a nonlinear association was noted between RDW and in-hospital mortality, with no statistically significant link detected when RDW exceeded 16.12 %.</div></div><div><h3>Conclusions</h3><div>Elevated RDW was an independent risk factor for in-hospital mortality in ICU patients with non-traumatic SAH, showing a \"J\"-shape nonlinear association. RDW is a readily available, low-cost biomarker for clinical intervention and identification of high-risk patients with non-traumatic SAH in the ICU.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109315"},"PeriodicalIF":1.6,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922892","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Recent outcomes of intravenous tissue plasminogen activator (t-PA) alone in the era of mechanical thrombectomy: A sub-analysis of the Kanagawa Intravenous and Endovascular Treatment (K-NET) registry","authors":"Noriko Usuki ,&nbsp;Toshihiro Ueda ,&nbsp;Masataka Takeuchi ,&nbsp;Masafumi Morimoto ,&nbsp;Yoshifumi Tsuboi ,&nbsp;Ryoo Yamamoto ,&nbsp;Satoshi Takaishi ,&nbsp;Kentaro Tatsuno ,&nbsp;Hidemichi Ito ,&nbsp;Takahiro Shimizu ,&nbsp;Yoshihisa Yamano ,&nbsp;on behalf of the K-NET Registry Investigators","doi":"10.1016/j.clineuro.2026.109316","DOIUrl":"10.1016/j.clineuro.2026.109316","url":null,"abstract":"<div><h3>Purpose</h3><div>Mechanical thrombectomy (MT) is now the standard of care for large vessel occlusion (LVO), leading to a decline in recent reports on the outcomes of intravenous tissue plasminogen activator (tPA) alone. This study aimed to assess the real-world effectiveness of intravenous tPA alone in the MT era, using data from the Kanagawa Intravenous and Endovascular Treatment (K-NET) registry, a prospective multicenter registry of acute ischemic stroke (AIS) in Japan.</div></div><div><h3>Methods</h3><div>Among 3954 AIS patients registered between 2018 and 2021, 767 received intravenous tPA without MT. Primary outcomes were the proportions of patients achieving a modified Rankin Scale (mRS) score of 0–1 or 0–2 at 90 days. Secondary outcomes included symptomatic intracranial hemorrhage (sICH) and 90-day mortality. Outcomes were further analyzed by occlusion site and stroke subtype.</div></div><div><h3>Results</h3><div>The median age was 77 years, and 42.9 % were female. The median National Institutes of Health Stroke Scale (NIHSS) score at presentation was 8. LVO was present in 24.1 % of patients. Favorable outcomes (mRS 0–2) at 90 days were observed in 47 % of all patients, and 56 % of those with pre-stroke mRS scores of 0–1. By the occlusion site, favorable outcome rates were highest in M3–4 occlusions (59 %) and lowest in internal carotid artery (ICA) occlusions (22 %). By stroke subtype, lacunar infarction (LI) showed the best outcomes (63.5 %), while cardioembolism (CE) had the worst (38.3 %). The overall sICH rate was 2.2 %, highest in basilar artery (BA) / vertebral artery (VA) occlusions (6.1 %) and CE cases (4.5 %).</div></div><div><h3>Conclusion</h3><div>Even in the MT era, intravenous tPA alone provides favorable outcomes in selected patients with AIS, particularly those without LVO. However, the proportion of LVO cases not receiving MT indicates gaps in referral and transfer systems. These findings underscore the significance of tPA alone as an important therapeutic option and as a potential indicator of the performance and equity of regional stroke care systems.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109316"},"PeriodicalIF":1.6,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922890","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When big data outpaces expertise: Safeguarding retrospective clinical research","authors":"Joshua Wang,&nbsp;Florian Roser","doi":"10.1016/j.clineuro.2026.109313","DOIUrl":"10.1016/j.clineuro.2026.109313","url":null,"abstract":"","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109313"},"PeriodicalIF":1.6,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917228","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-session combined middle meningeal artery embolization and hematoma evacuation versus staged approaches in symptomatic chronic subdural hematoma treatment: A single-center experience","authors":"Jaeha Kim ,&nbsp;Erin N. Walker ,&nbsp;Nathan Yu ,&nbsp;Sarah J. Snyder ,&nbsp;Mackenzie L. Castellanos ,&nbsp;Sami Almasri ,&nbsp;Om H. Gandhi ,&nbsp;Mikaeel Habib ,&nbsp;Luis O. Tierradentro-García ,&nbsp;Sarah Hamimi ,&nbsp;Aaron Anandarajah ,&nbsp;Adriana Castano ,&nbsp;Abdullah Feroze ,&nbsp;Patrick Connolly ,&nbsp;Linda Bagley ,&nbsp;Omar Choudhri","doi":"10.1016/j.clineuro.2026.109314","DOIUrl":"10.1016/j.clineuro.2026.109314","url":null,"abstract":"<div><h3>Background</h3><div>Middle meningeal artery (MMA) embolization can serve as an adjunct to prevent recurrent subdural hematoma. Hybrid operating rooms (ORs) with biplane neuroangiography now allow MMA embolization and cSDH drainage to be performed in a single stage. This study compares this single-stage approach with the traditional staged workflow, where patients undergo cSDH drainage in a neurosurgical OR followed by delayed MMA embolization in a separate neuroangiography suite.</div></div><div><h3>Methods</h3><div>Clinical data were extracted for 51 patients who underwent both cSDH drainage and MMA embolization at our center. Demographic information and surgically relevant parameters were compared between patients treated with a single-stage approach and those treated with a staged approach to identify differences beyond the timing of the procedures. The primary outcome was radiographic improvement following treatment, defined by reduction in hematoma thickness and midline shift. Secondary outcomes included total procedure room time, anesthesia duration, and operative duration.</div></div><div><h3>Results</h3><div>No significant differences were identified in the demographic characteristics of patients undergoing the single-stage or two-stage approach. Baseline cSDH characteristics, as well as operation-relevant parameters, were comparable between the two groups. Postoperative midline shift and reduction in hematoma thickness improved and were comparable between groups. Total procedure room time, anesthesia duration, and operative duration were also similar.</div></div><div><h3>Conclusion</h3><div>Results from this study suggest that single-stage MMA embolization procedures performed in hybrid ORs may not always be more efficient than the two-stage approach. Further research is needed to comprehensively evaluate the optimal timing and approach for patients undergoing MMA embolization procedures for cSDH management.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109314"},"PeriodicalIF":1.6,"publicationDate":"2026-01-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922889","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Combinations of clinical factors and radiomics for the hemorrhage-free survival of brainstem cavernous malformation patients","authors":"Xulei Huo ,&nbsp;Bohan Yao ,&nbsp;Jia Guo ,&nbsp;Sihan Ma ,&nbsp;Hongwei Wang ,&nbsp;Jiancong Weng ,&nbsp;Ke Wang ,&nbsp;Zhen Wu ,&nbsp;Da Li","doi":"10.1016/j.clineuro.2026.109310","DOIUrl":"10.1016/j.clineuro.2026.109310","url":null,"abstract":"<div><h3>Objectives</h3><div>This study aimed to develop a MRI-based prognostic nomogram including radiomics and clinical information for brainstem cavernous malformation patients (BSCMs).</div></div><div><h3>Methods</h3><div>114 BSCMs were randomly divided into a training cohort and a validation cohort. Clinical and radiomics nomograms were constructed. Radiomics features were selected using three algorithms: univariate analysis, Pearson correlation, and the elastic net algorithm. A Cox regression model was employed to build the radiomics nomogram. The concordance index (C-index), time-independent receiver operating characteristic (ROC) analysis, and decision curve analysis (DCA) were used to evaluate the clinical utility of the nomogram.</div></div><div><h3>Results</h3><div>The radiomics signature score was calculated using 11 radiomics features related to hemorrhage-free survival (HFS) from the training cohort. Patients were stratified into high-risk and low-risk groups based on the radiomics signature, with the low-risk group demonstrating significantly better HFS. Additionally, three clinical factors—number of hemorrhages, lesion size, and modified Rankin Scale score—along with the radiomics score were used to develop the radiomics nomogram. Calibration plots indicated good agreement between predicted and actual survival probabilities. The C-index for the training and validation cohorts was 0.784 and 0.787, respectively, in predicting HFS. The area under the curve was 72.51 and 76.41 for 3-year survival, and 67.62 and 72.57 for 5-year survival in the training and validation cohorts, respectively. The DCA curve demonstrated that the radiomics nomogram had superior clinical utility compared to the clinical model.</div></div><div><h3>Conclusions</h3><div>The radiomics nomogram showed great potential as a sensitive prognostic tool in predicting hemorrhage-free survival in BSCMs.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109310"},"PeriodicalIF":1.6,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic value of early creatinine trajectories in ischemic stroke patients: Insights from latent growth mixture modeling using MIMIC-IV","authors":"Xin Zuo ,&nbsp;Huan Zuo ,&nbsp;Pengyu Zhu","doi":"10.1016/j.clineuro.2026.109311","DOIUrl":"10.1016/j.clineuro.2026.109311","url":null,"abstract":"<div><h3>Background</h3><div>Renal dysfunction is common in ischemic ischemic ischemic stroke patients, but the prognostic value of dynamic creatinine trajectories remains unclear.</div></div><div><h3>Methods</h3><div>Using the MIMIC-IV database, we included 1998 ischemic ischemic stroke patients who had at least three creatinine measurements within 72 h of ICU admission. Latent growth mixture modeling (LGMM) was applied to identify creatinine trajectories. The primary outcome was 90-day in-hospital mortality. Cox regression, Kaplan–Meier survival analysis, and subgroup analyses were performed.</div></div><div><h3>Results</h3><div>Four distinct creatinine trajectories were identified: Class 1 (74.4 %) with stable low levels; Class 2 (20.9 %) with persistently moderate-to-high levels and a slight upward trend; Class 3 (2.2 %) with an initial increase followed by decline; and Class 4 (2.5 %) with high initial levels that decreased and then rose again. Significant differences in demographics, complications, and outcomes were observed across classes (all <em>P</em> &lt; 0.05). In unadjusted and partially adjusted models, Classes 2–4 were associated with higher mortality, but after full adjustment only Class 2 remained significant (HR = 1.55, <em>P</em> &lt; 0.001). Kaplan–Meier analysis confirmed significantly lower survival in non-Class 1 patients, most pronounced in Class 2. Subgroup analyses showed consistent results for Class 2 across sex, age, and comorbidity subgroups.</div></div><div><h3>Conclusion</h3><div>Early creatinine trajectories carry important prognostic value in ischemic stroke patients. The persistently moderate-to-high and gradually rising trajectory (Class 2) emerged as the strongest independent predictor of 90-day mortality, highlighting its potential role in risk stratification and clinical decision-making.</div></div>","PeriodicalId":10385,"journal":{"name":"Clinical Neurology and Neurosurgery","volume":"262 ","pages":"Article 109311"},"PeriodicalIF":1.6,"publicationDate":"2026-01-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145922893","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}