Impact of Ferritin/Albumin and Lactate/Albumin Ratios on Clinical Outcomes After Acute Ischemic Stroke in Patients Undergoing Endovascular Therapy

INTRODUCTION: This study aimed to evaluate the impact of the preoperative lactate-to-albumin ratio (LAR) and the postoperative ferritin-to-albumin ratio (FAR) on mortality, functional independence, and recanalization outcomes in patients who underwent endovascular thrombectomy (EVT) for acute ischemic stroke (AIS).
METHODS: This retrospective study evaluated 182 adult AIS patients who underwent EVT. Preoperative LAR was determined using blood samples collected within 6 hours prior to the procedure, while postoperative FAR was calculated from samples drawn within the first 24 hours following EVT. The primary endpoints were 90-day functional independence (modified Rankin Scale [mRS] 0–3), overall mortality, and technical recanalization success (modified Thrombolysis in Cerebral Infarction [TICI] ≥2b). We utilized ROC curves and multiple logistic regression to identify independent predictors.
RESULTS: Successful reperfusion was achieved in 90.7% of cases, yet the mortality rate stood at 28.6%, with 63.2% reaching functional independence. ROC analysis revealed LAR as the strongest mortality predictor (AUC=0.874). In multiple models, elevated LAR and FAR were strongly associated with both a higher mortality risk and a markedly reduced chance of 90-day functional recovery. Interestingly, classic predictors like age and admission NIHSS were overshadowed by these composite ratios in the final model. Diabetes was the sole independent predictor of failed recanalization.
DISCUSSION AND CONCLUSION: LAR and FAR emerged as potent, independent indicators of poor clinical outcomes in EVT-treated stroke patients. By capturing both tissue hypoperfusion and systemic inflammation simultaneously, these easily accessible laboratory parameters can help clinicians recognize high-risk cases early in the post-procedural phase and tailor follow-up care accordingly.

Keywords: lactate-to-albumin ratio, ferritin-to-albumin ratio, endovascular thrombectomy