U-shaped association between serum ferritin and futile recanalization in patients with acute ischemic stroke after mechanical thrombectomy

Objective

We aimed to investigate the association between serum ferritin levels and futile recanalization (FR) in patients with acute ischemic stroke (AIS) due to large vessel occlusion following mechanical thrombectomy (MT).

Methods

Patients with acute ischemic stroke due to large vessel occlusion who underwent mechanical thrombectomy (MT) at Huaian NO.1 People′s Hospital from August 2017 to January 2024 were retrospectively analysed. A total of 609 patients were enrolled in this study and were divided into effective and futile recanalization groups based on mRS scores at 90 days after MT. Multivariate logistic regression analysis was used to investigate the independent predictors of FR. The association between ferritin and FR was analysed after adjustment for confounders. Receiver operating characteristics (ROC) analysis was performed to determine the sensitivity and specificity of the model for predicting FR. Restricted cubic spline was used to describe the dose-response relationship between serum ferritin and FR.

Results

Multivariate logistic regression analysis showed that ferritin was independently associated with FR. When serum ferritin was analysed as a continuous variable, there was a 1.048-fold (95 %CI: 1.017–1.080, P = 0.002) increased risk of FR per 20 ng/ml increase in ferritin, after adjustment for confounders. When analyzed by quartiles of ferritin levels, compared to Q2 (127–217 ng/ml) after adjusting for confounding factors, the higher serum ferritin groups Q3 (217–326 ng/ml) and Q4 (≥326 ng/ml) exhibited 2.275-fold (95 % CI: 1.309–3.955, P = 0.004) and 2.911-fold (95 % CI: 1.646–5.150, P < 0.001) increased risks of FR, respectively, while the lower serum ferritin group Q1 (≤127 ng/ml) showed a non-significant 1.586-fold (95 % CI: 0.911–2.760, P = 0.103) increase in risk.

The AUC-ROC of the model was 0.843 (95 %CI: 0.813–0.874, P＜0.001) with a sensitivity of 66.5 % and a specificity of 86.2 %. Restricted cubic spline analysis showed a U-shaped association between serum ferritin and FR. The lowest risk of FR was observed at a serum ferritin concentration of 162 ng/ml. The risk increased significantly when ferritin levels were either below 62.22 ng/ml or above 272.71 ng/ml (P for nonlinearity = 0.003).

Conclusions

In patients with AIS due to large vessel occlusion, serum ferritin within a specific concentration range is physiologically essential, while both hypoferritinemia and hyperferritinemia are independently associated with an increased risk of FR, demonstrating a significant nonlinear U-shaped relationship.