Serum pentraxin-3 and plaque burden predict unexplained early neurological deterioration in branch atheromatous disease

Pentraxin-3 (PTX-3), an inflammatory biomarker, is associated with atherosclerosis-related cerebral infarction. Plaque burden is a known predictor of poor prognosis in cerebral infarction. This study aimed to determine whether serum PTX-3 levels and plaque burden are independent risk factors for unexplained early neurological deterioration (END) in patients with branch atheromatous disease (BAD). This prospective observational cohort study included 289 consecutive BAD patients. END was evaluated within 72 hours after acute ischemic stroke onset. Univariate and multivariate regression analyses were used to assess the relationships between PTX-3, plaque burden, and END. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive performance of PTX-3, plaque burden, and their combination for unexplained END. Among the 289 patients, 82 (28.4%) developed END. END was associated with higher PTX-3, oxLDL, and LDL levels; older age; hypertension; higher NIHSS scores after END; and greater plaque burden. After adjusting for confounders, both the highest PTX-3 quartile (OR = 1.256, 95% CI: 1.032–29.930) and plaque burden (OR = 1.568, 95% CI: 0.918–2.926) were independent predictors of END. The ROC analysis demonstrated that the combination of PTX-3(AUC = 0.742, 95% CI: 0.680–0.804) and plaque burden (AUC = 0.758, 95% CI: 0.697–0.818) yielded the highest predictive value (AUC = 0.785, 95% CI: 0.727–0.844, p < 0.001). Elevated serum PTX-3 levels and increased plaque burden were independently associated with unexplained END in BAD patients. Their combination showed superior predictive performance, indicating potential clinical utility for risk stratification.