Plasma Heparin-Binding Protein as a Predictor of Functional Recovery and a Potential Therapeutic Target in Acute Anterior Circulation Large-Vessel Occlusion Stroke

<b>Background:</b> Patients with acute anterior circulation large-vessel occlusion (AC-LVO) stroke frequently experience poor outcomes despite successful mechanical thrombectomy (MT). Heparin-binding protein (HBP), a neutrophil-derived mediator of inflammation and vascular permeability, may contribute to neuroinflammation and prognosis; however, its role in stroke remains unclear. <b>Methods:</b> In this retrospective study, 163 patients with AC-LVO stroke who underwent MT were enrolled. Plasma HBP levels were measured within 24 h after thrombectomy. Functional outcomes were evaluated using the modified Rankin Scale (mRS) at 90 days, with an mRS score 3-6 suggesting a poor outcome. Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed to assess associations between HBP and outcomes. <b>Results:</b> Of the 163 patients, 88 (54.0%) had poor functional outcomes. The median plasma HBP level of patients with poor outcomes was significantly higher than that of patients with good outcomes (28.80 vs. 18.42 ng/mL; <i>p</i> < 0.001). HBP remained independently associated with poor outcome (odds ratio [OR] 1.04; 95% confidence interval [CI] 1.01-1.07; <i>p</i> = 0.002) after adjusting for demographic, clinical, procedural, and laboratory covariates. ROC analysis showed a modest predictive value of HBP alone (area under the curve [AUC] = 0.671), whereas adding HBP to clinical models improved prognostic accuracy (AUC = 0.835 for model 2; AUC = 0.889 for model 3). <b>Conclusions:</b> For patients with AC-LVO stroke, elevated plasma HBP within 24 h after MT serves as an independent predictor of unfavorable functional outcomes at 90 days. Thus, HBP may serve as a prognostic biomarker and potential target for immunomodulatory therapy.