Association between dynamic serum lactate dehydrogenase levels and functional outcome after endovascular therapy for acute ischemic stroke: A retrospective cohort study

To investigate the dynamic changes in serum lactate dehydrogenase (LDH) levels and their association with 90-day functional outcome in patients with large vessel occlusion acute ischemic stroke (LVO-AIS) who underwent endovascular therapy (EVT). This retrospective cohort study consecutively enrolled 402 patients with LVO-AIS who underwent EVT at a comprehensive stroke center between January 2019 and November 2024. Serum LDH levels were measured at baseline, on postoperative day 1, and on postoperative day 3. The primary endpoint was poor functional outcome at 90 days, defined as a modified Rankin Scale score of 3 to 6. Multivariable logistic regression analysis was performed to evaluate the independent association between LDH levels and functional outcome. Receiver operating characteristic (ROC) curves were constructed to assess discriminative performance. A total of 244 patients (60.7%) had poor functional outcome at 90 days. Serum LDH levels were significantly higher in the poor outcome group than in the favorable outcome group across all time points: baseline, 216 vs 201 U/L (P = .004); postoperative day 1, 227 vs 202 U/L (P < .001); and postoperative day 3, 286 vs 219 U/L (P < .001). ROC analysis demonstrated that postoperative day 3 LDH had the best discriminative performance (AUC = 0.72), surpassing that of baseline LDH (AUC = 0.59) and postoperative day 1 LDH (AUC = 0.61). In the fully adjusted model, each 10 U/L increase in postoperative day 3 LDH was associated with a 4% increase in the odds of poor functional outcome (adjusted OR = 1.04; 95% CI, 1.02-1.06; P < .001). Quartile analysis further confirmed a dose-response relationship: compared with the lowest quartile (Q1: <205 U/L), the highest quartile (Q4: >337 U/L) was associated with a significantly elevated risk of poor outcome (adjusted OR = 3.63; 95% CI, 1.71-7.72; P < .001). Among patients with LVO-AIS who underwent EVT, serum LDH level on postoperative day 3 was independently associated with poor functional outcome at 90 days. As a readily available and routinely measured laboratory marker, dynamic LDH monitoring may provide supplementary information for early post-EVT risk stratification.