Back Support Pressure for Severity Evaluation and Long-Term Prognostication in Acute Anterior Circulation Ischemic Stroke: A Prospective Cohort Study

Introduction: Accurate early prognostication in acute anterior circulation infarction remains challenging. This study investigates the role of back support pressure, measured in a standardized semi-recumbent position, as a novel biomechanical biomarker for disease severity and outcome prediction. Methods: This prospective cohort study enrolled 150 anterior circulation infarction patients with longitudinal follow-up. Lumbar-sacral back support pressure (P3, kPa) was detected on days 1, 5, 10, and 15. Pearson correlation, ANOVA, and ROC analysis were adopted to explore its associations with NIHSS, GCS, infarct features, hospital-acquired pulmonary infection (HAP), and 90-day mRS score. P3 variation after thrombectomy was further analyzed in 93 enrolled cases. Results: P3 pressure exhibited strong, graded correlations with neurological severity (NIHSS: r = 0.657; GCS: r = −0.78), infarct size (r = 0.75, p < 0.04), and involvement of key motor areas. Patients with HAP showed a significant acute-phase P3 increase (31.05 ± 3.38 vs. 21.56 ± 3.23 kPa, p < 0.03). A Day-5 P3 value ≥ 28 kPa predicted 90-day poor outcome (mRS 3-6) with an AUC of 0.905. The dynamic change in P3 (ΔP Day5-Day1 +5.20 ± 2.41 kPa in infected vs. −1.30 ± 2.00 kPa in non-infected group, p < 0.04) showed relevant predictive value. Following effective thrombectomy, P3 decreased significantly within 24 h (ΔP = −2.75 ± 1.23 kPa, p < 0.05), while it remained unchanged after ineffective procedures. Conclusions: P3 is a dynamic, non-invasive biomarker that strongly reflects neurological injury severity, systemic stress, and therapeutic response in anterior circulation infarction. Its high prognostic accuracy and sensitivity to change offer a novel, practical tool for real-time monitoring and outcome prediction in acute ischemic stroke care.