Overlapping Epstein-Barr virus encephalitis and autoimmune glial fibrillary acidic protein astrocytopathy.

We describe three cases of overlapping Epstein-Barr virus (EBV) Encephalitis and Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy (GFAP-A). The three cases all presented with initial symptoms of fever, headache, coma, and posture tremor of the upper limbs, then followed by limb weakness and dysuria. All of the three cases were on ventilators. Case 1 and 2 improved dramatically after intravenous methylprednisoloneand immunoglobulin treatment. However, case 3 presented dyspneic, and died from gastrointestinal hemorrhage. The GFAP-A triggered by EBV intracranial infection could initially masquerade as EBV encephalitis only, and the detection of GFAP antibody is essential for differentiation.

Effect of the interaction between atrial fibrillation and rt-PA dose on the prognosis of acute ischaemic stroke with intravenous thrombolysis.

BACKGROUND: The association between atrial fibrillation (AF) and the prognosis of acute ischaemic stroke (AIS) remains controversial; whether the recombinant tissue plasminogen activator dose influences this association remains poorly understood. METHODS: Patients who had an AIS were enrolled from eight stroke centres in China. According to the recombinant tissue plasminogen activator dose, patients treated with intravenous recombinant tissue plasminogen activator within 4.5 hours after symptom onset were divided into a low-dose group (recombinant tissue plasminogen activator <0.85 mg/kg) and a standard-dose group (recombinant tissue plasminogen activator ≥0.85 mg/kg). Patients who had an AIS in the low-dose group and the standard dose group were divided into whether or not they had AF. The main outcomes were major disability (modified Rankin scale (mRS) score 3-5), mortality and vascular events occurring within 3 months. RESULTS: The study included 630 patients who received recombinant tissue plasminogen activator after AIS, including 391 males and 239 females, with a mean age of 65.8 years. Of these patients, 305 (48.4%) received low-dose recombinant tissue plasminogen activator and 325 (51.6%) received standard dose recombinant tissue plasminogen activator. The recombinant tissue plasminogen activator dose significantly influenced the association between AF and death or major disability (p-interaction=0.036). After multivariate adjustment, AF was associated with an increased risk of death or major disability (OR 2.90, 95% CI 1.47 to 5.72, p=0.002), major disability (OR 1.93, 95% CI 1.04 to 3.59, p=0.038) and vascular events (HR 5.01, 95% CI 2.25 to 11.14, p<0.001) within 3 months in patients with standard-dose recombinant tissue plasminogen activator. No significant association was found between AF and any clinical outcome in patients with low-dose recombinant tissue plasminogen activator (all p>0.05). With AF, the mRS score distribution showed a significantly worse shift in patients with standard-dose recombinant tissue plasminogen activator (p=0.016) than in those with low-dose recombinant tissue plasminogen activator (p=0.874). CONCLUSIONS: AF may be a strong predictor of poor prognosis in patients who had an AIS receiving standard-dose recombinant tissue plasminogen activator, suggesting that low-dose recombinant tissue plasminogen activator should be administered to patients who had a stroke with AF to improve their prognosis.

Association between CORIN methylation and hypertension in Chinese adults.

BACKGROUND: Corin, a physical activator of atrial natriuretic peptide, has been associated with hypertension with unclear mechanisms. Here, we aimed to examine whether CORIN gene methylation was involved in the underlying molecular mechanisms. METHODS: DNA methylation levels of CORIN were measured by target bisulfite sequencing using genomic DNA isolated from peripheral blood mononuclear cells in 2498 participants in the Gusu cohort (discovery sample) and 1771 independent participants (replication sample). We constructed a mediation model with DNA methylation as the predictor, serum corin as the mediator, and hypertension as the outcome, adjusting for covariates. Multiple testing was controlled by false discovery rate (FDR) approach. RESULTS: Of the 9 CpGs assayed, hypermethylation at all CpGs were significantly associated with a lower level of blood pressure in the discovery sample and eight associations were also significant in the replication sample (all FDR-adjusted p<0.05). Serum corin mediated approximately 3.07% (p=0.004), 6.25% (p=0.002) and 10.11% (p=0.034) of the associations of hypermethylation at one CpG (Chr4:47840096) with systolic and diastolic blood pressure, and hypertension, respectively. All these mediations passed the causal inference test. CONCLUSIONS: These results suggest that hypermethylation in the CORIN gene is associated with a lower odds of prevalent hypertension and may be involved in the role of corin in blood pressure regulation.

Transcatheter Closure of Perimembranous and Intracristal Ventricular Septal Defects Using Amplatzer Duct Occluder II in Children.

BACKGROUND: Transcatheter closure of aneurysmal perimembranous ventricular septal defect (pmVSD), pmVSD near the aortic valve, and intracristal VSD (icVSD) with symmetrical or asymmetrical ventricular septal defect occluders still presents significant challenges. We report our experience with transcatheter closure of pmVSD and icVSD using Amplatzer duct occluder II (ADO II) in children. METHOD: We retrospectively analyzed all children, who presented to our hospital consecutively between March 2014 and June 2020 for attempted transcatheter closure of pmVSD or icVSD with the ADO II device. Standard safety and last-follow-up outcomes were assessed and compared. RESULTS: In total, 41 patients underwent transcatheter closure of VSD with the ADO II (28 in pmVSD and 13 in icVSD groups) with a median age of 3.5 years (total range: 0.9 to 12 years) and median weight of 15.0 kg (total range: 10.0 to 43.0 kg). Implantation was successful in 40/41 patients (97.5%, 27/28 in pmVSD group, 13/13 in icVSD group). One patient with mild aortic valve prolapse in pmVSD group developed new-onset moderate aortic regurgitation after a 4/4 mm ADO II was deployed; however, this resolved after the device was retrieved and successfully replaced with a 5 mm zero eccentric VSD occluder. There was no procedure-related mortality. After a median follow-up of six months (total range: 6 to 72 months), complete closure rates were 85.1% and 76.9% among pmVSD and icVSD groups, respectively. In the pmVSD group, one case of new-onset moderate tricuspid regurgitation was observed at six months, and there was one case of severe tricuspid regurgitation that had progressed from mild tricuspid regurgitation at 12 months. No serious complications were noted in the icVSD group. CONCLUSION: ADO II provides a safe and reproducible alternative for the closure of perimembranous and intracristal ventricular septal defects with a diameter less than 5 mm in young children.

Large Scale Identification of Osteosarcoma Pathogenic Genes by Multiple Extreme Learning Machine.

At present, the main treatment methods of osteosarcoma are chemotherapy and surgery. Its 5-year survival rate has not been significantly improved in the past decades. Osteosarcoma has extremely complex multigenomic heterogeneity and lacks universally applicable signal blocking targets. Osteosarcoma is often found in adolescents or children under the age of 20, so it is very important to explore its genetic pathogenic factors. We used known osteosarcoma-related genes and computer algorithms to find more osteosarcoma pathogenic genes, laying the foundation for the treatment of osteosarcoma immune microenvironment-related treatments, so as to carry out further explorations on these genes. It is a traditional method to identify osteosarcoma related genes by collecting clinical samples, measuring gene expressions by RNA-seq technology and comparing differentially expressed gene. The high cost and time consumption make it difficult to carry out research on a large scale. In this paper, we developed a novel method "RELM" which fuses multiple extreme learning machines (ELM) to identify osteosarcoma pathogenic genes. The AUC and AUPR of RELM are 0.91 and 0.88, respectively, in 10-cross validation, which illustrates the reliability of RELM.

Autoimmune glial fibrillary acidic protein astrocytopathy mimicking acute disseminated encephalomyelitis: A case report.

INTRODUCTION: Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy is an increasingly recognized type of steroid-responsive autoimmune disease of the nervous system. Defined in 2016, it is associated with the presence of anti-GFAP immunoglobulinG in the serum or cerebrospinal fluid (CSF) of affected patients. PATIENT CHARACTERISTICS: Herein, we report a case of acute neurological symptoms, including headache, fever, confusion, and paralysis of the lower extremities. CSF analysis revealed lymphocytic pleocytosis and elevated protein levels, indicating acute disseminated encephalomyelitis, and the patient was given immunotherapy. Cranial magnetic resonance imaging showed multifocal T2/fluid-attenuated inversion recovery hyperintense signal changes in the periventricular white matter, and electromyography testing showed changes consistent with severe sensorimotor neuropathy, indicating the involvement of the brain and peripheral nerves. DIAGNOSES: Finally, a diagnosis of autoimmune GFAP astrocytopathy was confirmed due to the presence of GFAP-immunoglobulinG in the patient's CSF. INTERVENTIONS: The patient was treated with one course of intravenous immunoglobulin therapy, then followed with intravenous methylprednisolone (1.0 g/d for 3 days) and oral prednisolone. OUTCOMES: At 1 week after intravenous immunoglobulin therapy, his level of consciousness improved. However, flaccid paralysis persisted without substantial improvement. CONCLUSION: In conclusion, the provision of an accurate early diagnosis and appropriate treatment are crucial for improving the prognosis of patients with autoimmune GFAP astrocytopathy. Further, this case highlights the importance of recognizing the role of peripheral nerve involvement in GFAP autoimmunity.

Safety and Efficacy of Transcatheter Occlusion of Perimembranous Ventricular Septal Defect with Aortic Valve Prolapse: A Six-Year Follow-Up Study.

BACKGROUND: With the rapid development of transcatheter techniques and instruments, transcatheter occlusion for patients with perimembranous ventricular septal defect (pVSD) and aortic valve prolapse (AVP) was constantly being tried, while the efficacy and safety of pVSD with AVP remain controversial. OBJECTIVE: The aim of this study was to evaluate long-term efficacy and safety of transcatheter occlusion of pVSD with AVP. METHODS: We retrospectively analyzed 164 children with pVSD and AVP who underwent transcatheter occlusion between January 2013 and November 2014. AVP was divided into 3 degrees according to right coronary leaflet morphology at end-diastole during aortic root angiography. Patient demographic and clinical data were collected. RESULTS: There were 97 males and 67 females (median age, 40.0 (30.0-62.7) months; average weight, 16.94 ± 9.02 kg). Mild (n = 63), moderate (n = 89), and severe (n = 12) AVP success rates were 93.7%, 89.9%, and 58.3%, respectively. Immediately after procedure, there was no new-onset aortic regurgitation (AR) above trivial degree, residual shunt above mild degree, or complications requiring medication or operation, except for 1 patient who developed transient complete atrioventricular block. During follow-up, 1 mild AVP patient aggravated from mild to moderate AR and 1 moderate AVP patient aggravated from trivial to moderate AR. The new-onset AR in mild, moderate, and severe AVP was 2%, 1.8%, and 20%, respectively. AR disappeared in 17 patients. Residual shunt occurred in 9 patients after procedure, 4 of which disappeared during the follow-up period. No serious complications occurred in any patient during follow-up. Five-year cardiovascular event-free survival rates for mild, moderate, and severe AVP were 89.6%, 94.5%, and 80.0%, respectively. CONCLUSION: Transcatheter occlusion of pVSD with mild and moderate AVP has a high success rate and few complications, which is safe and effective in long-term follow-up. Transcatheter occlusion of pVSD with severe AVP has low success rates and high AR incidence. Therefore, transcatheter occlusion of pVSD with AVP is recommended for mild to moderate, but not severe, AVP.

Deficient serum furin predicts risk of abdominal obesity: findings from a prospective cohort of Chinese adults.

BACKGROUND: As a key enzyme of natriuretic peptides system playing an integral role in energy homeostasis, furin may be a potential contributor to obesity. However, the association between furin and obesity has been scarcely studied. This study aims to examine the prospective association between serum furin and abdominal obesity. METHODS: Waist circumference (WC) was measured twice 4 years apart for a total of 892 Chinese adults free of abdominal obesity at baseline. Abdominal obesity was defined as WC over 85 cm for men and as WC over 80 cm for women. A Cox proportional hazard model was constructed to examine the association of baseline serum furin with incident abdominal obesity. RESULTS: After an average 4 years of follow-up, 184 participants developed new abdominal obesity. Baseline serum furin was significantly associated with dynamic body weight during follow-up (ß=-0.593, p=0.003). Participants with a higher level of serum furin at baseline were less likely to develop new abdominal obesity compared with those with a lower level of serum furin (HR=0.81, 95% CI 0.67 to 0.97). CONCLUSIONS: A lower level of serum furin predicts a higher risk of developing future abdominal obesity in Chinese adults. Furin deficiency may be a contributor to abdominal obesity but still needs further investigations.

Gender difference of association between plasma N-terminal pro-atrial natriuretic peptide and metabolic syndrome.

PURPOSE: The natriuretic peptides (NPs) system, and mainly atrial natriuretic peptide (ANP), plays a key role in human metabolism and cardiometabolic disorders. Due to differences in NP levels and in prevalence of metabolic syndrome (MetS) between men and women, we aimed to explore the gender difference of association between N-terminal pro-atrial natriuretic peptide (NT-proANP) and MetS in a general population in China. METHODS: Participants' weight, height, waist circumference, blood pressure, plasma NT-proANP, and other traditional biomarkers were measured. Multivariate logistic regression models were used to determine the association between plasma NT-proANP and MetS, and the odds ratio (OR) and 95% confidence interval (CI) were calculated for men and women, respectively. RESULTS: Among 2203 participants, 1361 (61.78%) were women, 687(30.77%) participants had MetS, and the average age was 53 years. Women had a higher level of NT-proANP than men. However, adjusted logistic regression demonstrated that men in the upper quartile group of NT-proANP had 0.60 (95% CI 0.39-0.92) times the risk of having MetS, while women in the upper quartile group had 1.10 (95% CI 0.77-1.56) times the risk of having MetS compared to the lower quartile group. Furthermore, with the increase of the level of NT-proANP, the ORs showed a declining trend in men (P = 0.017), but it was not statistically significant among women (P = 0.700). CONCLUSIONS: There are gender differences in the relationship between NT-proANP and MetS, while an inverse association between plasma NT-proANP and MetS in men suggests that higher levels of NT-proANP may be a protective factor for MetS.

Dynamic Changes in Fibrinogen and Prognosis of Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis.

This study aimed to investigate the association between dynamic changes in fibrinogen and the prognosis of acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). We measured fibrinogen levels at admission and 24 h after IVT in 364 consecutively recruited AIS patients. The primary outcome was the composite measure of death or major disability (modified Rankin Scale score 3-6) at 3 months. During the 3-month follow-up, 127 (34.89%) patients experienced death or major disability. After multivariate adjustment, a ≥ 2.5% increase in fibrinogen was associated with an increased risk of the primary outcome (odds ratio [OR], 2.26; 95% confidence interval [CI] 1.08-4.75; p trend = 0.030) when 2 extreme tertiles were compared. Each 1% increase in fibrinogen after IVT was associated with a 1% increase in the risk of the primary outcome (OR 1.01, 95% CI 1.00-1.03). Multivariable-adjusted spline regression revealed a linear dose-response relationship between fibrinogen changes after IVT and the primary outcome (p for linearity = 0.032). The addition of fibrinogen changes to conventional risk factors improved the re-classification (but not discrimination) of the primary outcome (net reclassification index 27.6%, p = 0.011). These findings indicated that an increase in fibrinogen after IVT was associated with an increased risk of death or major disability in AIS patients, suggesting that monitoring the dynamic profile of fibrinogen levels may help neurologists improve stroke outcomes in clinical settings.

Transcatheter Closure of Perimembranous Ventricular Septal Defect with Aneurysm: Radiologic Characteristic and Interventional Strategy.

OBJECTIVES: We aimed to explore the radiologic characteristics and interventional strategies for perimembranous ventricular septal defect (pmVSD) with aneurysm. METHODS: 257 patients who underwent transcatheter closure of pmVSD with aneurysm were included in our study. We retrospectively reviewed the left ventricular opening of the aneurysm (a), diameter of the midsegment of the aneurysm (b), and diameter of the right ventricular opening of the aneurysm (c). If there were multiple defects within the aneurysm, the largest defect was denoted as c 1 and so forth. We developed a novel VSD classification method in which pmVSD with aneurysm was classified into three types (A, B, and C). When a >b ≥ c, it was classified as type A, when b > a ≥ c, it was type B, and when c > a ≥ b, it was type C; c/c 1 described the relationship among defects. RESULTS: All of the 257 cases of pmVSD with aneurysm were defined using left ventriculography: type A, 60, type B, 58, and type C, 139. Transcatheter closure was attempted in 244 patients and succeeded in 227 cases (success rate was 93.0%; 227/244). Forty symmetric VSD occluders and 13 asymmetric VSD occluders were used for type A aneurysm occlusion; 31 symmetric VSD occluders, 19 asymmetric VSD occluders, and one Amplatzer duct occluder II (ADOII) were used for type B; 59 VSD symmetric occluders, 59 asymmetric VSD occluders, three eccentric VSD occluders, and two ADOII were used for type C. Within 24 hours after procedure, 2.2% patients had postprocedural residual shunt, and 2.2% experienced malignant arrhythmia (including type II second-degree AVB, cAVB, and CLBBB). Two hundred and twelve patients completed follow-up (93%, 212/227). No new severe complications were reported during follow-up, except in one patient who underwent surgery (removal of the device, VSD repair, and tricuspid valvuloplasty) due to severe postprocedural tricuspid regurgitation. CONCLUSIONS: It is safe and effective to apply this method for the classification of pmVSD with aneurysm and its interventional strategy.

Prognostic Value of Cystatin C in Acute Ischemic Stroke Patients with Intravenous Thrombolysis.

BACKGROUND: Less is known about the prognostic value of serum cystatin C in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). The aim of the present study was to examine the association between serum cystatin C levels and prognosis of AIS patients after IVT. METHODS: Serum cystatin C was measured within 24 hours after recombinant tissue plasminogen activator (rt-PA) treatment in 280 consecutively recruited patients with AIS. The main outcomes included combination of death and major disability, death, major disability (modified Rankin Scale score 3-5) and vascular events at 3-month follow-up. RESULTS: During the 3-month follow-up, 94 patients (33.6%) experienced death or major disability (28 deaths and 66 major disability) and 49 patients (17.5%) experienced vascular events. After multivariate adjustment, serum cystatin C was significantly associated with an increased risk of the combined outcome of death and major disability (OR=4.51, P = 0.006). Adding serum cystatin C quartiles to a model containing conventional risk factors improved the predictive power for the combined outcome of death and major disability (continuous net reclassification index 43.88%, P < 0.001; categorical net reclassification index 9.15%, P = 0.013; integrated discrimination improvement 2.31%, P = 0.025). Similar phenomena were also observed in major disability and vascular events. CONCLUSION: Higher levels of serum cystatin C in AIS patients after IVT were independently associated with increased risks of poor functional outcomes and vascular events, especially combining conventional risk factors, suggesting that serum cystatin C might improve risk prediction for poor prognosis in AIS patients receiving rt-PA treatment.

Baseline Neutrophil Counts and Neutrophil Ratio May Predict a Poor Clinical Outcome in Minor Stroke Patients with intravenous Thrombolysis.

BACKGROUND: Evidence about whether neutrophil counts, neutrophil ratio linked with clinical outcome in patients with minor stroke after thrombolysis is scarce. The purpose of this study is to explore the association of neutrophil counts, neutrophil ratio with the 90-day clinical outcome in patients with minor stroke treated with intravenous thrombolysis. MATERIALS AND METHODS: A total of 163 patients with minor stroke treated with thrombolysis within window time were recruited from 2013 to 2017. Their total neutrophil and leukocyte counts on admission were measured. Disability or death (defined as a modified Rankin scale score ≥2) at 90-day were captured. Multiple logistic regression models were used to estimate the association between neutrophil counts, and neutrophil ratio to clinical outcome. Receiver operating characteristic curves were used to evaluate the predictive value of neutrophil counts or neutrophil ratio. RESULTS: At the 90-day follow-up, 36 patients (21%) had disability or death after stroke onset. Compared to the first tertile, the higher neutrophil counts increased the risk of 90-day disability or death (adjusted odds ratio [aOR] for third tertile: 2.93 (1.08-7.96); P for trend = .03). Similarly, higher neutrophil ratio also increased the risk of disability or death (aOR for third tertile: 5.81 (1.7-19.88); P for trend = .005). The comparison of area under the curve for neutrophil ratio versus neutrophils was .1 (P = .04). Thus, neutrophil ratio with the cutoff point of .74 had a better discriminative ability to the outcome (6.11, 2.36-15.86). CONCLUSIONS: Baseline higher neutrophil counts and neutrophil ratio were associated with an increased risk of 90-day disability or death in patients with minor stroke who received thrombolytic therapy.

Serum furin as a biomarker of high blood pressure: findings from a longitudinal study in Chinese adults.

The cardiovascular protective role of furin has been suggested by some animal-based studies but has not been well studied in humans. Therefore, the objective of this study was to examine the prospective association between serum furin and high blood pressure in a longitudinal cohort of Chinese adults. Leveraging a longitudinal prospective cohort with blood pressure examined twice on average 4 years apart, we systemically examined the cross-sectional, longitudinal, and prospective associations of baseline serum furin with blood pressure and incident hypertension. Conventional risk factors, including age, sex, education level, cigarette smoking, alcohol consumption, BMI, fasting glucose, and lipids, were controlled. All participants included were free of cardiovascular and kidney disease at baseline. The cross-sectional analysis of 2312 participants (mean age 53 years) revealed that individuals with the lowest quartile of serum furin had average systolic, diastolic, and mean arterial blood pressures that were 2.58, 1.38, and 1.61 mmHg higher, respectively, than the corresponding pressures in individuals with the highest quartile (all P < 0.001). These negative associations remained significant after controlling for the dynamic risk profiles during follow-up in the longitudinal analysis. The prospective analysis of 1088 participants free of prevalent hypertension at baseline revealed that compared with participants with the highest quartile of serum furin, those with the lowest quartile had a 46% increased risk of incident hypertension (HR = 1.46, P = 0.003). These results indicate that lower serum furin is significantly associated with higher blood pressure and predicts an increased future risk of developing hypertension in Chinese adults. Furin may be a protective factor or marker of hypertension.

Sex-specific association between soluble corin and metabolic syndrome in Chinese adults.

Soluble corin has been associated with cardiovascular disease and its risk factors, but whether it is associated with metabolic syndrome (MetS), a cluster of cardiometabolic disorders, remains unclear. We aimed to examine the association between soluble corin and MetS in Chinese men and women. We examined serum soluble corin using immunoassays in 962 men (mean age, 53 years) and 1536 women (mean age, 54 years) free of cardiovascular disease. Logistic regression was applied to examine the association between soluble corin and MetS in men and women. The results showed that participants in the 3rd and 4th quartiles of serum soluble corin had 1.99 (95% CI: 1.32-3.00) and 3.84 (95% CI: 2.54-5.83) times the risk of having MetS for men and 1.48 (95% CI: 1.06-2.06) and 1.53 (95% CI: 1.10-2.12) times the risk of having MetS for women compared to those in the lowest quartile. The magnitude of the association between serum soluble corin and MetS was significantly stronger for men than for women (P < 0.001). These results indicated that soluble corin was significantly associated with MetS, and this association was stronger for men than for women. Corin may contribute to cardiometabolic risks differently between men and women and thereby accounting, at least partly, for the sex difference in cardiovascular risk.

Dynamic Changes in the Estimated Glomerular Filtration Rate Predict All-Cause Mortality After Intravenous Thrombolysis in Stroke Patients.

Little is known about the prognostic value of the estimated glomerular filtration rate (eGFR) and the effect of dynamic changes in the eGFR on mortality in acute ischemic stroke (AIS) patients treated with intravenous thrombolysis (IVT). We aim to investigate the association between the eGFR and dynamic changes in the eGFR after IVT with all-cause mortality in AIS patients. A total of 391 AIS patients treated with IVT between May 2010 and May 2017 were included in the final analysis. Serum creatinine was measured at admission and within 24 h after IVT. The main outcomes included 3-month all-cause mortality and major adverse cardiac and cerebrovascular events (MACCE). During the 3-month follow-up, 37 (9.5%) patients died from all causes. Mortality was associated with a reduced eGFR at admission (adjusted hazard ratio (HR), 4.17; 95% confidence interval (CI), 1.50-11.58; P trend = 0.016) and within 24 h after IVT (adjusted HR, 5.88; 95% CI, 1.41-24.52; P trend = 0.009). Mortality was negatively correlated with increased eGFR after IVT (adjusted HR, 0.70; 95% CI, 0.51-0.96; P trend = 0.027). Additionally, a reduced eGFR after IVT was also associated with increased risk of MACCE (adjusted HR, 3.64; 95% CI, 1.41-9.39; P trend = 0.009). Using a multivariable Cox regression model with restricted cubic splines, we observed an L-shaped association between the eGFR and 3-month all-cause mortality and MACCE and observed a linear association between dynamic changes in the eGFR and 3-month all-cause mortality. A reduced eGFR and dynamic decreases in the eGFR after IVT independently predict 3-month all-cause mortality in AIS patients.