Urinary Microalbumin predicts early neurological deterioration in acute ischemic stroke: A study based on etiological classification.

Introduction: To investigate the correlation between urinary microalbumin (U-Alb) levels and early neurological deterioration (END), as well as its predictive ability, in patients with acute ischemic stroke (AIS) under different etiological subtypes.

Materials And Methods: We consecutively enrolled AIS patients within 72 h of onset, collecting relevant clinical characteristics and baseline laboratory data including U-Alb. END was defined as an increase of ≥4 points in NIHSS score within 72 h of onset, and TOAST criteria were used for stroke etiologic typing. Binary logistic regression analysis was employed to clarify the association between baseline U-Alb and the occurrence of END under different stroke etiological subtypes. ROC analysis was conducted to evaluate its predictive ability under different etiological subtypes.

Results: Finally, 615 patients were included, with 104 (16.9 %) developed END. Binary logistic regression analysis revealed that baseline U-Alb was independently associated with END occurrence (OR = 1.009, 95 % CI 1.002-1.016, p = 0.009). ROC analysis revealed that U-Alb had the best predictive ability for patients with small artery occlusion (AUC=0.707, p < 0.001), followed by large artery atherosclerosis (AUC = 0.632, p = 0.006), with corresponding optimal diagnostic cutoff points of 31.11 and 25.71 mg/L, respectively. However, U-Alb was not an independent risk factor for END in cardioembolic stroke patients (OR = 1.011, 95 % CI 0.980-1.043, p = 0.478). MAU was associated with stroke progression(p = 0.023), and U-Alb was positively correlated with increased infarct volume (r = 0.516, p < 0.01).

Conclusion: U-Alb is closely associated with END in AIS patients, serving as a potential indicator for predicting END, especially among those with small artery occlusion mechanisms.