# The endothelial activation and stress index as a key prognostic marker in severe ischemic stroke

## TL;DR

The study shows that a biomarker called EASIX can predict 28-day mortality in severe ischemic stroke patients, offering a simple and effective tool for early risk assessment.

## Contribution

The study introduces EASIX as a novel and accessible prognostic marker for predicting mortality in severe ischemic stroke.

## Key findings

- Elevated EASIX levels correlate with increased 28-day mortality risk in severe ischemic stroke patients.
- EASIX outperforms SOFA and SIRS scores in predicting mortality with an AUC of 0.765.
- The mortality risk increases nonlinearly beyond an EASIX threshold of 0.58.

## Abstract

Severe ischemic stroke (SIS) is a life-threatening condition associated with high mortality rates. Endothelial dysfunction plays a critical role in its progression, leading to further neurovascular damage. The endothelial activation and stress index (EASIX) is a simple and easily accessible biomarker and may serve as a potential prognostic indicator for SIS. This study investigates the relationship between EASIX levels and 28-day all-cause mortality (ACM) in patients with SIS.

The study utilized data from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Patients were stratified into three cohorts based on log2-transformed EASIX values. The association between EASIX and 28-day ACM in SIS was evaluated using Cox proportional hazards models, Kaplan–Meier survival analysis, restricted cubic spline (RCS) regression, and subgroup analyses. Receiver operating characteristic (ROC) curve analysis was performed to compare the predictive accuracy of EASIX with other prognostic markers.

A total of 786 patients with SIS were included in the study. The patients were stratified into tertiles based on their log₂(EASIX) values. Elevated EASIX levels were associated with prolonged hospital and ICU stays as well as an increased risk of 28-day ACM. Kaplan–Meier survival analysis revealed that higher EASIX levels significantly correlated with reduced survival probability. Cox regression analysis indicated that each unit increase in log₂(EASIX) was associated with a 17% higher mortality risk. Moreover, patients in the highest EASIX tertile exhibited a significantly greater mortality risk. RCS regression further identified a nonlinear increase in mortality risk beyond an EASIX threshold of 0.58. ROC analysis demonstrated that log₂(EASIX) had superior predictive accuracy for 28-day ACM (AUC = 0.765), outperforming both the SOFA and SIRS scores. Subgroup analyses confirmed the robustness of this association across various patient characteristics, with no significant interactions.

EASIX is a simple and accessible biomarker that provides early warning for identifying high-risk patients. Elevated EASIX levels are strongly associated with an increased risk of 28-day ACM in SIS patients.