# Pre-procedural vitamin D deficiency and poor prognosis post-thrombectomy in patients with acute anterior circulation large vessel occlusion: a retrospective cohort study

## TL;DR

Low vitamin D levels before a stroke procedure are linked to worse recovery and higher death rates after treatment.

## Contribution

Identifies pre-procedural vitamin D deficiency as an independent predictor of poor outcomes after mechanical thrombectomy for stroke.

## Key findings

- Patients with vitamin D <10 ng/mL had 38.1% 180-day mortality vs. 5% for those with ≥30 ng/mL.
- Severe vitamin D deficiency (<10 ng/mL) and delayed recanalization were independent risk factors for poor outcomes.
- A nonlinear threshold effect of vitamin D on prognosis was observed, with an inflection point at 20 ng/mL.

## Abstract

Vitamin D deficiency is associated with poor prognosis of stroke. However, its role after mechanical thrombectomy (MT) in acute ischemic stroke (AIS) remains unclear. This study aimed to explore the relationship between pre-procedural vitamin D levels and the clinical prognosis of AIS patients after MT.

A total of 113 AIS patients with successful MT were enrolled in this study and their clinical data were analyzed. Patients were divided into two groups based on their 3-month modified Rankin Scale scores (mRS: 0–2 vs. 3–6). Predictors of adverse prognosis were determined using multivariate logistic regression analysis. In order to evaluate nonlinear associations and mortality risk, restricted cubic spline (RCS) models, receiver operating characteristic (ROC) curve analysis, and Kaplan–Meier survival curve analysis were used.

In the patient cohort, compared to the favorable outcome group (mRS 0–2; 31%), patients with poor outcomes (mRS 3–6; 69%) exhibited significantly lower pre-procedural vitamin D levels (14.72 vs. 28.38 ng/mL). Multivariate logistic regression analysis identified severe vitamin D deficiency, delayed recanalization, and elevated high-sensitivity C-reactive protein as independent risk factors. RCS analysis revealed a nonlinear threshold effect of vitamin D on prognosis, with an inflection point at 20 ng/mL. Patients with severe vitamin D deficiency (<10 ng/mL) exhibited markedly higher 180-day mortality compared to those with normal vitamin D levels (≥30 ng/mL) (38.1% vs. 5.0%).

Pre-procedural vitamin D deficiency is independently associated with poor functional outcomes and increased mortality after successful MT. Our findings highlight the potential prognostic value of vitamin D assessment in this patient population. Future interventional studies are needed to determine whether correcting vitamin D deficiency could optimize post-thrombectomy management.