Latent class analysis identifies three biologically distinct phenotypes among patients undergoing…

Abstract

Background: Despite successful vascular recanalization, approximately half of patients undergoing endovascular thrombectomy (EVT) fail to achieve functional independence at 3 months. The biological determinants of this heterogeneity remain poorly characterized.

Methods: Latent class analysis (LCA) was applied to 825 consecutive EVT-treated patients (development cohort, January 2021–December 2024) using 12 routine post-procedural clinical and laboratory indicators. Phenotype associations with favorable 3-month outcome (modified Rankin Scale 0–2) were assessed using multivariable logistic regression. Reproducibility was evaluated in an independent temporal validation cohort ( n = 211).

Results: LCA identified three phenotypes. The Low-burden phenotype (Class 1, 44.4%) had the lowest inflammatory and coagulatory burden and achieved favorable outcome in 70.8% of patients. The Metabolic phenotype (Class 2, 42.7%), characterized by hyperglycemia and elevated neutrophil-to-lymphocyte ratio, had a favorable outcome rate of 44.9% and symptomatic intracranial hemorrhage (sICH) rate of 7.1%. The hypercoagulable phenotype (Class 3, 13.0%), defined by markedly elevated D-dimer and atrial fibrillation, had a favorable outcome rate of 40.2% and sICH rate of 8.4%. After multivariable adjustment, both Class 2 (OR 0.49, 95% CI 0.35–0.69) and Class 3 (OR 0.41, 95% CI 0.25–0.67) were independently associated with unfavorable outcome (both p < 0.001). Class distribution and outcome associations were reproduced in the validation cohort.

Conclusion: LCA identified three biologically distinct phenotypes among EVT-treated patients with divergent functional outcomes. Multicenter prospective validation is needed before these findings can inform clinical practice.

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BibTeX RIS

BibTeX

@article{yang2026latent,
  title = {{Latent class analysis identifies three biologically distinct phenotypes among patients undergoing endovascular thrombectomy: a derivation and temporal validation study}},
  author = {Li-Li Yang and Chao Chen and Li-Li Sun and Meng-Xia Li and Li Han},
  journal = {Frontiers in Neurology},
  year = {2026},
  month = oct,
  doi = {10.3389/fneur.2026.1855033},
  url = {https://www.frontiersin.org/articles/10.3389/fneur.2026.1855033/full},
  note = {CC BY 4.0},
}

RIS

TY  - JOUR
TI  - Latent class analysis identifies three biologically distinct phenotypes among patients undergoing endovascular thrombectomy: a derivation and temporal validation study
AU  - Li-Li Yang
AU  - Chao Chen
AU  - Li-Li Sun
AU  - Meng-Xia Li
AU  - Li Han
PY  - 2026
DA  - 2026/10/15
JO  - Frontiers in Neurology
DO  - 10.3389/fneur.2026.1855033
UR  - https://www.frontiersin.org/articles/10.3389/fneur.2026.1855033/full
AB  - Background: Despite successful vascular recanalization, approximately half of patients undergoing endovascular thrombectomy (EVT) fail to achieve functional independence at 3 months. The biological determinants of this heterogeneity remain poorly characterized.  Methods: Latent class analysis (LCA) was applied to 825 consecutive EVT-treated patients (development cohort, January 2021–December 2024) using 12 routine post-procedural clinical and laboratory indicators. Phenotype associations with favorable 3-month outcome (modified Rankin Scale 0–2) were assessed using multivariable logistic regression. Reproducibility was evaluated in an independent temporal validation cohort ( n = 211).  Results: LCA identified three phenotypes. The Low-burden phenotype (Class 1, 44.4%) had the lowest inflammatory and coagulatory burden and achieved favorable outcome in 70.8% of patients. The Metabolic phenotype (Class 2, 42.7%), characterized by hyperglycemia and elevated neutrophil-to-lymphocyte ratio, had a favorable outcome rate of 44.9% and symptomatic intracranial hemorrhage (sICH) rate of 7.1%. The hypercoagulable phenotype (Class 3, 13.0%), defined by markedly elevated D-dimer and atrial fibrillation, had a favorable outcome rate of 40.2% and sICH rate of 8.4%. After multivariable adjustment, both Class 2 (OR 0.49, 95% CI 0.35–0.69) and Class 3 (OR 0.41, 95% CI 0.25–0.67) were independently associated with unfavorable outcome (both p &lt; 0.001). Class distribution and outcome associations were reproduced in the validation cohort.  Conclusion: LCA identified three biologically distinct phenotypes among EVT-treated patients with divergent functional outcomes. Multicenter prospective validation is needed before these findings can inform clinical practice.
SN  - 1664-2295
ER  -

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