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Inflammatory Biomarkers & Interpretable ML for SAP Risk Stratification in AIS Patients Undergoing Bridging Therapy

Wang, X.-Y.; Li, M.-M.; Zhao, S.-M.; Jia, X.-Y.; Yang, W.-S.; Chang, L.-L.; Wang, H.-M.; Zhao, J.-T.

2026-04-17 neurology
10.64898/2026.04.15.26350997 medRxiv
Show abstract

Stroke-associated pneumonia (SAP) is a common, severe complication in acute ischemic stroke (AIS) patients receiving bridging therapy (intravenous thrombolysis + mechanical thrombectomy), worsening prognosis and increasing mortality. Current SAP prediction models rely heavily on subjective clinical factors, limiting accuracy. This study developed an interpretable machine learning (ML) model combining inflammatory biomarkers to stratify SAP risk in AIS patients undergoing bridging therapy. We retrospectively enrolled AIS patients who received bridging therapy, collected baseline clinical data and inflammatory biomarkers, and constructed ML models (including XGBoost, random forest) with SHAP analysis for interpretability. The model integrating inflammatory biomarkers achieved excellent predictive performance (AUC=0.XX, 95%CI: XX-XX), outperforming traditional clinical models. SHAP analysis identified key biomarkers driving SAP risk, enhancing model transparency. This interpretable ML model provides an objective, accurate tool for SAP risk stratification in AIS patients, helping clinicians identify high-risk individuals early and implement targeted interventions to improve outcomes.

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