Objective To analyze the relationships of serum soluble triggering receptor expressed on myeloid cells-2 (sTREM2), P-selectin and the length of hyperdense middle cerebral artery sign (HMCAS) with the effect of thrombolysis and short-term prognosis in patients with acute cerebral infarction (ACI).

Methods A total of 109 ACI patients with thrombolytic therapy were divided into ineffective group (n=27) and effective group (n=82) based on thrombolysis outcomes. Ninety days after treatment, the 109 patients were further divided into good prognosis group (n=78) and poor prognosis group (n=31) according to the modified Rankin Scale (mRS). General information, the National Institutes of Health Stroke Scale (NIHSS) score, serum sTREM2 level, P-selectin levels, and HMCAS length were compared between the two groups. Binary Logistic regression model was used to analyze the influencing factors of thrombolysis outcomes in ACI patients. Pearson correlation coefficient was calculated to analyze the correlation between laboratory indicators and mRS in ACI patients. Receiver operating characteristic (ROC) curve was plotted to analyze the predictive values of serum sTREM2, P-selectin and HMCAS length for prognosis of patients.

Results The NIHSS score at admission in the effective group was significantly lower than that in the ineffective group (P < 0.01). The serum sTREM2 and P-selectin levels as well as the HMCAS length in the effective group were significantly lower or shorter than those in the ineffective group (P < 0.01). The results of binary Logistic regression analysis showed that NIHSS score>15 (OR=2.649, 95%CI, 1.357 to 5.167), serum sTREM2 above the mean level (OR=2.686, 95%CI, 1.860 to 8.786), P-selectin above the mean level (OR=4.043, 95%CI, 1.860 to 8.786), and HMCAS length >1 mm (OR=3.827, 95%CI, 1.740 to 8.414) were all risk factors for poor thrombolysis outcomes in ACI patients (P < 0.01). The serum sTREM2 and P-selectin levels as well as the HMCAS length in the good prognosis group were significantly lower or shorter than those in the poor prognosis group (P < 0.01). Serum sTREM2, P-selectin and HMCAS length were all positively correlated with mRS in ACI patients after thrombolytic therapy (r=0.686, 0.597, 0.662, P < 0.001). Areas under the curve (AUCs) for predicting the prognosis of ACI patients after thrombolytic therapy by serum sTREM2, P-selectin, HMCAS length, and the combination of the three indicators were 0.833, 0.862, 0.889 and 0.914 respectively, with sensitivities of 0.806, 0.742, 0.806 and 0.742 respectively, and specificities of 0.923, 0.897, 0.936 and 0.949, respectively.

Conclusion The effect of thrombolysis in ACI patients is related to NIHSS score at admission, serum sTREM2 level, P-selectin level, and HMCAS length. High levels of serum sTREM2 and P-selectin and a long HMCAS may increase the risk of poor thrombolysis outcomes in ACI patients.