Baroreceptor sensitivity as an independent predictor for functional outcomes in acute ischemic stroke

BACKGROUND: Post-stroke autonomic dysfunction is a critical determinant of long-term prognosis. Reduced baroreceptor sensitivity (BRS), a marker of this dysfunction, has been linked to adverse outcomes, but its independent predictive value for functional recovery requires clarification. AIM: To evaluate the independent prognostic value of BRS measured in the acute phase of a first-ever ischemic stroke for predicting 12-month functional outcomes. DESIGN: A prospective, single-center, observational cohort study. METHODS: We enrolled 292 patients with a first-ever acute ischemic stroke. BRS was measured within 7 days of onset, typically between days 4 and 7, using the sequence method under standardized conditions. Patients were dichotomized into low-BRS (≤11 ms/mmHg) and high-BRS groups. The primary endpoint was 12-month functional outcome, assessed by the modified Rankin Scale (mRS) and Barthel Index (BI). We used inverse probability of treatment weighting (IPTW) and multiple logistic regression to assess the independent association between BRS and outcomes. RESULTS: After adjustment, low BRS remained a significant independent predictor of poor 12-month outcomes. Patients in the low-BRS group had more than double the adjusted odds of an unfavorable outcome (mRS 3-6; adjusted OR 2.06, 95% CI 1.12-3.78) and more than triple the adjusted odds of moderate-to-severe dependency (BI ≤ 90; adjusted OR 3.13, 95% CI 1.63-6.00) compared with the high-BRS group. CONCLUSIONS: Reduced BRS in the acute phase of ischemic stroke was independently associated with poor 12-month functional outcomes. If confirmed in external cohorts and implemented with standardized protocols, BRS assessment may help early risk stratification after stroke.