Association of splenic contraction with stroke severity and diabetes mellitus in patients with acute ischemic stroke

Background: Splenic contraction (SC) is characterized by reduced splenic volume (SV) due to the release of splenocytes into systemic circulation. This study aimed to investigate the differences between patients with acute ischemic stroke with and without SC and identify SC-associated factors. Methods: In this retrospective study, 79 patients with acute ischemic stroke who underwent abdominal computed tomography within 5 years before and within 7 days after stroke onset were analyzed. Patients were categorized into SC (SV change ≤−5 cm3, n=39) and non-SC (SV change >0 cm3, n=40) groups based on changes in SV. Clinical characteristics and laboratory findings were compared between the two groups. Multivariate logistic regression analysis was performed to identify independent factors associated with SC. Results: The SC group had significantly higher National Institutes of Health Stroke Scale (NIHSS) scores on admission compared to the non-SC group {median 7 [interquartile range (IQR) 3–12] vs. 5 [IQR 2–9], P=0.025}. Diabetes mellitus (DM) was less prevalent in the SC group than in the non-SC group (35.9% vs. 62.5%, P=0.018). Multivariate analysis revealed that higher NIHSS scores at admission were independently associated with SC [adjusted odds ratio (aOR) 1.119, 95% confidence interval (CI): 1.001–1.252, P=0.048], whereas DM was associated with a lower risk of SC (aOR 0.278, 95% CI: 0.097–0.798, P=0.017). Conclusions: DM was associated with a lower incidence of post-stroke SC, possibly due to DM-associated pathophysiology such as blunted sympathetic response or oxidative stress-induced splenic dysfunction. These findings emphasize the potential role of the spleen in stroke pathophysiology and highlight its potential as a therapeutic target.