Study on the relationship between systemic inflammation response index and early neurological deterioration and prognosis in patients with acute ischemic stroke_West China Medical Journal

Authors：

HE Ni ¹ , HUANG Pan ² , LIU Meng ¹ , MENG Bing ² ,  HAO Zilong ¹

1. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Department of Neurology, Deyang People’s Hospital, Deyang, Sichuan 618000, P. R. China;

Corresponding author：

HAO Zilong, Email: zhilong1983@126.com

Keywords：

Acute ischemic stroke; neutrophil count/lymphocyte count ratio; systemic inflammation response index; early neurological deterioration; modified Rankin Scale

DOI：

10.7507/1002-0179.202311186

Video：

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Objective To investigate the relationship between systemic inflammation response index (SIRI) and early neurological deterioration (END) and 3-month prognosis in patients with acute ischemic stroke. Methods Patients with acute ischemic stroke treated at West China Hospital of Sichuan University and Deyang People’s Hospital between April 2020 and October 2020 were collected. Clinical data were collected using a unified case form and outcomes were followed up for 3 months. According to the poor prognosis, the patients were divided into END group and non-END group. The multivariate logistic regression analysis was used to explore the relationship of SIRI, END and 3-month prognosis. We drew receiver operating characteristic curve to evaluate the value of related factors in predicting the occurrence of END and poor prognosis after 3 months. Results A total of 242 patients were included, of which 47 (19.42%) were in the END group. There were statistically significant differences between the two groups in National Institutes of Health stroke Scale (NIHSS) score on admission, hypertension, creatinine, urea nitrogen, neutrophils count, lymphocyte count, neutrophil count/lymphocyte count ratio (NLR), lymphocyte count/monocyte count ratio, platelet count/lymphocyte count ratio, complications (besides cerebral edema) and SIRI (P<0.05). Logistic regression analysis showed that NIHSS score on admission, hypertension, SIRI and NLR were independent risk factors for END (P<0.05). SIRI had better predictive value for the occurrence of END than NLR (P<0.05). Compared with the non-END group, the patients in the END group had worse prognosis at 3-month [44.7%(21/47) vs. 17.4% (34/195), P<0.05]. NIHSS score on admission had predictive value for clinical prognosis of acute ischemic stroke patients at 3-month. Conclusion SIRI is an independent risk factor for END in patients with acute ischemic stroke, and there is no independent correlation with the 3-month prognosis.

Citation： HE Ni, HUANG Pan, LIU Meng, MENG Bing, HAO Zilong. Study on the relationship between systemic inflammation response index and early neurological deterioration and prognosis in patients with acute ischemic stroke. West China Medical Journal, 2024, 39(4): 580-587. doi: 10.7507/1002-0179.202311186 Copy

1.	Liu M, Wu B, Wang WZ, et al. Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol, 2007, 6(5): 456-464.
2.	Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
3.	郝子龙, 刘鸣, 李伟, 等. 成都卒中登记方法及 3123 例患者基本特征和功能结局. 中华神经科杂志, 2011, 44(12): 826-831.
4.	Kwan J, Hand P. Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM, 2006, 99(9): 625-633.
5.	Mitsias PD. Early Neurological deterioration after intravenous thrombolysis: still no end in sight in the quest for understanding END. Stroke, 2020, 51(9): 2615-2617.
6.	Helleberg BH, Ellekjær H, Rohweder G, et al. Mechanisms, predictors and clinical impact of early neurological deterioration: the protocol of the Trondheim early neurological deterioration study. BMC Neurol, 2014, 14: 201.
7.	Seners P, Turc G, Oppenheim C, et al. Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications. J Neurol Neurosurg Psychiatry, 2015, 86(1): 87-94.
8.	Birchel P, Ellul J, Barer D. Progressing stroke: towards an internationally agreed definition. Cerebrovasc Dis, 2004, 17(2/3): 242-252.
9.	Dagonnier M, Donnan GA, Davis SM, et al. Acute stroke biomarkers: are we there yet?. Front Neurol, 2021, 12: 619721.
10.	Martin AJ, Price CI. A systematic review and meta-analysis of molecular biomarkers associated with early neurological deterioration following acute stroke. Cerebrovasc Dis, 2019, 46(5/6): 230-241.
11.	Bi R, Chen S, Chen S, et al. The role of leukocytes in acute ischemic stroke-related thrombosis: a notable but neglected topic. Cell Mol Life Sci, 2021, 78(17/18): 6251-6264.
12.	Li S, Liu K, Gao Y, et al. Prognostic value of systemic immune-inflammation index in acute/subacute patients with cerebral venous sinus thrombosis. Stroke Vasc Neurol, 2020, 5(4): 368-373.
13.	Yan K, Wei W, Shen W, et al. Combining the systemic inflammation response index and prognostic nutritional index to predict the prognosis of locally advanced elderly esophageal squamous cell carcinoma patients undergoing definitive radiotherapy. J Gastrointest Oncol, 2022, 13(1): 13-25.
14.	Gao W, Zhang F, Ma T, et al. High preoperative fibrinogen and systemic inflammation response index (F-SIRI) predict unfavorable survival of resectable gastric cancer patients. J Gastric Cancer, 2020, 20(2): 202-211.
15.	Yang R, Chang Q, Meng X, et al. Prognostic value of systemic immune-inflammation index in cancer: a meta-analysis. J Cancer, 2018, 9(18): 3295-3302.
16.	European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis, 2008, 25(5): 457-507.
17.	Chen YF, Qi S, Yu ZJ, et al. Systemic inflammation response index predicts clinical outcomes in patients with acute ischemic stroke (AIS) after the treatment of intravenous thrombolysis. Neurologist, 2023, 28(6): 355-361.
18.	Zhou Y, Zhang Y, Cui M, et al. Prognostic value of the systemic inflammation response index in patients with acute ischemic stroke. Brain Behav, 2022, 12(6): e2619.
19.	Lim HH, Jeong IH, An GD, et al. Early prediction of severity in acute ischemic stroke and transient ischemic attack using platelet parameters and neutrophil-to-lymphocyte ratio. J Clin Lab Anal, 2019, 33(3): e22714.
20.	Hirahara T, Arigami T, Yanagita S, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer. BMC Cancer, 2019, 19(1): 672.
21.	Shaarawy A, Baki AH, Teama M, et al. Neutrophils to lymphocytes ratio is an easy non expensive marker of inflammation in hemodialysis patients. J Clin Exp Nephrol, 2018, 38(4): 19.
22.	Vidale S, Consoli A, Arnaboldi M, et al. Postischemic inflammation in acute stroke. J Clin Neurol, 2017, 13(1): 1-9.
23.	Ruhnau J, Schulze J, Dressel A, et al. Thrombosis, neuroinflammation, and poststroke infection: the multifaceted role of neutrophils in stroke. J Immunol Res, 2017: 5140679.
24.	Wang Y, Jin HJ, Wang WF, et al. Myosin1 f-mediated neutrophil migration contributes to acute neuroinflammation and brain injury after stroke in mice. J Neuroinflammation, 2019, 16(1): 77.
25.	Cai W, Liu S, Hu M, et al. Functional dynamics of neutrophils after ischemic stroke. Transl Stroke Res, 2020, 11(1): 108-121.
26.	Quan K, Wang A, Zhang X, et al. Neutrophil to lymphocyte ratio and adverse clinical outcomes in patients with ischemic stroke. Ann Transl Med, 2021, 9(13): 1047.
27.	Zhao BQ, Wang S, Kim HY, et al. Role of matrix metalloproteinases in delayed cortical responses after stroke. Nat Med, 2006, 12(4): 441-445.
28.	Jiang X, Andjelkovic AV, Zhu L, et al. Blood-brain barrier dysfunction and recovery after ischemic stroke. Prog Neurobiol, 2018(163/164): 144-171.
29.	Cai W, Wang J, Hu M, et al. All trans-retinoic acid protects against acute ischemic stroke by modulating neutrophil functions through STAT1 signaling. J Neuroinflammation, 2019, 16(1): 175.
30.	Li GZ, Zhong D, Yang LM, et al. Expression of interleukin-17 in ischemic brain tissue. Scand J Immunol, 2005, 62(5): 481-486.
31.	Qi Q, Zhuang L, Shen Y, et al. A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy. Cancer, 2016, 122(14): 2158-2167.
32.	Xin Y, Zhang X, Li Y, et al. A systemic inflammation response index (SIRI)-based nomogram for predicting the recurrence of early stage hepatocellular carcinoma after radiofrequency ablation. Cardiovasc Intervent Radiol, 2022, 45(1): 43-53.
33.	Yu T, Wang Z. Use of A systemic inflammatory response index to predict non-traumatic non-aneurysmal subarachnoid hemorrhage patient outcomes. J Stroke Cerebrovasc Dis, 2022, 31(12): 106863.
34.	Li J, Yuan Y, Liao X, et al. Prognostic significance of admission systemic inflammation response index in patients with spontaneous intracerebral hemorrhage: a propensity score matching analysis. Front Neurol, 2021: 718032.
35.	Li Z, Cui L, Ma J, et al. Association between neutrophil to lymphocyte ratio and atrial fibrillation. Int J Cardiol, 2015, 187: 361-362.
36.	Liesz A, Zhou W, Na SY, et al. Boosting regulatory T cells limits neuroinflammation in permanent cortical stroke. J Neurosci, 2013, 33(44): 17350-17362.
37.	Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest, 2020, 50(5): e13230.
38.	Liu H, Wang R, Shi J, et al. Baseline Neutrophil Counts and Neutrophil Ratio May Predict a Poor Clinical Outcome in Minor Stroke Patients with intravenous Thrombolysis. J Stroke Cerebrovasc Dis, 2019, 28(11): 104340.
39.	Brambilla R, Couch Y, Lambertsen KL. The effect of stroke on immune function. Mol Cell Neurosci, 2013: 26-33.
40.	Faura J, Bustamante A, Miró-Mur F, et al. Stroke-induced immunosuppression: implications for the prevention and prediction of post-stroke infections. J Neuroinflammation, 2021, 18(1): 127.
41.	Westendorp WF, Dames C, Nederkoorn PJ, et al. Immunodepression, Infections, and functional outcome in ischemic stroke. Stroke, 2022, 53(5): 1438-1448.

1. Liu M, Wu B, Wang WZ, et al. Stroke in China: epidemiology, prevention, and management strategies. Lancet Neurol, 2007, 6(5): 456-464.
2. Wang W, Jiang B, Sun H, et al. Prevalence, incidence, and mortality of stroke in China: results from a nationwide population-based survey of 480 687 adults. Circulation, 2017, 135(8): 759-771.
3. 郝子龙, 刘鸣, 李伟, 等. 成都卒中登记方法及 3123 例患者基本特征和功能结局. 中华神经科杂志, 2011, 44(12): 826-831.
4. Kwan J, Hand P. Early neurological deterioration in acute stroke: clinical characteristics and impact on outcome. QJM, 2006, 99(9): 625-633.
5. Mitsias PD. Early Neurological deterioration after intravenous thrombolysis: still no end in sight in the quest for understanding END. Stroke, 2020, 51(9): 2615-2617.
6. Helleberg BH, Ellekjær H, Rohweder G, et al. Mechanisms, predictors and clinical impact of early neurological deterioration: the protocol of the Trondheim early neurological deterioration study. BMC Neurol, 2014, 14: 201.
7. Seners P, Turc G, Oppenheim C, et al. Incidence, causes and predictors of neurological deterioration occurring within 24 h following acute ischaemic stroke: a systematic review with pathophysiological implications. J Neurol Neurosurg Psychiatry, 2015, 86(1): 87-94.
8. Birchel P, Ellul J, Barer D. Progressing stroke: towards an internationally agreed definition. Cerebrovasc Dis, 2004, 17(2/3): 242-252.
9. Dagonnier M, Donnan GA, Davis SM, et al. Acute stroke biomarkers: are we there yet?. Front Neurol, 2021, 12: 619721.
10. Martin AJ, Price CI. A systematic review and meta-analysis of molecular biomarkers associated with early neurological deterioration following acute stroke. Cerebrovasc Dis, 2019, 46(5/6): 230-241.
11. Bi R, Chen S, Chen S, et al. The role of leukocytes in acute ischemic stroke-related thrombosis: a notable but neglected topic. Cell Mol Life Sci, 2021, 78(17/18): 6251-6264.
12. Li S, Liu K, Gao Y, et al. Prognostic value of systemic immune-inflammation index in acute/subacute patients with cerebral venous sinus thrombosis. Stroke Vasc Neurol, 2020, 5(4): 368-373.
13. Yan K, Wei W, Shen W, et al. Combining the systemic inflammation response index and prognostic nutritional index to predict the prognosis of locally advanced elderly esophageal squamous cell carcinoma patients undergoing definitive radiotherapy. J Gastrointest Oncol, 2022, 13(1): 13-25.
14. Gao W, Zhang F, Ma T, et al. High preoperative fibrinogen and systemic inflammation response index (F-SIRI) predict unfavorable survival of resectable gastric cancer patients. J Gastric Cancer, 2020, 20(2): 202-211.
15. Yang R, Chang Q, Meng X, et al. Prognostic value of systemic immune-inflammation index in cancer: a meta-analysis. J Cancer, 2018, 9(18): 3295-3302.
16. European Stroke Organisation (ESO) Executive Committee, ESO Writing Committee. Guidelines for management of ischaemic stroke and transient ischaemic attack 2008. Cerebrovasc Dis, 2008, 25(5): 457-507.
17. Chen YF, Qi S, Yu ZJ, et al. Systemic inflammation response index predicts clinical outcomes in patients with acute ischemic stroke (AIS) after the treatment of intravenous thrombolysis. Neurologist, 2023, 28(6): 355-361.
18. Zhou Y, Zhang Y, Cui M, et al. Prognostic value of the systemic inflammation response index in patients with acute ischemic stroke. Brain Behav, 2022, 12(6): e2619.
19. Lim HH, Jeong IH, An GD, et al. Early prediction of severity in acute ischemic stroke and transient ischemic attack using platelet parameters and neutrophil-to-lymphocyte ratio. J Clin Lab Anal, 2019, 33(3): e22714.
20. Hirahara T, Arigami T, Yanagita S, et al. Combined neutrophil-lymphocyte ratio and platelet-lymphocyte ratio predicts chemotherapy response and prognosis in patients with advanced gastric cancer. BMC Cancer, 2019, 19(1): 672.
21. Shaarawy A, Baki AH, Teama M, et al. Neutrophils to lymphocytes ratio is an easy non expensive marker of inflammation in hemodialysis patients. J Clin Exp Nephrol, 2018, 38(4): 19.
22. Vidale S, Consoli A, Arnaboldi M, et al. Postischemic inflammation in acute stroke. J Clin Neurol, 2017, 13(1): 1-9.
23. Ruhnau J, Schulze J, Dressel A, et al. Thrombosis, neuroinflammation, and poststroke infection: the multifaceted role of neutrophils in stroke. J Immunol Res, 2017: 5140679.
24. Wang Y, Jin HJ, Wang WF, et al. Myosin1 f-mediated neutrophil migration contributes to acute neuroinflammation and brain injury after stroke in mice. J Neuroinflammation, 2019, 16(1): 77.
25. Cai W, Liu S, Hu M, et al. Functional dynamics of neutrophils after ischemic stroke. Transl Stroke Res, 2020, 11(1): 108-121.
26. Quan K, Wang A, Zhang X, et al. Neutrophil to lymphocyte ratio and adverse clinical outcomes in patients with ischemic stroke. Ann Transl Med, 2021, 9(13): 1047.
27. Zhao BQ, Wang S, Kim HY, et al. Role of matrix metalloproteinases in delayed cortical responses after stroke. Nat Med, 2006, 12(4): 441-445.
28. Jiang X, Andjelkovic AV, Zhu L, et al. Blood-brain barrier dysfunction and recovery after ischemic stroke. Prog Neurobiol, 2018(163/164): 144-171.
29. Cai W, Wang J, Hu M, et al. All trans-retinoic acid protects against acute ischemic stroke by modulating neutrophil functions through STAT1 signaling. J Neuroinflammation, 2019, 16(1): 175.
30. Li GZ, Zhong D, Yang LM, et al. Expression of interleukin-17 in ischemic brain tissue. Scand J Immunol, 2005, 62(5): 481-486.
31. Qi Q, Zhuang L, Shen Y, et al. A novel systemic inflammation response index (SIRI) for predicting the survival of patients with pancreatic cancer after chemotherapy. Cancer, 2016, 122(14): 2158-2167.
32. Xin Y, Zhang X, Li Y, et al. A systemic inflammation response index (SIRI)-based nomogram for predicting the recurrence of early stage hepatocellular carcinoma after radiofrequency ablation. Cardiovasc Intervent Radiol, 2022, 45(1): 43-53.
33. Yu T, Wang Z. Use of A systemic inflammatory response index to predict non-traumatic non-aneurysmal subarachnoid hemorrhage patient outcomes. J Stroke Cerebrovasc Dis, 2022, 31(12): 106863.
34. Li J, Yuan Y, Liao X, et al. Prognostic significance of admission systemic inflammation response index in patients with spontaneous intracerebral hemorrhage: a propensity score matching analysis. Front Neurol, 2021: 718032.
35. Li Z, Cui L, Ma J, et al. Association between neutrophil to lymphocyte ratio and atrial fibrillation. Int J Cardiol, 2015, 187: 361-362.
36. Liesz A, Zhou W, Na SY, et al. Boosting regulatory T cells limits neuroinflammation in permanent cortical stroke. J Neurosci, 2013, 33(44): 17350-17362.
37. Yang YL, Wu CH, Hsu PF, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest, 2020, 50(5): e13230.
38. Liu H, Wang R, Shi J, et al. Baseline Neutrophil Counts and Neutrophil Ratio May Predict a Poor Clinical Outcome in Minor Stroke Patients with intravenous Thrombolysis. J Stroke Cerebrovasc Dis, 2019, 28(11): 104340.
39. Brambilla R, Couch Y, Lambertsen KL. The effect of stroke on immune function. Mol Cell Neurosci, 2013: 26-33.
40. Faura J, Bustamante A, Miró-Mur F, et al. Stroke-induced immunosuppression: implications for the prevention and prediction of post-stroke infections. J Neuroinflammation, 2021, 18(1): 127.
41. Westendorp WF, Dames C, Nederkoorn PJ, et al. Immunodepression, Infections, and functional outcome in ischemic stroke. Stroke, 2022, 53(5): 1438-1448.

West China Medical Journal

Study on the relationship between systemic inflammation response index and early neurological deterioration and prognosis in patients with acute ischemic stroke

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