The Relationship Between Systemic Inflammation Index, Systemic Immune-Inflammatory Index, and Inflammatory Prognostic Index and 90-Day Outcomes in Acute Ischemic Stroke Patients Treated with Intravenous Thrombolysis

Abstract

Background and purpose This study aimed to explore the association between the systemic inflammatory index (SIRI), systemic immune-inflammatory index (SII), and inflammatory prognosis index (IPI) with the 90-day outcomes of patients with acute ischemic stroke (AIS) after intravenous thrombolysis. Methods 190 AIS patients who underwent intravenous thrombolysis from September 2019 to December 2022 were enrolled in the present study. The National Institutes of Health Stroke Scale (NIHSS) and modified Rankin score (mRS) were assessed in AIS patients who met the inclusion criteria before thrombolysis, immediately after thrombolysis, and at 90 days. Peripheral venous blood was collected within 24 hours after admission and used to assess the following parameters: neutrophil count, lymphocyte count, monocyte count, platelet count, average platelet volume, and albumin. Next, the SIRI, SII, and IPI values were calculated, respectively. The correlation among SIRI, SII, IPI, and admission NIHSS scores was examined by Spearman correlation analysis. ROC curve analysis was conducted to determine the optimal cut-off value of SIRI, SII, and SIRI and their corresponding sensitivity and specificity to evaluate their predictive value on admission for poor prognosis. To investigate whether high SIRI, SII, and IPI were independent predictors of poor outcomes within 90 days, variables with P-value < 0.05 during univariate analysis were included in multivariate analysis. Results Compared with the good outcome group, the poor outcome group had higher age, baseline NIHSS, neutrophil count, mRS, NLR, SIRI, IPI, and SII, while the lymphocyte count was lower. Spearman correlation analysis showed that the SIRI, IPI, and SII levels significantly correlated with the admission NIHSS score (r = 0.338, 0.356, 0.427, respectively; Ps < 0.001). The Mann-Whitney U test showed that the SIRI, SII, and IPI levels in patients with moderate and severe AIS were higher than in patients with mild AIS (P < 0.001). Univariate analysis showed that admission NIHSS, NLR, SIRI, SII, and IPI were significantly correlated with poor 90-day prognosis. Although age, smoking and drinking history, and underlying diseases were not significantly associated with prognosis, they were considered potential risk factors for AIS and included in the analysis as potential confounding factors. Using the optimal cut-off value determined by ROC analysis, multivariate logistic regression analysis revealed high SIRI, SII, and IPI values as independent risk factors for poor 90-day prognosis (OR = 2.867, 3.721, and 2.877, respectively). Conclusions High SIRI, IPI, and SII values are correlated with poor 90d outcomes in AIS patients undergoing intravenous thrombolysis.