Higher systemic immune-inflammation index associated with increased mortality after ischemic stroke
Photo by National Institute of Allergy and Infectious Diseases / Unsplash
Key Takeaway
Consider SII as a potential prognostic marker in ischemic stroke, but recognize this is observational data from a single center.
This single-center retrospective cohort study analyzed 1,156 ischemic stroke patients discharged from Dandong Central Hospital in 2024. The exposure was the systemic immune-inflammation index (SII), a composite marker derived from platelet, neutrophil, and lymphocyte counts. Patients were followed for a median of 14.23 months, with the primary outcome being all-cause mortality.
During follow-up, 97 patients (8.4%) died. Each one-standard-deviation increase in SII was associated with a 17% higher risk of mortality (hazard ratio [HR] 1.172, 95% confidence interval [CI] 1.019–1.348, p=0.026). When comparing high versus low SII groups, the high SII group had a 54% higher risk (HR 1.543, 95% CI 1.017–2.340, p=0.041). Kaplan-Meier analysis showed significant differences in cumulative mortality risk among SII groups (p<0.05).
For predictive performance, SII alone had an area under the receiver operating characteristic curve (AUC) of 0.605 for mortality prediction, slightly better than platelet-to-lymphocyte ratio (AUC 0.579) and monocyte-to-high-density-lipoprotein cholesterol ratio (AUC 0.487). Combining SII with National Institutes of Health Stroke Scale and modified Rankin Scale scores improved predictive value (AUC 0.683). Safety and tolerability data were not reported.
Key limitations include the single-center retrospective design, which cannot establish causality, and lack of reported data on patient comorbidities, treatments, or causes of death. The study population was from one Chinese hospital, limiting generalizability. While SII shows promise as a prognostic marker in this cohort, its clinical utility for individual patient management remains uncertain and requires prospective validation in diverse populations.
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View Original Abstract ↓
ObjectivesThis study is designed to assess the association between the systemic immune-inflammation index (SII) and all-cause mortality among patients with ischemic stroke (IS).MethodsA single-center retrospective cohort study was conducted, including 1,156 IS patients discharged from Dandong Central Hospital from January to December 2024. The formula for SII is as follows: SII = (neutrophil count × platelet count)/lymphocyte count. Multivariate Cox regression model, subgroup analysis, sensitivity analysis, receiver operating characteristic (ROC) curve, and Kaplan–Meier survival analysis were used to evaluate the association between SII and all-cause mortality.ResultsDuring the median follow-up period of 14.23 months, a total of 97 (8.4%) patients with all-cause mortality were identified. Multivariate Cox regression analysis showed that after adjusting for a variety of confounding factors, for every one-standard-deviation increase in SII, the risk of all-cause mortality increased by 17.2% [hazard ratio (HR) = 1.172, 95% confidence interval (CI): 1.019–1.348, p = 0.026]. Moreover, the risk of all-cause mortality in the high SII group was 1.543 times that of the low SII group (HR = 1.543, 95% CI: 1.017–2.340, p = 0.041). Multiple subgroup analyses and sensitivity analyses reverified the stability of these results. ROC curve analysis indicated that SII had a certain predictive value for all-cause mortality (overall population, AUC = 0.605; male, AUC = 0.609; female, AUC = 0.600), and the predictive value of SII was higher than that of platelet-to-lymphocyte ratio (PLR) and monocyte to high-density lipoprotein cholesterol ratio (MHR) (overall population, AUC of PLR = 0.579; AUC of MHR = 0.487). Furthermore, SII combined with NIHSS score and mRS score could improve its predictive value for all-cause mortality in patients with IS (overall population, AUC = 0.683). The Kaplan–Meier survival curve analysis revealed significant differences in the cumulative risk of all-cause mortality among different SII groups, and the cumulative risk of all-cause mortality was higher in the high SII group (p
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