The Prognostic Value of the Acute Phase Systemic Immune-Inflammation Index in Patients With Intracerebral Hemorrhage

Abstract

Background and Purpose: The systemic immune-inflammation index (SII) is a novel prognostic index in various diseases. We evaluated the predictive value of SII in patients with intracerebral hemorrhage (ICH). Methods: Patients with primary spontaneous ICH were enrolled. SII was constructed based on peripheral platelet (P), neutrophil (N), and lymphocyte (L) and defined as P^*N/L. In addition to admission testing, acute phase SII was collected to analyze the potential dynamic change. Poor outcome was defined as modified Rankin Scale of more than 3 at 90 days. Results: We included 291 patients; 98 (34%) achieved favorable functional outcomes. Day-1 SII was higher and was more related to poor outcome than was admission SII. Median time of day-1 SII was 29 h from onset. Day-1 SII had an OR in outcome (mRS >3) 1.74 (95% CI = 1.03-3.00, p = 0.04). The binary cutoff point of SII calculated using the area under the curve (AUC) method was 1,700 × 10⁹/L, AUC 0.699 (95% CI = 0.627-0.774) (sensitivity 53.3%, specificity 77.3%) (OR = 2.36, 95% CI = 1.09-5.26, p = 0.03). Conclusions: SII, especially day-1 SII, was highly associated with 90-day functional outcome in patients with ICH and could be used to predict outcomes.

Keywords: blood platelets; intracerebral hemorhage; neutrophils lymphocyte ratio; prognosis; stroke.

Figure 1

(A) SII distribution and fitting curve according to 90-day outcome; (B) ANC distribution and fitting curve according to 90-day outcome; (C) ALC distribution and fitting curve according to 90-day outcome; (D) PLT distribution and fitting curve according to 90-day outcome. Red indicates patients with unfavorable outcomes, and blue indicates patients with favorable outcomes. Right-side rungs indicate SII distribution in the first 12 h from onset; the left side indicates SII distribution 24–48 h from onset.

Figure 2

Boxplots of admission and day-1 SII stratified by ordinal mRS.