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. 2025 Jul 22:16:1616128.
doi: 10.3389/fneur.2025.1616128. eCollection 2025.

Neutrophil-to-lymphocyte ratio and systemic inflammation response index as biomarkers for the clinical outcomes of intracerebral hemorrhagic stroke patients: a prospective cohort study

Ziyi Hu  1 , Wei Zhu  2 , Chaofeng Fan #  2 , Yan Jiang #  1
Affiliations

Neutrophil-to-lymphocyte ratio and systemic inflammation response index as biomarkers for the clinical outcomes of intracerebral hemorrhagic stroke patients: a prospective cohort study

Ziyi Hu et al. Front Neurol. .

Abstract

Purpose: To examine the associations between the neutrophil-to-lymphocyte ratio (NLR), systemic inflammation response index (SIRI) and clinical outcomes of intracerebral hemorrhagic (ICH) stroke patients.

Methods: This prospective cohort study recruited and investigated longitudinally 294 ICH stroke patients in a general tertiary hospital in Sichuan Province, China at baseline (admission), 1-month post-discharge, 3-month post-discharge and 6-month post-discharge from January 2020 to January 2022. We calculated the NLR and SIRI from blood samples collected at baseline. The Mann-Whitney test, logistic regression analysis and receiver operating characteristic (ROC) analysis were performed to evaluate differences in the NLR and SIRI between hemorrhagic stroke patients at three follow-up time points. The interaction between these variables was evaluated via multiplicative and additive interaction models.

Results: Our study revealed that the cut-off values of the NLR and SIRI to predict the clinical outcomes were determined to be 6 and 4, respectively. NLR > 6 (OR 2.202, 95% CI: 1.094-4.430) and SIRI>4 (OR 2.056, 95% CI: 1.065-3.968) were associated with increased risks for poor clinical outcomes at 1-month post-discharge. SIRI>4 (OR 2.428, 95% CI: 1.389-4.243) were associated with increased risks for poor clinical outcomes at 3-month post-discharge. NLR > 6 (OR 1.978, 95% CI: 1.093-3.580) were associated with increased risks for poor clinical outcomes at 6-month post-discharge.

Conclusion: The NLR and SIRI did not have an additive effect on the clinical outcome at 1-month post-discharge. Our findings indicate that high NLRs and SIRIs, particularly NLR > 6 and SIRI>4, are associated with poor clinical outcomes in ICH stroke patients.

Keywords: MRS; intracerebral hemorrhagic stroke; neutrophil-to-lymphocyte ratio; prognosis; systemic inflammation response index.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow chart of the study design.
Figure 2
Figure 2
ROC curves showing the values of the NLR and SIRI for evaluating the clinical outcomes of ICH stroke patients at 1- (A), 3- (B) and 6- (C) month post-discharge.
See this image and copyright information in PMC

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