ArticleBrain and behavior2026
Association and Comparative Analysis of Four Inflammatory Indices With 90-Day Outcomes in Acute Ischemic Stroke Patients Treated With Intravenous Thrombolysis.
Article in Brain and behavior, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo investigate and compare the associations of the systemic immune-inflammation index (SII), the systemic inflammation response index (SIRI), the platelet-to-lymphocyte ratio (PLR), and the neutrophil-to-lymphocyte ratio (NLR) with 90-day functional outcomes in AIS patients treated with IV rt-PA., with particular attention to their nonlinear relationships and threshold effects.
methodsNote that 503 AIS patients who received intravenous thrombolysis with alteplase (rt-PA) were consecutively enrolled, and clinical information along with laboratory data were collected. ROC curve analysis was conducted to determine the optimal cut-off value of SII, PLR, NLR, and SIRI. Multivariate analysis was included for variables with p < 0.05 in univariate analysis. The restricted cubic spline (RCS) curve illustrates the nonlinear relationship between SII, PLR, NLR, SIRI, and the 90-day unfavorable outcomes.
resultsA total of 503 patients were included. According to multivariate logistic regression analysis, admission NIHSS scores (OR = 1.156, 95% CI: 1.049-1.274), albumin (OR = 0.875, 95% CI: 0.774-0.989), and SII (OR = 1.004, 95% CI: 1.001-1.006) were independent indicators of unfavorable outcomes at 90 day after intravenous thrombolysis (p < 0.05). The ROC analysis showed that an SII cutoff value of 1268.00 could predict poor 90-day outcomes with a sensitivity of 61.58% and a specificity of 92.02%. The AUC was 0.764 (95% CI 0.677-0.852, p < 0.05). Pairwise comparison using the DeLong test revealed that SII and NLR demonstrated comparable discriminative ability (p = 0.392), and both significantly outperformed PLR (SII vs. PLR: p = 0.001; NLR vs. PLR: p = 0.006). No significant difference was detected between SII and SIRI (p = 0.709) or between NLR and SIRI (p = 0.211). SII showed the most consistent independent association in multivariable analysis (OR = 1.004, 95% CI: 1.001-1.006). The RCS curve illustrates the nonlinear relationship between SII, PLR, NLR, SIRI, and the 90-day unfavorable outcomes.
conclusionsAmong the inflammatory indices studied, SII showed the strongest association with 90-day unfavorable outcomes in this cohort. Our findings suggest a potential role of systemic inflammation in patient prognosis post-thrombolysis, warranting further prospective validation.
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