Efficacy of systemic immune inflammation index and National Institutes of Health Stroke Scale score on evaluating the short-term prognosis of patients with acute ischemic stroke receiving intravenous thrombolysis_West China Medical Journal

Authors：

HU Zhouquan ¹ , JIANG Peng ² , TANG Yong ² , XU Baoli ² ,  ZHANG Shu ¹

1. Department of Emergency, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Emergency Department, the Second People’s Hospital of Chengdu, Chengdu, Sichuan 610017, P. R. China;

Corresponding author：

ZHANG Shu, Email: 5042708@qq.com

Keywords：

Systemic immune inflammation index; National Institutes of Health Stroke Scale; acute ischemic stroke; intravenous thrombolysis; prognosis

DOI：

10.7507/1002-0179.202311160

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Objective To investigate the efficacy of systemic immune inflammation index (SII) at admission and National Institutes of Health Stroke Scale (NIHSS) score immediately after thrombolysis on evaluating the short-term prognosis of neurological function in patients with acute ischemic stroke (AIS) receiving intravenous thrombolysis. Methods Patients with AIS treated with intravenous thrombolysis in the Second People’s Hospital of Chengdu between March 2022 and March 2023 were retrospectively analyzed. The basic data of the patients, NIHSS score at emergency admission, NIHSS score immediately after thrombolysis, modified Rankin Scale (mRS) score 3 months after discharge, and laboratory data at admission were collected, and SII at admission was calculated. According to the mRS score 3 months after discharge, the patients were divided into the good prognosis group (mRS≤2) and the poor prognosis group (mRS>2). Multivariate logistic regression analysis was used to screen out the factors affecting the prognosis of patients, and the receiver operating characteristic curve was drawn to analyze the evaluation effect of SII at admission and NIHSS score immediately after thrombolysis on the poor prognosis of neurological function of patients in the short term. Results A total of 213 patients were enrolled, and the prognosis was poor in 88 patients. Multivariate logistic regression analysis showed that age, onset-to-needle time, uric acid at admission, SII at admission, fasting blood glucose after admission, and NIHSS score immediately after thrombolysis were independent risk factors for poor prognosis in AIS patients (P<0.05). The area under the receiver operating characteristic curve (AUC) of SII at admission for predicting poor prognosis was 0.715, the sensitivity was 55.7%, and the specificity was 84.0%. The AUC of NIHSS score immediately after thrombolysis for predicting poor prognosis of patients was 0.866, the sensitivity was 87.5%, and the specificity was 72.8%. The AUC of SII at admission combined with NIHSS score immediately after thrombolysis for predicting poor prognosis of patients was 0.875, the sensitivity was 84.1%, the specificity was 77.6%, the positive predictive value was 72.5%, and the negative predictive value was 87.4%. SII at admission was positively correlated with NIHSS score at emergency admission, NIHSS score immediately after thrombolysis, and mRS score 3 months after discharge (P<0.05). Conclusion SII at admission can predict the short-term prognosis of neurological function of patients with AIS after thrombolysis therapy, and the combination of SII at admission and NIHSS score immediately after thrombolysis can improve the prediction efficiency.

Citation： HU Zhouquan, JIANG Peng, TANG Yong, XU Baoli, ZHANG Shu. Efficacy of systemic immune inflammation index and National Institutes of Health Stroke Scale score on evaluating the short-term prognosis of patients with acute ischemic stroke receiving intravenous thrombolysis. West China Medical Journal, 2024, 39(5): 699-704. doi: 10.7507/1002-0179.202311160 Copy

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2.	Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
3.	Weng Y, Zeng T, Huang H, et al. Systemic immune-inflammation index predicts 3-month functional outcome in acute ischemic stroke patients treated with intravenous thrombolysis. Clin Interv Aging, 2021, 16: 877-886.
4.	Petty K, Lemkuil BP, Gierl B. Acute ischemic stroke. Anesthesiol Clin, 2021, 39(1): 113-125.
5.	Fest J, Ruiter R, Mulder M, et al. The systemic immune-inflammation index is associated with an increased risk of incident cancer. A population-based cohort study. Int J Cancer, 2020, 146(3): 692-698.
6.	Hou D, Wang C, Luo Y, et al. Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). Int J Neurosci, 2021, 131(12): 1203-1208.
7.	Li Y, Wen D, Cui W, et al. The prognostic value of the acute phase systemic immune-inflammation index in patients with intracerebral hemorrhage. Front Neurol, 2021, 12: 628557.
8.	《中国急性缺血性脑卒中诊治指南 2018》发布. 中华医学信息导报, 2018, 33(19): 10.
9.	Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res, 2014, 20(23): 6212-6222.
10.	Maida CD, Norrito RL, Daidone M, et al. Neuroinflammatory mechanisms in ischemic stroke: focus on cardioembolic stroke, background, and therapeutic approaches. Int J Mol Sci, 2020, 21(18): 6454.
11.	Venkatraghavan L, Tan TP, Mehta J, et al. Neutrophil lymphocyte ratio as a predictor of systemic inflammation: a cross-sectional study in a pre-admission setting. F1000Res, 2015, 4: 123.
12.	Shah AD, Denaxas S, Nicholas O, et al. Low eosinophil and low lymphocyte counts and the incidence of 12 cardiovascular diseases: a CALIBER cohort study. Open Heart, 2016, 3(2): e000477.
13.	Kim JY, Kawabori M, Yenari MA. Innate inflammatory responses in stroke: mechanisms and potential therapeutic targets. Curr Med Chem, 2014, 21(18): 2076-2097.
14.	Massberg S, Brand K, Grüner S, et al. A critical role of platelet adhesion in the initiation of atherosclerotic lesion formation. J Exp Med, 2002, 196(7): 887-896.
15.	Wang Y, Zhang JH, Sheng J, et al. Immunoreactive cells after cerebral ischemia. Front Immunol, 2019, 10: 2781.
16.	渠成, 张尊胜. 全身免疫炎症指数对急性缺血性脑卒中患者发生卒中相关性肺炎的预测价值. 徐州医科大学学报, 2021, 41(7): 528-533.
17.	Yan D, Dai C, Xu R, et al. Predictive ability of systemic inflammation response index for the risk of pneumonia in patients with acute ischemic stroke. Gerontology, 2023, 69(2): 181-188.
18.	Liu L, Wang W. Risk factors for acute ischemic stroke following intravenous thrombolysis: a 2-center retrospective cohort study. Ann Palliat Med, 2022, 11(1): 185-200.
19.	Martin-Schild S, Albright KC, Tanksley J, et al. Zero on the NIHSS does not equal the absence of stroke. Ann Emerg Med, 2011, 57(1): 42-45.
20.	Tsivgoulis G, Alleman J, Katsanos AH, et al. Comparative efficacy of different acute reperfusion therapies for acute ischemic stroke: a comprehensive benefit-risk analysis of clinical trials. Brain Behav, 2014, 4(6): 789-797.
21.	Saver JL, Fonarow GC, Smith EE, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA, 2013, 309(23): 2480-2488.
22.	Lyngdoh T, Marques-Vidal P, Paccaud F, et al. Elevated serum uric acid is associated with high circulating inflammatory cytokines in the population-based Colaus study. PLoS One, 2011, 6(5): e19901.
23.	Glantzounis GK, Tsimoyiannis EC, Kappas AM, et al. Uric acid and oxidative stress. Curr Pharm Des, 2005, 11(32): 4145-4151.
24.	Seet RC, Kasiman K, Gruber J, et al. Is uric acid protective or deleterious in acute ischemic stroke? A prospective cohort study. Atherosclerosis, 2010, 209(1): 215-219.
25.	Allen CL, Bayraktutan U. Oxidative stress and its role in the pathogenesis of ischaemic stroke. Int J Stroke, 2009, 4(6): 461-470.
26.	Fidler TP, Marti A, Gerth K, et al. Glucose metabolism is required for platelet hyperactivation in a murine model of type 1 diabetes. Diabetes, 2019, 68(5): 932-938.
27.	Xing L, Liu S, Tian Y, et al. C-R relationship between fasting plasma glucose and unfavorable outcomes in patients of ischemic stroke without diabetes. J Stroke Cerebrovasc Dis, 2019, 28(5): 1400-1408.

1. Diener HC, Hankey GJ. Primary and secondary prevention of ischemic stroke and cerebral hemorrhage: JACC focus seminar. J Am Coll Cardiol, 2020, 75(15): 1804-1818.
2. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke, 2019, 50(12): e344-e418.
3. Weng Y, Zeng T, Huang H, et al. Systemic immune-inflammation index predicts 3-month functional outcome in acute ischemic stroke patients treated with intravenous thrombolysis. Clin Interv Aging, 2021, 16: 877-886.
4. Petty K, Lemkuil BP, Gierl B. Acute ischemic stroke. Anesthesiol Clin, 2021, 39(1): 113-125.
5. Fest J, Ruiter R, Mulder M, et al. The systemic immune-inflammation index is associated with an increased risk of incident cancer. A population-based cohort study. Int J Cancer, 2020, 146(3): 692-698.
6. Hou D, Wang C, Luo Y, et al. Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS). Int J Neurosci, 2021, 131(12): 1203-1208.
7. Li Y, Wen D, Cui W, et al. The prognostic value of the acute phase systemic immune-inflammation index in patients with intracerebral hemorrhage. Front Neurol, 2021, 12: 628557.
8. 《中国急性缺血性脑卒中诊治指南 2018》发布. 中华医学信息导报, 2018, 33(19): 10.
9. Hu B, Yang XR, Xu Y, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res, 2014, 20(23): 6212-6222.
10. Maida CD, Norrito RL, Daidone M, et al. Neuroinflammatory mechanisms in ischemic stroke: focus on cardioembolic stroke, background, and therapeutic approaches. Int J Mol Sci, 2020, 21(18): 6454.
11. Venkatraghavan L, Tan TP, Mehta J, et al. Neutrophil lymphocyte ratio as a predictor of systemic inflammation: a cross-sectional study in a pre-admission setting. F1000Res, 2015, 4: 123.
12. Shah AD, Denaxas S, Nicholas O, et al. Low eosinophil and low lymphocyte counts and the incidence of 12 cardiovascular diseases: a CALIBER cohort study. Open Heart, 2016, 3(2): e000477.
13. Kim JY, Kawabori M, Yenari MA. Innate inflammatory responses in stroke: mechanisms and potential therapeutic targets. Curr Med Chem, 2014, 21(18): 2076-2097.
14. Massberg S, Brand K, Grüner S, et al. A critical role of platelet adhesion in the initiation of atherosclerotic lesion formation. J Exp Med, 2002, 196(7): 887-896.
15. Wang Y, Zhang JH, Sheng J, et al. Immunoreactive cells after cerebral ischemia. Front Immunol, 2019, 10: 2781.
16. 渠成, 张尊胜. 全身免疫炎症指数对急性缺血性脑卒中患者发生卒中相关性肺炎的预测价值. 徐州医科大学学报, 2021, 41(7): 528-533.
17. Yan D, Dai C, Xu R, et al. Predictive ability of systemic inflammation response index for the risk of pneumonia in patients with acute ischemic stroke. Gerontology, 2023, 69(2): 181-188.
18. Liu L, Wang W. Risk factors for acute ischemic stroke following intravenous thrombolysis: a 2-center retrospective cohort study. Ann Palliat Med, 2022, 11(1): 185-200.
19. Martin-Schild S, Albright KC, Tanksley J, et al. Zero on the NIHSS does not equal the absence of stroke. Ann Emerg Med, 2011, 57(1): 42-45.
20. Tsivgoulis G, Alleman J, Katsanos AH, et al. Comparative efficacy of different acute reperfusion therapies for acute ischemic stroke: a comprehensive benefit-risk analysis of clinical trials. Brain Behav, 2014, 4(6): 789-797.
21. Saver JL, Fonarow GC, Smith EE, et al. Time to treatment with intravenous tissue plasminogen activator and outcome from acute ischemic stroke. JAMA, 2013, 309(23): 2480-2488.
22. Lyngdoh T, Marques-Vidal P, Paccaud F, et al. Elevated serum uric acid is associated with high circulating inflammatory cytokines in the population-based Colaus study. PLoS One, 2011, 6(5): e19901.
23. Glantzounis GK, Tsimoyiannis EC, Kappas AM, et al. Uric acid and oxidative stress. Curr Pharm Des, 2005, 11(32): 4145-4151.
24. Seet RC, Kasiman K, Gruber J, et al. Is uric acid protective or deleterious in acute ischemic stroke? A prospective cohort study. Atherosclerosis, 2010, 209(1): 215-219.
25. Allen CL, Bayraktutan U. Oxidative stress and its role in the pathogenesis of ischaemic stroke. Int J Stroke, 2009, 4(6): 461-470.
26. Fidler TP, Marti A, Gerth K, et al. Glucose metabolism is required for platelet hyperactivation in a murine model of type 1 diabetes. Diabetes, 2019, 68(5): 932-938.
27. Xing L, Liu S, Tian Y, et al. C-R relationship between fasting plasma glucose and unfavorable outcomes in patients of ischemic stroke without diabetes. J Stroke Cerebrovasc Dis, 2019, 28(5): 1400-1408.

West China Medical Journal

Efficacy of systemic immune inflammation index and National Institutes of Health Stroke Scale score on evaluating the short-term prognosis of patients with acute ischemic stroke receiving intravenous thrombolysis

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