Zhang Aimei, Zhu Yuan, Liao Junqi, Wu Dan, Yan Xiaohui, Chen Jingyi, He Qiuhua, Song Fantao, Li Li, Li Yunze, Chen Zhaoyao, Li Wenlei, Yang Qin, Fang Zhuyuan, Wu Minghua
Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China,
Department of Neurology, Affiliated Hospital of Nanjing University of Chinese Medicine, Jiangsu Province Hospital of Chinese Medicine, Nanjing, China.
Neuroepidemiology. 2025;59(1):31-42. doi: 10.1159/000539132. Epub 2024 May 15.
The contribution of individual and combined inflammatory markers for the prognosis of acute ischemic stroke (AIS) remains elusive. This study investigated the effect of systemic inflammatory response index (SIRI), and neutrophil to high-density lipoprotein ratio (NHR), which is mediated by fasting blood glucose (FBG), on 90-day prognosis of patients with AIS.
In this pre-specified substudy of an observational cohort study, 2,828 patients with AIS were enrolled from the Nanjing Stroke Registry between January 2017 and July 2021. Peripheral venous blood was collected from patients fasting for at least 8 h within 24 h of admission to gather information on the following parameters: neutrophil count, lymphocyte count, monocyte count, HDL level, and fasting blood glucose level. Then, the SIRI and NHR values were calculated. Following this, the correlation among SIRI, NHR, and modified Rankin Scale (mRS) scores 90 days after onset was examined via univariate and multivariate logistic analyses. Lastly, mediation analysis was performed to examine the relationship between systematic inflammatory response and study outcomes mediated by FBG.
SIRI and NHR were both negatively correlated with clinical outcomes (p < 0.05). Logistic regression analysis revealed that SIRI and NHR were independently associated with poor outcomes after adjusting for potential confounders. Subgroup analyses further validated these correlations. Meanwhile, mediation analysis corroborated that FBG partially mediated the associations between SIRI and a poor prognosis at 90 days (indirect effect estimate = 0.0038, bootstrap 95% CI 0.001-0.008; direct effect estimate = 0.1719, bootstrap 95% CI 0.1258-0.2179). Besides, FBG also played a mediating role between NHR and poor outcomes (indirect effect estimate = 0.0066, bootstrap 95% CI 0.002-0.120; direct effect estimate = 0.1308, bootstrap 95% CI 0.0934-0.1681).
Our study demonstrated that SIRI and NHR are positively associated with poor clinical and mortality outcomes at 90 days in AIS patients, which was partially mediated by FBG.
The contribution of individual and combined inflammatory markers for the prognosis of acute ischemic stroke (AIS) remains elusive. This study investigated the effect of systemic inflammatory response index (SIRI), and neutrophil to high-density lipoprotein ratio (NHR), which is mediated by fasting blood glucose (FBG), on 90-day prognosis of patients with AIS.
In this pre-specified substudy of an observational cohort study, 2,828 patients with AIS were enrolled from the Nanjing Stroke Registry between January 2017 and July 2021. Peripheral venous blood was collected from patients fasting for at least 8 h within 24 h of admission to gather information on the following parameters: neutrophil count, lymphocyte count, monocyte count, HDL level, and fasting blood glucose level. Then, the SIRI and NHR values were calculated. Following this, the correlation among SIRI, NHR, and modified Rankin Scale (mRS) scores 90 days after onset was examined via univariate and multivariate logistic analyses. Lastly, mediation analysis was performed to examine the relationship between systematic inflammatory response and study outcomes mediated by FBG.
SIRI and NHR were both negatively correlated with clinical outcomes (p < 0.05). Logistic regression analysis revealed that SIRI and NHR were independently associated with poor outcomes after adjusting for potential confounders. Subgroup analyses further validated these correlations. Meanwhile, mediation analysis corroborated that FBG partially mediated the associations between SIRI and a poor prognosis at 90 days (indirect effect estimate = 0.0038, bootstrap 95% CI 0.001-0.008; direct effect estimate = 0.1719, bootstrap 95% CI 0.1258-0.2179). Besides, FBG also played a mediating role between NHR and poor outcomes (indirect effect estimate = 0.0066, bootstrap 95% CI 0.002-0.120; direct effect estimate = 0.1308, bootstrap 95% CI 0.0934-0.1681).
Our study demonstrated that SIRI and NHR are positively associated with poor clinical and mortality outcomes at 90 days in AIS patients, which was partially mediated by FBG.
个体及联合炎症标志物对急性缺血性卒中（AIS）预后的影响仍不明确。本研究调查了由空腹血糖（FBG）介导的全身炎症反应指数（SIRI）和中性粒细胞与高密度脂蛋白比值（NHR）对AIS患者90天预后的影响。
在这项观察性队列研究的预先指定的子研究中，2017年1月至2021年7月期间从南京卒中登记处纳入了2828例AIS患者。在入院后24小时内，从至少禁食8小时的患者中采集外周静脉血，以收集以下参数的信息：中性粒细胞计数、淋巴细胞计数、单核细胞计数、高密度脂蛋白水平和空腹血糖水平。然后，计算SIRI和NHR值。随后，通过单因素和多因素逻辑分析检查SIRI、NHR与发病后90天改良Rankin量表（mRS）评分之间的相关性。最后，进行中介分析以检查由FBG介导的全身炎症反应与研究结果之间的关系。
SIRI和NHR均与临床结局呈负相关（p<0.05）。逻辑回归分析显示，在调整潜在混杂因素后，SIRI和NHR与不良结局独立相关。亚组分析进一步验证了这些相关性。同时，中介分析证实FBG部分介导了SIRI与90天时不良预后之间的关联（间接效应估计值=0.0038，自抽样95%CI 0.001-0.008；直接效应估计值=0.1719，自抽样95%CI 0.1258-0.2179）。此外，FBG在NHR与不良结局之间也起中介作用（间接效应估计值=0.0066，自抽样95%CI 0.002-0.120；直接效应估计值=0.1308，自抽样95%CI 0.0934-0.1681）。
我们的研究表明，SIRI和NHR与AIS患者90天时不良临床和死亡结局呈正相关，这部分由FBG介导。
个体及联合炎症标志物对急性缺血性卒中（AIS）预后的影响仍不明确。本研究调查了由空腹血糖（FBG）介导的全身炎症反应指数（SIRI）和中性粒细胞与高密度脂蛋白比值（NHR）对AIS患者90天预后的影响。
在这项观察性队列研究的预先指定的子研究中，2017年1月至2021年7月期间从南京卒中登记处纳入了2828例AIS患者。在入院后24小时内，从至少禁食8小时的患者中采集外周静脉血，以收集以下参数的信息：中性粒细胞计数、淋巴细胞计数、单核细胞计数、高密度脂蛋白水平和空腹血糖水平。然后，计算SIRI和NHR值。随后，通过单因素和多因素逻辑分析检查SIRI、NHR与发病后90天改良Rankin量表（mRS）评分之间的相关性。最后，进行中介分析以检查由FBG介导的全身炎症反应与研究结果之间的关系。
SIRI和NHR均与临床结局呈负相关（p<0.05）。逻辑回归分析显示，在调整潜在混杂因素后，SIRI和NHR与不良结局独立相关。亚组分析进一步验证了这些相关性。同时，中介分析证实FBG部分介导了SIRI与90天时不良预后之间的关联（间接效应估计值=0.0038，自抽样95%CI 0.001-0.008；直接效应估计值=0.1719，自抽样95%CI 0.1258-0.2179）。此外，FBG在NHR与不良结局之间也起中介作用（间接效应估计值=0.0066，自抽样95%CI 0.002-0.120；直接效应估计值=0.1308，自抽样95%CI 0.0934-0.1681）。
我们的研究表明，SIRI和NHR与AIS患者90天时不良临床和死亡结局呈正相关，这部分由FBG介导。
