Zhou Yuanfeng, Yang Qian, Zhou Zhangming, Yang Xin, Zheng Danni, He Zhongchun, Liu Yizhou, Xu Tianzhu, Yin Ying, Wei Wenhui, Si Chunli, Zhang Bozhi, Yu Jianping
Chengdu Medical College, Chengdu, Sichuan, China.
Department of Neurology, The First Affiliated Hospital of Chengdu Medical College, Chengdu, Sichuan, China.
PLoS One. 2025 Mar 27;20(3):e0319920. doi: 10.1371/journal.pone.0319920. eCollection 2025.
The systemic immune-inflammation index (SII) has been proven to predict the outcome in cancerous and non-cancerous diseases. We aimed to investigate the relationship between SII and other inflammatory markers and the prognosis in patients receiving intravenous thrombolysis (IVT).
Acute ischemic stroke patients treated with IVT were collected retrospectively. SII, neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were constructed based on admission blood testing. Favorable outcome was defined as modified Rankin Scale of less than or equal to 2 at 90 days. In addition to outcome, cerebral edema was analyzed. The severity of brain edema was graded into three levels according to Thrombolysis in Stroke-Monitoring Study. Malignant cerebral edema (MCE) was defined as brain edema with midline shift.
278 patients were included. 140 (50.4%) achieved favorable outcome, 35 (12.6%) developed MCE. In patients with favorable outcomes, the levels of SII, NLR and PLR were lower compared to those with unfavorable outcomes [422.33 (258.69-624.68) vs 1269.83 (750.82-2497.22), p < 0.001; 2.73 (1.68-4.40) vs 4.76 (2.59-7.72), p < 0.001; 92.98 (62.35-126.24) vs 115.64 (85.51-179.04), p < 0.001]. The area under the Receiver Operating Characteristic curve was 0.698 for SII (95% CI = 0.637-0.760, p < 0.001), 0.694 for NLR (95% CI = 0.632-0.756, p < 0.001), 0.643 for PLR (95% CI = 0.579-0.707, p < 0.001). The optimal cut-off values were 652.73 for SII (sensitivity 0.572, specificity 0.786), 3.57 for NLR (sensitivity 0.659, specificity 0.693), 127.01 for PLR (sensitivity 0.457, specificity 0.757).
An early increase in SII levels was related to 3 months of unfavorable outcomes in AIS patients after IVT. However, it is not associated with malignant edema.
全身免疫炎症指数（SII）已被证明可预测癌症和非癌症疾病的预后。我们旨在研究SII与其他炎症标志物之间的关系以及接受静脉溶栓（IVT）患者的预后。
回顾性收集接受IVT治疗的急性缺血性卒中患者。根据入院时的血液检测构建SII、中性粒细胞与淋巴细胞比值（NLR）和血小板与淋巴细胞比值（PLR）。良好预后定义为90天时改良Rankin量表评分小于或等于2分。除了评估预后外，还对脑水肿进行了分析。根据卒中监测研究中的溶栓情况，将脑水肿的严重程度分为三个级别。恶性脑水肿（MCE）定义为伴有中线移位的脑水肿。
纳入278例患者。140例（50.4%）获得良好预后，35例（12.6%）发生MCE。预后良好的患者，其SII、NLR和PLR水平低于预后不良的患者[422.33（258.69 - 624.68）对1269.83（750.82 - 2497.22），p < 0.001；2.73（1.68 - 4.40）对4.76（2.59 - 7.72），p < 0.001；92.98（62.35 - 126.24）对115.64（85.51 - 179.04），p < 0.001]。SII的受试者工作特征曲线下面积为0.698（95%CI = 0.637 - 0.760，p < 0.001），NLR为0.694（9�%CI = 0.632 - 0.756，p < 0.001），PLR为0.643（95%CI = 0.579 - 0.707，p < 0.001）。SII的最佳截断值为652.73（敏感性0.572，特异性0.786），NLR为3.57（敏感性0.659，特异性0.693），PLR为127.01（敏感性0.457，特异性0.757）。
IVT治疗后AIS患者早期SII水平升高与3个月时的不良预后相关。然而，它与恶性水肿无关。
