Chen Anni, Wang Jiahui, Huang Qiaoying, Hu Zhizhou, Jiang Donglan, Hu Yunnan, Pan Liying, Chen Jianhui, Hu Xiaohong
Department of Neurology, Longyan First Affiliated Hospital of Fujian Medical University, Longyan, China.
Front Neurol. 2025 Aug 18;16:1644817. doi: 10.3389/fneur.2025.1644817. eCollection 2025.
Systemic inflammation and immune responses are key contributors to the onset and progression of ischemic stroke, influencing both tissue damage and repair. This study investigates the association between the pan-immune inflammatory value (PIV)-a composite biomarker derived from routine blood tests-and all-cause mortality (ACM) in critically ill ischemic stroke patients.
We extracted data from the MIMIC-IV (v3.0) database, identifying ischemic stroke patients using ICD-9/10 codes. PIV was calculated using the formula: (monocytes × neutrophils × platelets) ÷ lymphocytes. ACM was assessed during hospitalization and at 30-, 90-, and 365-days post-admission. Multivariable Cox proportional hazards models and restricted cubic spline (RCS) analyses were used to assess the relationship between PIV and mortality. Kaplan-Meier curves, time-dependent ROC curves, and decision curve analysis (DCA) evaluated survival differences and predictive performance. Subgroup and interaction analyses were conducted using likelihood ratio tests.
A total of 1,365 critically ill ischemic stroke patients were included, with 50.48% male. Elevated PIV was significantly associated with higher mortality during hospitalization (HR: 1.98), and at 30-day (HR: 2.56), 90-day (HR: 1.97), and 365-day (HR: 1.76) follow-ups (all < 0.01). RCS analysis revealed a J-shaped relationship between PIV and ACM. Subgroup analyses showed consistent results without significant interaction effects.
PIV is an independent predictor of short- and long-term mortality in critically ill ischemic stroke patients. These findings suggest PIV could serve as a practical and cost-effective biomarker for risk stratification and prognosis in clinical settings.
全身炎症和免疫反应是缺血性中风发病和进展的关键因素，影响组织损伤和修复。本研究调查了泛免疫炎症值（PIV）——一种从常规血液检查中得出的综合生物标志物——与重症缺血性中风患者全因死亡率（ACM）之间的关联。
我们从MIMIC-IV（v3.0）数据库中提取数据，使用ICD-9/10编码识别缺血性中风患者。PIV使用公式计算：（单核细胞×中性粒细胞×血小板）÷淋巴细胞。在住院期间以及入院后30天、90天和365天评估ACM。使用多变量Cox比例风险模型和受限立方样条（RCS）分析来评估PIV与死亡率之间的关系。Kaplan-Meier曲线、时间依赖性ROC曲线和决策曲线分析（DCA）评估生存差异和预测性能。使用似然比检验进行亚组和交互分析。
共纳入1365例重症缺血性中风患者，男性占50.48%。PIV升高与住院期间（HR：1.98）、30天（HR：2.56）、90天（HR：1.97）和3天（HR：1.76）随访时较高的死亡率显著相关（均P<0.01）。RCS分析显示PIV与ACM之间呈J形关系。亚组分析显示结果一致，无显著交互作用。
PIV是重症缺血性中风患者短期和长期死亡率的独立预测指标。这些发现表明，PIV可作为临床环境中风险分层和预后的实用且具有成本效益的生物标志物。
