The Role of the Multi-Inflammatory Index as a Novel Predictor of Hospital Mortality in Acute Ischemic Stroke

Background and objective Ischemic strokes account for the majority of all strokes. The severity of an acute ischemic stroke (AIS) can be estimated with the help of a number of different scoring systems. However, there is a need for bedside tests that will support the clinical diagnosis and thus help predict the severity of stroke. The research on the multi-inflammatory index (MII), which is calculated using hemogram parameters, has shown immense promise. In light of this, the aim of this study was to establish the association between MII and the severity of AIS. Methods The study included 452 ischemic stroke patients over the age of 18 years who presented to the hospital within 72 hours of the onset of symptoms. Demographic information such as patient age and gender, hemogram parameters, ratios, indices, hospitalization, and mortality status were all recorded. The demographic data, hemogram parameters, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), and C-reactive protein (CRP)/lymphocyte ratio (CLR), and MII 1, 2, and 3 were compared between surviving and deceased patients. Results The MII-1, MII-2, and MII-3 index values were determined to be significantly low in the patients with Glasgow Coma Scale (GCS) scores of 13-15 compared to those with GCS scores ≤8, and in patients with National Institutes of Health Stroke Scale (NIHSS) score of 1-4 compared to those with scores of 5-14, 15-20, and ≥21. The NLR, CLR, PLR, MII-1, MII-2, and MII-3 index values were significantly higher in the non-survivors (PLR: p=0.004, all other values: p<0.001). The performances of multiple models developed for the mortality cut-off points were evaluated. Together with other factors, Model 1 included the MII-1, Model 2 the MII-2, and Model 3 the MII-3. Although there was no significant difference between the AUC values of the models, the highest sensitivity rate was reached with Model 2 (74.48%), and the highest specificity rate with Model 3 (90.62%). Conclusion Based on our findings, MII is a simple and practical biomarker that can be easily obtained from NLR, PLR, and CRP, and can help in the early detection of poor prognosis in AIS. NLR was found to be superior to PLR and CLR in distinguishing fatal AIS cases.