Changes in Immune-Inflammation Status and Acute Ischemic Stroke Prognosis in Prospective Cohort

Inflammation is a critical risk factor for poor outcomes in cerebral infarction. Prior studies focused primarily on baseline inflammation status, neglecting dynamic longitudinal changes. We try to investigate the association between immune-inflammation status alterations and stroke prognosis, and evaluated three systemic biomarkers' predictive efficacy.

In this prospective cohort study of ischemic stroke patients, C-reactive protein-albumin-lymphocyte (CALLY), Systemic Immune-Inflammation Index (SII), and Systemic Inflammation Response Index (SIRI) were assessed. Immune-inflammation changes were measured between baseline and a second survey. The primary outcome was death or major disability (modified Rankin Scale score ≥ 3) after stroke onset. Prognostic performance for poor outcomes was evaluated at baseline. The association was calculated by Cox proportional hazard models.

Elevated baseline CALLY correlated with reduced poor outcome risk (OR 0.33, 95% CI 0.20-0.53), while higher SII and SIRI indicated increased risk (SII OR 2.54, 95% CI 1.61-4.06; SIRI OR 2.37, 95% CI 1.47-3.87). Adding these markers to conventional risk factors significantly improved prediction, with CALLY showing the greatest enhancement (C-statistic 0.882 vs. 0.862; p = 0.004; NRI = 29.68%; IDI = 0.39%). Compared to stable mild status, progression to severe status increased poor outcome risk, while recovery to mild status reduced risk (CALLY OR 14.2, 95% CI 2.31-64.27; SII OR 1.27, 95% CI 1.01-7.10; SIRI OR 4.10, 95% CI 1.61-10.71). High inflammatory indices and significant changes predicted poor outcomes.

CALLY demonstrated superior predictive ability for ischemic stroke outcomes versus SII/SIRI. Both baseline levels and dynamic changes in immune-inflammation status significantly correlated with prognosis, suggesting these biomarkers could valuably predict outcomes and guide intervention.