Dynamic inflammatory markers as predictors of 90-day outcomes in spontaneous intracerebral hemorrhage

To investigate the time-dependent characteristics of composite inflammatory biomarkers in patients with spontaneous intracerebral hemorrhage (ICH), and to evaluate the associations of their dynamic changes with 90-day functional outcomes and mortality.

This single-center retrospective study consecutively enrolled 230 patients with spontaneous ICH admitted between 2021 and 2024. Peripheral blood samples were collected within 24 h after admission (T1) and on day 7 after onset (T2). The neutrophil-to-lymphocyte ratio (NLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and inflammation prognostic index (IPI) were calculated at both time points. Dynamic changes from T1 to T2 were assessed using fold change (FC = T2/T1) and relative percentage change, defined as c1-2 = (T2 - T1) / T1 × 100%, equivalent to (FC - 1) × 100%. Functional outcomes at 90 days were assessed using the modified Rankin Scale, with favorable outcome defined as mRS 0-2 and unfavorable outcome defined as mRS 3-6. Mortality was defined as mRS 6. Logistic regression and receiver operating characteristic curve analyses were performed.

Levels of NLR, SII, SIRI, and IPI at T2 were higher in patients with unfavorable outcomes and in non-survivors than in patients with favorable outcomes and survivors, respectively. Dynamic changes from T1 to T2, assessed using FC and c1-2, were also more pronounced in patients with unfavorable outcomes and in non-survivors. Multivariate analysis showed that T2 levels and c1-2 indicators were significantly associated with 90-day unfavorable functional outcomes. For mortality, T2 indices showed more consistent independent associations than T1 indices, and most dynamic change indicators remained significant after adjustment. ROC analysis indicated that T2 indices and dynamic change indicators generally had better predictive performance than T1 indices.

Composite inflammatory biomarkers in patients with spontaneous ICH exhibit a time-dependent pattern in prognostic evaluation. Compared with baseline measurements alone, day-7 inflammatory levels and their dynamic changes from T1 to T2 show more stable associations with 90-day unfavorable functional outcomes and mortality, and may provide useful complementary information for clinical risk stratification.