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Predictive Value of Composite Inflammatory Markers for Stroke Prognosis: A Prospective Cohort Study
Bing Wu1, Jie-Jie Li1, Jing Jing1
1China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Six novel composite inflammatory markers, including the systemic inflammatory response index (SIRI), are linked to worse stroke prognosis. SIRI showed the strongest predictive ability for stroke recurrence in a large patient study.
Area of Science:
- Neurology
- Cardiology
- Immunology
Background:
- The prognostic value of novel composite inflammatory markers in stroke is not well understood.
- Identifying the best predictor of stroke outcomes requires further investigation.
Purpose of the Study:
- To systematically evaluate the associations between six novel composite inflammatory markers and stroke prognosis.
- To determine the predictive performance of these markers for various adverse outcomes.
Main Methods:
- Analysis of 14,476 participants from the Third China National Stroke Registry (CNSR-III) with ischemic stroke or transient ischemic attack.
- Calculation of neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and pan-immune inflammation value (PIV).
- Assessment of 1-year outcomes including stroke recurrence, ischemic stroke, composite vascular events, mortality, and poor functional outcome using multivariable regression, XGBoost, IDI, and NRI.
Main Results:
- All six markers (SII, PIV, PLR, NLR, SIRI, MLR) were positively associated with stroke recurrence, with hazard ratios indicating increased risk.
- A significant graded increase in stroke risk was observed across increasing quartiles of these markers.
- The systemic inflammatory response index (SIRI) demonstrated superior predictive performance for stroke recurrence compared to the other five markers, and improved XGBoost model accuracy.
Conclusions:
- Novel composite inflammatory markers are significantly associated with an increased risk of adverse outcomes post-stroke.
- The systemic inflammatory response index (SIRI) exhibits stronger predictive capability for stroke recurrence than other evaluated inflammatory markers.
Background:
Novel composite inflammatory markers' role in stroke prognosis is understudied, and the best predictor is unclear, requiring further exploration.
Objectives:
This study aimed to systematically evaluate the associations of 6 novel composite inflammatory markers on stroke prognosis.
Methods:
Based on the Third China National Stroke Registry (CNSR-III), we analyzed 14,476 participants aged ≥ 18 years with ischemic stroke or transient ischemic attack. Novel composite inflammatory markers were calculated, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and pan-immune inflammation value (PIV). Outcomes at 1 year included stroke recurrence (primary outcome) and ischemic stroke, composite vascular events, mortality, and poor functional outcome (mRS 2-6) as secondary outcomes. Multivariable Cox or logistic regression analyses were performed to estimate the association of composite inflammatory markers with these outcomes. XGBoost, IDI, and NRI were utilized to evaluate predictive performance. Additionally, subgroup analyses and sensitivity tests were conducted to assess the robustness of the findings.
Results:
There were 1403 (9.7%), 1300 (9.0%), 1484 (10.3), 483 (3.3%) and 2865 (21.7%) patients with recurrent stroke, ischemic stroke, composite vascular events, mortality, and poor functional outcome within 1 year. SII, PIV, PLR, NLR, SIRI, and MLR were positively associated with stroke recurrence, with hazard ratios (95% CIs) of highest-quartile vs. lowest-quartile 1.39 (1.20, 1.61), 1.40 (1.21, 1.62), 1.16 (1.00, 1.34), 1.42 (1.22, 1.66), 1.38 (1.18, 1.61) and 1.18 (1.02, 1.37), respectively. A graded increase in stroke risk across quartiles was observed (Log-rank p < 0.05). All six markers were positively associated with ischemic stroke, composite vascular events, mortality, and poor functional outcome. SIRI demonstrated better predictive performance [IDI: 0.004 (0.002, 0.007); NRI: 0.082 (0.052, 0.107)] than the other five composite inflammatory markers for stroke recurrence. Among eight XGBoost models, the AUC increased from 0.598 (base) to 0.610 (adding NIHSS/mRS), and further to 0.624 with the addition of SIRI, which was the highest.
Conclusions:
Novel composite inflammatory markers were significantly associated with an increased risk of adverse outcomes in stroke patients. When accounting for the influence of inflammatory markers, SIRI demonstrated stronger predictive ability for stroke recurrence than the other markers.
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