Clinical Application Of Systemic Immune Inflammatory Index In Acute Ischemic Stroke Patients

Objective:To explore the relationship between the Systemic Immune inflammation Index(SII)and the severity of acute ischemic stroke(AIS)patients,the predictive value of systemic immune inflammation index to Stroke Associated Pneumonia(SAP)and neurological prognosis in acute ischemic stroke patients after 3 months onset.Methods:1.Select patients who have been admitted to the Department of Neurology of the First Affiliated Hospital of Kunming Medical University within 24 hours after onset and meet the diagnostic criteria for ischemic stroke.Collect general and clinical data of the patients within 24 hours after admission.The clinical outcome included the severity of stroke at admission,whether SAP occurred after admission,and the prognosis of after 3 months onset.2.According to the NIHSS score at the time of admission,patients were divided into mild stroke group(NIHSS score≤5 points)and moderate-severe stroke group(NIHSS score≥6 points).The independent risk factors of stroke severity in AIS patients were analyzed by multivariate logistic regression.Spearman correlation analysis was used to evaluate the relationship between blood routine parameters and the severity of stroke in AIS patients.3.According to whether AIS patients are occured SAP within 1 week after onset,patients are divided into SAP group and non-SAP group.The SAP diagnostic criteria refer to the 2019 Chinese Expert Consensus on the Diagnosis and Treatment of Stroke Associated Pneumonia.And independent risk factors of AIS patients were analyzed by multivariate logistic regression,using ROC curve to evaluate the predictive value of SII for SAP.4.According to the mRS score after 3 months onset of AIS patients,the patients were divided into good prognosis group(mRS score≤2 points)and poor prognosis group(mRS score≥3 points).The independent risk factors for the prognosis of AIS patients were analyzed by multivariate logistic regression,using ROC curve to evaluates the predictive value of SII for the poor prognosis of AIS patients.Results:1.Compared with patients in the mild stroke group,patients in moderate-severe stroke group have higher neutrophils,NLR,PLR,and SII,while lymphocytes,platelets were lower.Multivariate logistic regression analysis showed that,after adjusting the mixed factors such as gender,age,etc.NLR(OR=1.203,95%CI1.083～1.338,P<0.05),SII(OR=2.337,95%CI 1.386～3.942,P<0.05)are independent risk factors of stroke severity in AIS patients.Spearman correlation analysis was used to test the correlation between the NIHSS scores and SII.The results showed that there was a positive correlation between SII and the NIHSS scores(P<0.001).2.Compared with patients in non-SAP group,patients in SAP group have higher neutrophils,NLR,PLR,and SII,while lymphocytes,platelets were lower.Multivariate logistic regression analysis showed that,after adjusting the mixed factors such as gender,age,etc.NLR(OR=1.167,95%CI 1.047～1.300,P<0.05),SII(OR=1.978,95%CI 1.128～3.468,P<0.05)are independent risk factors for the occurrence of SAP.The ROC curve found that the area under the curve for SII predicting SAP is 0.742.When SII is at a cut-off value of 0.70,the sensitivity of predicting SAP is 73.9%,and the specificity is 66.9%(P<0.001).3.Compared with patients in the good prognosis group,patients in the poor prognosis group have higher neutrophils,NLR,PLR,and SII,while lymphocytes,platelet were lower.Multivariate logistic regression analysis showed that,after adjusting the mixed factors such as gender,age,etc.NLR(OR=1.143,95%CI 1.021～1.280,P<0.05)、SII(OR=2.023,95%CI 1.095～3.739,P<0.05)are independent risk factors for poor prognosis of AIS patients.The ROC curve found that the area under the curve for SII to predict the prognosis of patients with AIS was 0.702(P<0.001).When SII was at a cut-off value of 0.58,the sensitivity for predicting poor prognosis is 73.1%,and the specificity is 69.7%.When SII is combined with the NIHSS score,the area under the curve is 0.799,it predicts the risk of poor prognosis in AIS patients is more accuracy than SII alone(P<0.001).Conclusions:1.SII is an independent risk factor for the stroke severity of AIS patients,and SII is positively correlated with the stroke severity of AIS patients;2.SII is an independent risk factor for SAP in AIS patients,and has early predictive value for SAP;3.SII is related to the 3-month prognosis of AIS patients.The higher the SII level,the greater the risk of poor prognosis.After combining SII and NIHSS scores,it predicts the risk of poor prognosis in AIS patients is more effective than SII alone.