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Systemic Immune-Inflammation (SII) index predicts poor outcome after spontaneous supratentorial intracerebral hemorrhage

      Highlights

      • Intracerebral hemorrhage has a high morbidity and mortality rate.
      • Enhanced innate and peripheral immune inflammatory responses after intracerebral hemorrhage contributes to secondary brain injury.
      • The activity of the peripheral immune system can be estimated using the Systemic Immune-Inflammation Index.
      • Systemic Immune-Inflammation Index predicts poor outcome after intracerebral hemorrhage.

      Abstract

      Background and Aims

      In experimental models, enhanced inflammation contributes to secondary brain injury in spontaneous intracerebral hemorrhage (ICH). Several inflammatory markers have investigated in humans with inconclusive results. Here, we report the relationship between Systemic Immune-Inflammation (SII) Index and outcome.

      Methods

      We reviewed the medical records of 239 supratentorial spontaneous ICH patients. Patients were dichotomized based on modified Rankin Scale (mRS) at discharge in good (mRS 0-3) and poor (mRS 4-6) outcome. Demographic, clinical, laboratory and imaging data at admission were compared for both groups. SII index was calculated as [(Platelet counts x Absolute Neutrophil Counts (ANC)/Absolute Lymphocyte Counts (ALC))/1000]. Logistic regression analyses were performed to determine the association between markers of inflammation (ANC, ALC, Platelets, SII index) and outcome adjusting for baseline differences.

      Results

      Sixty-two percent of patients had poor outcome (median [IQR] age= 60 [52-71] years). Patients with poor outcome had lower Glasgow coma scale, larger hematoma volumes, and higher incidence of diabetes and intraventricular extension (p<0.05 for each variable). In univariate analysis, ANC and SII index were independently associated with poor outcome (p<0.05). In multivariate analysis, only SII index remained significantly associated with poor outcome (OR=1.34, 95% CI=1.04-1.72, p=0.02). ROC analysis showed that adjusted SII index is a good discriminator for poor outcome (AUC=0.89, 95% CI=0.84–0.93; P <0.0001), with the best cut-off value being 0.73 (Sensitivity 95%, Specificity 71%).

      Conclusions

      In patients with supratentorial spontaneous ICH early SII index is an independent predictor of poor outcome at time of hospital discharge.

      Keywords

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