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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Article info
Publication history
Accepted:
June 12,
2020
Received in revised form:
June 2,
2020
Received:
May 6,
2020
Footnotes
Data collection, analysis and manuscript preparation were performed at the University of Illinois at Chicago College of Medicine, Department of Neurology and Rehabilitation.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105057
Copyright
© 2020 Elsevier Inc. All rights reserved.
