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<p>The systemic immune-inflammation index (SII) has emerged as a novel biomarker in vascular diseases. We investigated its association with hemorrhagic transformation after endovascular therapy (EVT), stress hyperglycemia ratio (SHR), early neurological deterioration (END), and long-term clinical outcomes in acute ischemic stroke. We screened consecutive ischemic stroke patients eligible for EVT between May 2014 and May 2025. Inclusion criteria were: (1) availability of admission SII, calculated as platelets×neutrophils/lymphocytes [10³/µL]; and (2) assessment of symptomatic intracerebral hemorrhage (ICH) after EVT, defined as an NIHSS score worsening ≥4. SHR was defined as admission glucose [mg/dL]/(28.7 × HbA1c [%]–46.7). END was defined as neurological worsening of NIHSS ≥ 2 within 72 h after admission. An unfavorable outcome was defined as an mRS score of 4–6 at 3 months. Of 336 screened patients, 317 (161 men; median age, 80 years) were included. Symptomatic ICH was observed in 30 (9%). Higher SII was significantly associated with symptomatic ICH across all multivariable models (<i>p</i> &lt; 0.005). Higher SII was also associated with Safe Implementation of Treatments in Stroke–Monitoring Study (SITS-MOST)-defined parenchymal hematoma type 2 and type 1 at 24 h after EVT (<i>p</i> &lt; 0.005). In addition, SII positively correlated with SHR (B 1090, 95% CI 636 – 1544, <i>p</i> &lt; 0.001), and was associated with END (PR 1.119, 95% CI 1.002 – 1.249, <i>p</i> = 0.045) and unfavorable outcome (PR 1.119, 95% CI 1.029 – 1.217, <i>p</i> = 0.009). Elevated SII reflects acute immune–inflammatory imbalance and stress response in ischemic stroke undergoing EVT and may serve as a predictor of hemorrhagic complications and unfavorable outcomes.</p><p></p>

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Systemic immune-inflammation index predicts hemorrhagic transformation after endovascular therapy for ischemic stroke

  • 期刊论文

  • 发表日期：

    2026年7月21日

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  • Takeo Sato,
  • Yuki Hamada,
  • Kyosuke Hamada,
  • Takumi Shimada,
  • Yutaro Kawabata,
  • Kana Iwamoto,
  • Mei Ikeda,
  • Go Takaguchi,
  • Yujiro Higuchi,
  • Hideki Matsuoka,
  • Hiroshi Takashima

摘要

The systemic immune-inflammation index (SII) has emerged as a novel biomarker in vascular diseases. We investigated its association with hemorrhagic transformation after endovascular therapy (EVT), stress hyperglycemia ratio (SHR), early neurological deterioration (END), and long-term clinical outcomes in acute ischemic stroke. We screened consecutive ischemic stroke patients eligible for EVT between May 2014 and May 2025. Inclusion criteria were: (1) availability of admission SII, calculated as platelets×neutrophils/lymphocytes [10³/µL]; and (2) assessment of symptomatic intracerebral hemorrhage (ICH) after EVT, defined as an NIHSS score worsening ≥4. SHR was defined as admission glucose [mg/dL]/(28.7 × HbA1c [%]–46.7). END was defined as neurological worsening of NIHSS ≥ 2 within 72 h after admission. An unfavorable outcome was defined as an mRS score of 4–6 at 3 months. Of 336 screened patients, 317 (161 men; median age, 80 years) were included. Symptomatic ICH was observed in 30 (9%). Higher SII was significantly associated with symptomatic ICH across all multivariable models (p < 0.005). Higher SII was also associated with Safe Implementation of Treatments in Stroke–Monitoring Study (SITS-MOST)-defined parenchymal hematoma type 2 and type 1 at 24 h after EVT (p < 0.005). In addition, SII positively correlated with SHR (B 1090, 95% CI 636 – 1544, p < 0.001), and was associated with END (PR 1.119, 95% CI 1.002 – 1.249, p = 0.045) and unfavorable outcome (PR 1.119, 95% CI 1.029 – 1.217, p = 0.009). Elevated SII reflects acute immune–inflammatory imbalance and stress response in ischemic stroke undergoing EVT and may serve as a predictor of hemorrhagic complications and unfavorable outcomes.