Prognostic value of aggregate index of systemic inflammation in acute ischemic stroke mortality

Year 2025, Volume: 16 Issue: 2, 276 - 282, 30.06.2025

Neslihan Ergün Süzer , Mehmet Ozel

https://doi.org/10.18663/tjcl.1648206

Abstract

Aim: Systemic inflammation plays a key role in the pathophysiology of acute ischemic stroke (AIS), influencing disease severity and outcomes. The Aggregate Index of Systemic Inflammation (AISI) is a novel inflammatory biomarker that integrates multiple hematological parameters. This study aimed to evaluate the prognostic value of AISI in predicting 30-day mortality in AIS patients.

Material and Methods: This retrospective cohort study included patients diagnosed with AIS in the emergency department of a tertiary care hospital between January 1, 2022, and January 1, 2025. AISI was calculated as (Neutrophil count × Monocyte count × Platelet count) / Lymphocyte count, with all components expressed in absolute values (×10⁹/L). The primary outcome was 30-day all-cause mortality. Logistic regression analysis was performed to assess the independent prognostic value of AISI. Model performance was evaluated using accuracy, sensitivity, specificity, and the area under the receiver operating characteristic curve (AUROC).

Results: A total of 663 AIS patients were analyzed, including 573 survivors (86.4%) and 90 non-survivors (13.6%). AISI values were significantly higher in non-survivors compared to survivors (755.4 ± 410.8 vs. 396.7 ± 216.1, p < 0.001). Multivariate logistic regression analysis identified AISI as an independent predictor of 30-day mortality (OR: 1.10, 95% CI: 1.02–1.19, p = 0.040). The AUROC for AISI was 0.820, indicating good discriminatory ability.

Conclusions: AISI was found to be an independent predictor of 30-day mortality in AIS patients, highlighting the potential role of systemic inflammation in stroke prognosis. Given its accessibility and ease of calculation, AISI could serve as a useful marker for early risk stratification in clinical practice. However, further prospective, multicenter studies are needed to validate its clinical utility and compare it with other established inflammatory indices.

Keywords

Acute ischemic stroke , inflammation , mortality

Ethical Statement

This study was approved by the Gazi Yaşargil Education and Research Hosptial’s ethics committee (ethics committee ruling number: 349, date: 07.02.2025).

Supporting Institution

he authors received no financial support for the research and/or authorship of this article.

Akut iskemik inmede sistemik inflamasyonun toplam indeksinin prognostik değeri

Abstract

Amaç: Sistemik inflamasyon, akut iskemik inmenin (Aİİ) patofizyolojisinde kritik bir rol oynayarak hastalık şiddetini ve sonuçlarını etkiler. Sistemik İnflamasyonun Toplam İndeksi (AISI), birden fazla hematolojik parametreyi entegre eden yeni bir inflamatuvar biyobelirteçtir. Bu çalışmada, AISI’nin Aİİ hastalarında 30 günlük mortaliteyi öngörmedeki prognostik değeri değerlendirilmiştir.

Gereç ve Yöntemler: Bu retrospektif kohort çalışmasına, 1 Ocak 2022 ile 1 Ocak 2025 tarihleri arasında üçüncü basamak bir hastanenin acil servisinde Aİİ tanısı alan hastalar dahil edilmiştir. AISI, (Nötrofil sayısı × Monosit sayısı × Trombosit sayısı) / Lenfosit sayısı formülüyle hesaplanmış ve tüm bileşenler mutlak değerler (×10⁹/L) cinsinden ifade edilmiştir. Birincil sonuç değişkeni, 30 günlük tüm nedenlere bağlı mortalite olarak belirlenmiştir. AISI’nin bağımsız prognostik değerini değerlendirmek için lojistik regresyon analizi yapılmış, model performansı doğruluk, duyarlılık, özgüllük ve alıcı işletim karakteristik eğrisi altındaki alan (AUROC) kullanılarak değerlendirilmiştir.

Bulgular: Toplam 663 Aİİ hastası analiz edilmiş, bunlardan 573’ü (%86,4) sağ kalırken, 90’ı (%13,6) yaşamını kaybetmiştir. AISI değerleri, yaşamını kaybeden hastalarda sağ kalanlara kıyasla anlamlı olarak daha yüksek bulunmuştur (755,4 ± 410,8 vs. 396,7 ± 216,1, p < 0,001). Çok değişkenli lojistik regresyon analizinde AISI, 30 günlük mortalitenin bağımsız bir prediktörü olarak belirlenmiştir (OR: 1,10, %95 GA: 1,02 - 1,19, p = 0,040). AISI için AUROC değeri 0,820 olup iyi bir ayırt edici güce işaret etmektedir.

Sonuçlar: AISI, Aİİ hastalarında 30 günlük mortalitenin bağımsız bir öngörücüsü olarak belirlenmiş ve sistemik inflamasyonun inme prognozundaki potansiyel rolünü ortaya koymuştur. Erişilebilirliği ve kolay hesaplanabilirliği göz önüne alındığında, AISI klinik uygulamada erken risk sınıflandırması için faydalı bir belirteç olarak kullanılabilir. Ancak, klinik kullanımının doğrulanması ve diğer yerleşik inflamatuvar indekslerle karşılaştırılması için daha fazla prospektif, çok merkezli çalışmaya ihtiyaç vardır.

Keywords

Akut iskemik inme , inflamasyon , mortalite

References

• He Q, Wang Y, Fang C, Feng Z, Yin M, Huang J et al. Advancing stroke therapy: A deep dive into early phase of ischemic stroke and recanalization. CNS Neurosci Ther 2024; 30: 14634.
• Sakal C, Ak R, Taşçı A, Kırkpantur ED, Ünal Akoğlu E, Cimilli Ozturk T. Admission blood lactate levels of patients diagnosed with cerebrovascular disease effects on short- and long-term mortality risk. Int J Clin Pract 2021; 75: 14161.
• Zubair AS, Sheth KN. Hemorrhagic Conversion of Acute Ischemic Stroke. Neurotherapeutics 2023; 20: 705-11.
• Hou S, Zhang Y, Xia Y, Liu Y, Deng X, Wang W et al. Global, regional, and national epidemiology of ischemic stroke from 1990 to 2021. Eur J Neurol 2024; 31: 16481.
• Kim J, Thayabaranathan T, Donnan GA, Howard G, Howard VJ, Rothwell PM et al. Global stroke statistics 2019. Int J Stroke 2020; 15: 819-38.
• DeLong JH, Ohashi SN, O'Connor KC, Sansing LH. Inflammatory Responses After Ischemic Stroke. Semin Immunopathol 2022; 44: 625-48.
• Koutsaliaris IK, Moschonas IC, Pechlivani LM, Tsouka AN, Tselepis AD. Inflammation, Oxidative Stress, Vascular Aging and Atherosclerotic Ischemic Stroke. Curr Med Chem 2022; 29: 5496-509.
• Lin KB, Fan FH, Cai MQ, Yu Y, Fu CL, Ding LY et al. Systemic immune inflammation index and system inflammation response index are potential biomarkers of atrial fibrillation among the patients presenting with ischemic stroke. Eur J Med Res 2022; 27: 106.
• Zhang Y, Xing Z, Zhou K, Jiang S. The Predictive Role of Systemic Inflammation Response Index (SIRI) in the Prognosis of Stroke Patients. Clin Interv Aging 2021; 16: 1997-2007.
• Ma F, Li L, Xu L, Wu J, Zhang A, Liao J et al. The relationship between systemic inflammation index, systemic immune-inflammatory index, and inflammatory prognostic index and 90-day outcomes in acute ischemic stroke patients treated with intravenous thrombolysis. J Neuroinflammation 2023; 20: 220.
• Göçmen A, Gesoglu Demir T. The Aggregate Index of Systemic Inflammation as a Predictor of Mortality in Stroke Patients. Cureus 2024; 16: 64007.
• Ercan Z, Evren Öztop K, Pınar M, Varim C, Dheir H, Karacaer C et al. The aggregate index of systemic inflammation may predict mortality in COVID-19 patients with chronic renal failure. Eur Rev Med Pharmacol Sci 2023; 27: 3747-52.
• Endres M, Moro MA, Nolte CH, Dames C, Buckwalter MS, Meisel A. Immune Pathways in Etiology, Acute Phase, and Chronic Sequelae of Ischemic Stroke. Circ Res 2022; 130: 1167-86.
• Xie L, He M, Ying C, Chu H. Mechanisms of inflammation after ischemic stroke in brain-peripheral crosstalk. Front Mol Neurosci 2024; 17: 1400808.
• Jayaraj RL, Azimullah S, Beiram R, Jalal FY, Rosenberg GA. Neuroinflammation: friend and foe for ischemic stroke. J Neuroinflammation 2019; 16: 142.
• Xiu J, Lin X, Chen Q, Yu P, Lu J, Yang Y et al. The aggregate index of systemic inflammation (AISI): a novel predictor for hypertension. Front Cardiovasc Med 2023; 10: 1163900.
• Zinellu A, Collu C, Nasser M, Paliogiannis P, Mellino S, Zinellu E et al. The Aggregate Index of Systemic Inflammation (AISI): A Novel Prognostic Biomarker in Idiopathic Pulmonary Fibrosis. J Clin Med 2021; 10: 4134.
• Hosseninia S, Ghobadi H, Garjani K, Hosseini SAH, Aslani MR. Aggregate index of systemic inflammation (AISI) in admission as a reliable predictor of mortality in COPD patients with COVID-19. BMC Pulm Med 2023; 23: 107.
• Zinellu A, Paliogiannis P, Sotgiu E, Mellino S, Mangoni AA, Zinellu E et al. Blood Cell Count Derived Inflammation Indexes in Patients with Idiopathic Pulmonary Fibrosis. Lung 2020; 198: 821-7.