Systemic inflammation response index as a clinical outcome evaluating tool and prognostic indicator for hospitalized stroke patients: a systematic review and meta-analysis

Abstract

Background Stroke, which is the main element of cerebrovascular disease (CVD), has become the foremost reason for death and disability on a global scale. The systemic inflammation response index (SIRI), a newly developed and comprehensive indicator, has demonstrated promise in forecasting clinical results for diverse ailments. Nevertheless, the uncertainty surrounding the assessment and prediction of clinical outcomes for stroke patients by SIRI persists, and the conflicting findings from the limited studies conducted on this matter further complicate the situation. Consequently, we performed a thorough systematic review and meta-analysis to explore the correlation between SIRI and the clinical results in individuals suffering from stroke. Methods This research was registered in PROSPERO and carried out following the PRISMA guidelines. A thorough investigation was carried out on PubMed, Embase, the Cochrane Library, Web of Science, and Scopus databases. Furthermore, we conducted a manual search in Chinese databases, such as China national Knowledge Infrastructure (CNKI), WanFang, VIP, and China Biology Medicine (CBM). We assessed the potential for bias in the studies included by utilizing the Newcastle–Ottawa Scale (NOS) tool. Adverse clinical outcomes were the main focus of the study, with secondary endpoints including mortality, the predictive value of SIRI, SIRI values across various endpoints, and clinical parameters associated with subarachnoid hemorrhage (SAH) in relation to low and high SIRI group. Results Following rigorous evaluation, a grand total of 22 investigations, encompassing a populace of 12,737 individuals, were considered suitable for incorporation in the final analysis. The findings from our meta-analysis indicate a strong and consistent correlation between elevated SIRI levels and adverse functional outcomes, irrespective of the method used to evaluate unfavorable outcomes. Furthermore, increased SIRI values have a strong correlation with mortality rates in both the short and long term. Besides, SIRI is a useful indicator of the severity of SAH. SIRI demonstrates strong predictive ability in identifying unfavorable outcomes and stroke-related pneumonia (SAP), as higher SIRI values are typically linked to negative endpoints. Nevertheless, the meta-analysis indicated that there was no significant increase in the risk of early neurological deterioration (END) and acute hydrocephalus (AHC) in high SIRI group when comparing to low SIRI. Conclusion This study could potentially pave the way for groundbreaking insights into the relationship between SIRI and stroke patient outcomes, as it appears to be the first meta-analysis to explore this association. Given the critical role of the inflammatory response in stroke recovery, closely monitoring patients with high SIRI levels could represent a promising strategy for mitigating brain damage post-stroke. Thus, further investigation into SIRI and its impact on clinical outcomes is essential. While our initial findings offer valuable insights into this area, continued research is necessary to fully elucidate the potential of SIRI, ideally through dynamic monitoring and large-scale, multi-center studies. Ultimately, this research has the potential to inform clinical decision-making and improve patient outcomes following stroke. Systematic review registration:https://www.crd.york.ac.uk/prospero/; Identifier CRD42023405221.

Higher systemic inflammation response index is associated with increased risk of heart failure in adults: An observational study

“…[24] Huang et al conducted a systemic review and meta-analysis and found that SIRI possessed a high clinical value in indicating the clinical outcome and prognosis in hospitalized stroke patients. [25] Consistent with the positive association between SIRI and CVD mortality reported by previous studies, we observed that a greater SIRI was significantly correlated with elevated risk of HF in adults, indicating that SIRI could be a novel indicator of HF and management of SIRI may alleviate the development of HF in patients.…”

Association of systemic inflammation response index with mortality risk in older patients with hip fracture: a 10-year retrospective cohort study

“…Frontiers in Medicine frontiersin.org found to be an independent predictor of in-hospital death in older patients with acute myocardial infarction (odds ratio [OR] = 3.948, 95% CI: 1.910-8.158) (23). In addition, this positive association between SIRI and mortality has been observed in other diseases (e.g., cancer, coronary artery disease, stroke, asthma, obesity) (20)(21)(22)(25)(26)(27)(28). However, we found that there were no significant differences in the risks of death between second and third tertile.…”

“…Also, SIRI was found to be an independent predictor of in-hospital death in older patients with acute myocardial infarction (odds ratio [OR] = 3.948, 95% CI: 1.910–8.158) ( 23 ). In addition, this positive association between SIRI and mortality has been observed in other diseases (e.g., cancer, coronary artery disease, stroke, asthma, obesity) ( 20 – 22 , 25 – 28 ).…”

“…More recently, the system inflammation response index (SIRI) has been considered as a novel marker that comprehensively reflects the balance between host inflammatory and immune status ( 20 ). Emerging studies indicated that high SIRI level was closely associated with poor prognosis in many diseases, including cancer (e.g., liver cancer, prostate cancer) ( 20 , 21 ), cardiovascular disease (e.g., coronary artery disease, myocardial infarction) ( 22 – 24 ), cerebrovascular disease (e.g., stroke, intracerebral hemorrhage) ( 25 , 26 ), respiratory disease (e.g., asthma) ( 27 ), and obesity ( 28 ). The SIRI is calculated from peripheral neutrophil, monocyte and lymphocyte ( 20 ).…”