Prognostic value of systemic immune-inflammation index (SII), systemic inflammation response index (SIRI) and white blood cell–mean platelet volume ratio (WMR) in predicting mortality in acute ischemic stroke

Abstract

Background & Objective: Systemic inflammatory markers have recently gained attention as potential predictors of clinical outcomes in acute ischemic stroke. This study aimed to evaluate the prognostic value of the Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and White Blood Cell–Mean Platelet Volume Ratio (WMR) in predicting early mortality and neurological status at hospital admission.

Methods: This retrospective study included 140 patients diagnosed with acute ischemic stroke. Demographic data, laboratory parameters, and clinical scores (NIHSS, mRS, GCS) at admission were recorded. Patients were grouped as survivors and non-survivors. Between-group comparisons, correlation analyses, ROC curves, and binary logistic regression were performed to evaluate the predictive role of SII, SIRI, and WMR.

Results: Non-survivors had significantly higher SIRI, SII, and WMR values compared with survivors (p<0.001 for all). SIRI and SII showed moderate positive correlations with baseline NIHSS (r=0.346 and r=0.401) and mRS scores (r=0.368 and r=0.402), while correlating negatively with GCS (r=–0.336 and r=–0.393). ROC analyses demonstrated good diagnostic performance for SIRI (AUC=0.760), SII (AUC=0.724), and WMR (AUC=0.678) in distinguishing mortality. In multivariable logistic regression, SII (OR=36.42; p=0.001), SIRI (OR=1.41; p=0.023), and WMR (OR=0.05; p=0.003) were identified as independent predictors of mortality.

Conclusion: Higher SIRI, SII, and WMR values are strongly associated with early mortality and worse neurological status in acute ischemic stroke. These readily available and low-cost inflammatory indices may assist in rapid risk stratification and early clinical decision-making in the acute phase.