ArticleHypertension research : official journal of the Japanese Society of Hypertension2026
Systemic immune-inflammation index predicts hemorrhagic transformation after endovascular therapy for ischemic stroke.
Article in Hypertension research : official journal of the Japanese Society of Hypertension, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
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.
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