A LARGE prospective cohort study has revealed that composite inflammatory markers strongly predict stroke prognosis, with the systemic inflammatory response index (SIRI) emerging as the most reliable marker for identifying patients at risk of stroke recurrence.
Uncertain Predictive Value of Inflammatory Markers
Inflammation has been increasingly recognised as a key contributor to stroke pathophysiology and recurrence risk. Novel composite inflammatory markers have been proposed as prognostic tools, yet their comparative value for stroke outcomes remained understudied and the best-performing marker remained unclear.
Prospective Cohort Analysis of the CNSR-III Registry
Researchers analysed 14,476 participants aged 18 years or older with ischaemic stroke or transient ischaemic attack from the Third China National Stroke Registry (CNSR-III), a prospective cohort. Six composite inflammatory markers were calculated: NLR, PLR, MLR, SII, SIRI, and PIV. The primary outcome was one-year stroke recurrence; secondary outcomes included ischaemic stroke, composite vascular events, mortality, and poor functional outcome (modified Rankin Scale score 2 to 6). Multivariable Cox and logistic regression assessed marker-outcome associations, with XGBoost, IDI, and NRI used to evaluate predictive performance.
SIRI Showed Strongest Predictive Performance for Recurrence
Within one year, 1,403 patients (9.7%) had recurrent stroke, 1,300 (9.0%) had ischaemic stroke, 1,484 (10.3%) had composite vascular events, 483 (3.3%) died, and 2,865 (21.7%) had poor functional outcome. SII, PIV, PLR, NLR, SIRI, and MLR were positively associated with stroke recurrence (log-rank p<0.05). All six markers were also positively associated with ischaemic stroke, composite vascular events, mortality, and poor functional outcome. SIRI showed better predictive performance than the other markers for recurrence. Among eight XGBoost models, the area under the curve rose from 0.598 at baseline to 0.624, the highest value, with the addition of SIRI.
Implications for Stroke Risk Stratification
These findings have confirmed that composite inflammatory markers are associated with adverse stroke outcomes, with SIRI emerging as the strongest predictor of recurrence. As this was an observational study, causality cannot be established, but SIRI could help identify patients at higher risk of recurrent stroke who may benefit from closer monitoring.
Reference
Wu B et al. Predictive value of composite inflammatory markers for stroke prognosis: a prospective cohort study. Ann Clin Transl Neurol. 2026;DOI:10.1002/acn3.70473.
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