Association of Systemic Inflammation Indexes with 90-Day Functional Outcomes in Acute Ischemic Stroke Patients Undergoing Intravenous Thrombolysis

Weijun Wang,1,* Huiying Huang,2,* Qing Ma,1 Kun Cao1 1Department of Neurology, North Sichuan Medical College, Nanchong, Sichuan, 637000, People’s Republic of China; 2Department of Neurology, People’s Hospital of Leshan, Leshan, Sichuan, 614000, People’s Republic of China*These authors contributed equally to this workCorrespondence: Huiying Huang, Department of Neurology, People’s Hospital of Leshan, No. 639, Huian Road, Shizhong District, Leshan, Sichuan, 614000, People’s Republic of China, Tel +86 2090900, Email [email protected] and Purpose: The neutrophil-to-lymphocyte ratio (NLR) is a well-established inflammatory marker, while newer indices such as the systemic inflammation response index (SIRI), inflammation prognostic index (IPI), systemic immune-inflammation index (SII), and pan-immune-inflammation value (PIV) provide broader insights into systemic inflammation and immune status. This study evaluated the association between these composite indices, their dynamic changes after intravenous thrombolysis, and 90-day outcomes in acute ischemic stroke (AIS).Methods: We retrospectively included AIS patients treated with intravenous rt-PA within 4.5 hours at Leshan People’s Hospital and Qianwei County People’s Hospital (September 2021–January 2025). Hematological parameters at admission and day 7 were used to calculate NLR, SIRI, SII, IPI, and PIV. Outcomes were assessed by the modified Rankin Scale (mRS) at 3 months, categorized as favorable (mRS 0– 2) vs unfavorable (mRS 3– 6), or survival (mRS 0– 5) vs death (mRS 6). Multivariable logistic regression and receiver operating characteristic (ROC) analyses were performed.Results: Among 269 patients, inflammatory indices showed distinct patterns across groups. SII, SIRI, PIV, and IPI increased in patients with unfavorable outcomes or death but decreased in those with favorable outcomes or survival. T2 values and relative changes (FC) were significantly associated with outcomes. In adjusted models, IPI, SIRI, and PIV at T2 and their dynamic changes remained independent predictors, while SII was significant for unfavorable outcomes but marginal for mortality (P = 0.072). ROC analysis showed moderate discrimination (AUC > 0.6), with IPI and SIRI demonstrating the best predictive value.Conclusion: Dynamic changes in composite inflammatory indices after thrombolysis are closely associated with 3-month outcomes in AIS. As simple and reproducible markers derived from routine blood tests, these indices may aid short-term risk stratification and individualized management.Keywords: systemic inflammation index, systemic immune-inflammation index, inflammation prognostic index, pan-immune-inflammation value, acute ischemic stroke, intravenous thrombolysis, retrospective study