Systemic immune-inflammatory and inflammatory response indices in hemorrhagic transformation of acute ischemic stroke patients undergoing intravenous thrombolysis

Hemorrhagic transformation (HT) is a frequent complication following intravenous thrombolysis in patients with acute ischemic stroke (AIS). This study investigated the association between the systemic immune-inflammation index (SII) and the systemic inflammatory response index (SIRI) before thrombolysis and HT in patients with AIS. This retrospective analysis included patients with AIS who received intravenous thrombolysis with recombinant tissue plasminogen activator from January 2021 to January 2025. We computed the SII and SIRI using pretreatment hematological parameters. Multivariable logistic regression models were used to evaluate the independent associations of the SII and SIRI with post-thrombolysis HT risk. Receiver operating characteristic curves were employed to evaluate the predictive value of the SII and SIRI for HT. Of the 329 patients examined, 51 (15.5%) had HT. Multivariable logistic models showed that both SII (odds ratio, 1.004; 95% confidence interval, 1.002–1.005; P < .001) and SIRI (odds ratio, 3.133; 95% confidence interval, 1.985–4.945; P < .001) were independent risk factors for HT. For distinguishing HT, SII and SIRI had identical area under the curve values (0.828). This study demonstrates that the SII and SIRI indices can be predictive biomarkers for post-thrombolysis HT.