Systemic immune-inflammatory and inflammatory response indices in hemorrhagic transformation of acute ischemic stroke patients undergoing intravenous thrombolysis: A cohort study.

Hemorrhagic transformation occurred in 15.5% of acute ischemic stroke patients who received intravenous thrombolysis.

• 329 total patients were examined in this retrospective cohort study.
• 51 patients (15.5%) developed hemorrhagic transformation (HT) after thrombolysis.
• Patients were treated with recombinant tissue plasminogen activator (rt-PA) between January 2021 and January 2025.
• Data collection spanned a 4-year period at a single center.

The systemic immune-inflammation index (SII) was an independent risk factor for post-thrombolysis hemorrhagic transformation.

• Multivariable logistic regression yielded an odds ratio of 1.004 (95% CI: 1.002–1.005) for SII.
• The association was statistically significant at P < .001.
• SII was computed from pretreatment hematological parameters.
• The analysis controlled for other variables via multivariable logistic regression modeling.

The systemic inflammatory response index (SIRI) was an independent risk factor for post-thrombolysis hemorrhagic transformation.

• Multivariable logistic regression yielded an odds ratio of 3.133 (95% CI: 1.985–4.945) for SIRI.
• The association was statistically significant at P < .001.
• SIRI was computed from pretreatment hematological parameters.
• The odds ratio for SIRI was substantially larger than that for SII on a per-unit basis.

SII and SIRI had identical and moderate-to-good discriminatory ability for predicting hemorrhagic transformation, each achieving an area under the curve of 0.828.

• Receiver operating characteristic (ROC) curve analysis was used to assess predictive value.
• Both SII and SIRI achieved an area under the curve (AUC) of 0.828.
• The identical AUC values suggest comparable overall predictive performance between the two indices.
• An AUC of 0.828 indicates moderate-to-good discrimination between patients who did and did not develop HT.

The study concluded that SII and SIRI, derived from routine pretreatment blood parameters, can serve as predictive biomarkers for post-thrombolysis hemorrhagic transformation.

• Both indices are calculated from standard hematological parameters available before treatment.
• The retrospective design included patients from January 2021 to January 2025.
• Multivariable logistic regression was used to establish independent associations after adjusting for confounders.
• The authors describe SII and SIRI as potentially useful clinical tools given their accessibility from routine blood tests.