Comparison of the predictive performance of systemic immune-inflammation index and neutrophil-to-lymphocyte ratio for three-month poor functional outcome in ischemic stroke: a systematic review and meta-analysis.
Xuan Ma, Yinjuan Zhou, Zhenhua Li et al.
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In 30 seconds
This systematic review and meta-analysis compared the prognostic performance of the systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) for poor functional outcome at three months after ischemic stroke. It included 21 observational studies involving 7520 patients. NLR had a numerically higher area under the curve than SII (0.71, 95% CI: 0.67-0.76 vs. 0.68, 95% CI: 0.64-0.71), but the difference was not statistically significant. Elevated NLR was associated with poor outcome; SII was not significantly associated, although both markers showed moderate effect sizes.
Key findings
- NLR’s AUC was 0.71 (95% CI: 0.67-0.76), compared with 0.68 (95% CI: 0.64-0.71) for SII; the difference was not statistically significant.
- Elevated NLR was associated with poor outcome (OR = 1.26, 95% CI: 1.17-1.37, p < .001); SII was not (OR = 1.00, 95% CI: 1.00-1.00, p = .384).
- Both markers showed moderate effect sizes (SMD: NLR = 0.69, SII = 0.72; p < .001).
- NLR performed better in non-intervention and Chinese subgroups, while SII showed consistent AUC values across treatment and ethnic subgroups.
Why it matters
Three-month functional prognosis can inform risk stratification after ischemic stroke. This synthesis suggests that NLR may offer useful prognostic information and had a numerically higher discriminative performance than SII, while the lack of a statistically significant AUC difference cautions against treating the markers as definitively different. SII’s reported subgroup consistency may also be relevant when considering performance across patient groups.
What to keep in mind
The analysis included observational studies, so the reported associations do not establish causation. The abstract does not report whether study populations or measurement methods varied substantially.