Association between systemic inflammatory markers and all-cause mortality in patients with stroke: a prospective study using data from the UK Biobank

Aimin Wang; Fenglin Wang; Yiming Huang; Qingxia Cui; Yaqi Xu; Wenjing Zhang; Guiya Guo; Wangchen Song; Yujia Kong; Qinghua Wang; Suzhen Wang; Fuyan Shi

doi:10.1016/j.jstrokecerebrovasdis.2024.108076

Association between systemic inflammatory markers and all-cause mortality in patients with stroke: a prospective study using data from the UK Biobank

J Stroke Cerebrovasc Dis. 2024 Oct 9:108076. doi: 10.1016/j.jstrokecerebrovasdis.2024.108076. Online ahead of print.

Authors

Aimin Wang¹, Fenglin Wang², Yiming Huang³, Qingxia Cui⁴, Yaqi Xu⁵, Wenjing Zhang⁶, Guiya Guo⁷, Wangchen Song⁸, Yujia Kong⁹, Qinghua Wang¹⁰, Suzhen Wang¹¹, Fuyan Shi¹²

Affiliations

¹ Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: wam1299253675@163.com.
² Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: wangfenglin202210@163.com.
³ Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: hym033098@163.com.
⁴ Department of Mathematical Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: cuiqx@sdsmu.edu.cn.
⁵ Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: xyaqi1213@163.com.
⁶ Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: wjzhang0120@163.com.
⁷ Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: 13210767112@163.com.
⁸ Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: 17861282239@163.com.
⁹ Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: yujia_kyj80@163.com.
¹⁰ Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: wangqinghua@sdsmu.edu.cn.
¹¹ Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: wangsz@sdsmu.edu.cn.
¹² Department of Health Statistics, School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China. Electronic address: shifuyan@126.com.

PMID: 39393512
DOI: 10.1016/j.jstrokecerebrovasdis.2024.108076

Abstract

Background and aims: The systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) are novel inflammatory biomarkers used to determine various disease prognoses. However, the effects of these systemic inflammatory markers on all-cause mortality in patients with stroke remain unclear.

Methods: We used data from the UK Biobank for this prospective analysis. Overall, 6,020 eligible individuals were included. Over a median follow-up of 13.4 years, 1,233 participants died. we examined the effects of systemic inflammatory markers on all-cause mortality using random survival forest (RSF) and Cox proportional hazards models. Covariate adjustments in the Cox model, selected by RSF, included age, sex, body mass index (BMI), Townsend deprivation index, smoking status, alcohol intake frequency, sleep duration, diabetes, and malignant neoplasms.

Results: In the marginal effect plots and restricted cubic spline analysis for systemic inflammatory markers, LMR exhibited a linear negative correlation, NLR showed a linear positive correlation, and SII and PLR demonstrated a U-shaped association. After covariates were adjusted, the all-cause mortality risk increased by 14% for LMR <4 (hazards ratio [HR]: 1.14, 95% confidence interval [CI]: 1.01-1.29; p = 0.03), by 26% for NLR ≥2 (HR: 1.26; 95% CI: 1.11-1.43; p < 0.001),by 26% for PLR ≥175 (HR: 1.26; 95% CI: 1.07-1.47; p < 0.001), and by 31% for SII ≥526 (HR: 1.31; 95% CI, 1.16-1.47; p = 0.014). In addition, sensitivity analyses, excluding participants who had been followed-up for <2 years and those with malignant neoplasms, yielded results consistent with those of previous research.

Conclusion: SII, NLR, PLR, and LMR significantly correlate with all-cause mortality in stroke patients. Thresholds established by the RSF model could potentially refine prognostic decision-making in stroke care.

Keywords: mortality; random survival forest; stroke; systemic inflammation markers.