Inflammatory burden index is associated with poor functional outcome and stroke-associated pneumonia in patients with primary brainstem hemorrhage: a retrospective cohort study
Abstract
Background Primary brainstem hemorrhage (PBH) is a severe, poorly-prognostic stroke subtype. Since single biomarkers cannot reflect global inflammatory status, we constructed a composite Inflammatory Burden Index (IBI) incorporating neutrophil-to-lymphocyte ratio (NLR), C-reactive protein-to-albumin ratio (CAR), and systemic immune-inflammation index (SII), and assessed its links with 90-day poor functional outcome and stroke-associated pneumonia (SAP) in PBH patients. Methods This retrospective cohort included 347 PBH patients (2015–2023). The IBI was calculated as 0.50 × NLRz + 0.30 × CARz + 0.20 × SIIz, where the weights were assigned a priori from a qualitative synthesis of prior literature and expert judgment rather than derived from the study data. Patients were stratified into tertiles. Primary outcome was poor 90-day functional outcome (modified Rankin Scale 3–6). Secondary outcomes were 90-day mortality and SAP. Multivariable logistic regression, restricted cubic spline analysis, and decision curve analysis were performed. Incremental value over a reference clinical model (age, Glasgow Coma Scale, hematoma volume, intraventricular hemorrhage) was assessed via DeLong test, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results The overall rates of poor outcome, mortality, and SAP were 30.3, 12.1, and 16.7%, respectively. Higher IBI tertiles were associated with progressively higher rates of poor functional outcome (18.1,…
How strong is the evidence?
Evidence Hub reads this as a cohort study, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 347 participants or records.
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