Predictive value of the systemic immune-inflammation index in 28-day survival after surgery for intracerebral hemorrhage.

Abstract

Background: Intracerebral hemorrhage (ICH) is a severe cerebrovascular condition posing complex clinical challenges, including poor neurological outcomes and high morbidity. Surgery remains the primary treatment, but reliable prognostic markers are still lacking, thus emphasizing the need for an effective predictive tool.

Methods: This retrospective study analyzed 587 patients with ICH admitted to the Neurosurgery Department and Intensive Care Unit (ICU) at the Third Affiliated Hospital of Anhui Medical University (2015-2019). The collected data included demographics, radiological findings, preoperative and intraoperative parameters, and follow-up outcomes. The Systemic Immune-Inflammation Index (SIRI) was calculated to assess its prognostic value.

Results: Univariate analysis identified the Glasgow Coma Scale (GCS) score, systolic blood pressure, and blood volume as risk factors for postoperative complications. Logistic regression analysis revealed seven key predictors: surgery type, drug-resistant infection, paralysis, gastrointestinal bleeding, GCS score, activated partial thromboplastin time, and SIRI. A nomogram incorporating these factors was developed. Receiver-Operating Characteristic (ROC) analysis showed high predictive accuracy (training set: Area Under the Curve (AUC) = 0.936, sensitivity = 87.5%, specificity = 87.0%, cut off = 0.573; validation set: AUC = 0.915, sensitivity = 79.8%, specificity = 90.4%, cut off = 0.768). Bootstrap validation confirmed the nomogram's robustness. Calibration curves demonstrated high consistency between predicted and actual outcomes. The Hosmer-Lemeshow test showed good model fit (training set: χ² = 2.79, p = 0.95; validation set: χ² = 6.65, p = 0.58). Decision curve analysis supported broad clinical applicability (threshold probabilities: training set 1%-99%, validation set 5%-97%).

Conclusions: The SIRI is an independent risk factor for 28-day mortality. It can serve as a reliable prognostic indicator for patients with ICH who have undergone surgical treatment.