What is the clinical evidence from this study?

Study design: Cohort. Population: Intracerebral hemorrhage (n=562). Intervention: Systemic inflammatory indices (MLR, SIRI, AISI) vs. Lower levels of inflammatory indices. Primary outcome: Acute cardiac injury (hs-cTnT >0.014 ng/mL with at least one electrocardiographic abnormality) (OR 1.75, 95% CI 1.04-2.92, p=0.034).

May 20, 2026Open Access

Systemic inflammatory indexes mediate cardiac injury following intracerebral hemorrhage

Key Result

Elevated systemic inflammatory indices, particularly SIRI (OR 1.75), MLR, and AISI, were independently associated with acute cardiac injury following intracerebral hemorrhage.

Study Design

Type

Cohort (n=562)

Multicenter

Structured PICO

Are composite inflammatory indices associated with acute cardiac injury in patients with acute spontaneous intracerebral hemorrhage?

Population

562 patients (age ≥18 years) with acute spontaneous intracerebral hemorrhage (ICH) admitted within 24 h of symptom onset. Excluded: primary intraventricular hemorrhage, secondary ICH, multiple concurrent ICHs, missing key baseline data, or lost to follow-up.

Intervention

Composite inflammatory indices (NLR, PLR, MLR, SII, SIRI, AISI) derived from admission peripheral blood cell counts.

Outcome

Acute cardiac injury, defined as hs-cTnT level >0.014 ng/mL at admission accompanied by at least one electrocardiographic abnormality.surrogate

Systemic inflammatory indices (MLR, SIRI, and AISI) are independently associated with acute cardiac injury following intracerebral hemorrhage and mediate the pathway between neurological severity and mortality.

Main Result

Effect estimate: OR 1.75 (95% CI 1.04-2.92)

p-value: p=0.034

Limitations

Single-center retrospective analysis with a limited sample size, introducing potential selection bias
Key physiological factors such as autonomic function and stress hormones were not assessed
Mediation analysis relied on cross-sectional data, limiting causal inference

Abstract

Background Cardiac injury is a common complication following intracerebral hemorrhage (ICH), contributing to poor prognosis. Systemic inflammation has been proposed as a critical mediator along the brain-heart axis, linking neurological injury to remote cardiac damage. This study aimed to investigate the association between a composite inflammatory indicator and acute cardiac injury following ICH. Methods This single-center retrospective cohort study included patients with ICH admitted within 24 h of symptom onset between 2017 and 2022. Composite inflammatory indices ( N LR, PLR, MLR, SII, SIRI, AISI) were derived from admission peripheral blood cell counts. The primary outcome, acute cardiac injury, was defined as a hs-cTnT level 0.014 ng/mL accompanied by at least one electrocardiographic abnormality. Independent associations were evaluated using multivariable logistic regression, with dose-response relationships assessed via trend tests. Mediation analyses were conducted using PROCESS macro (models 4 and 6). Robustness was examined through stratified and sensitivity analyses. Results Acute cardiac injury occurred in 166 (29.5%) of the 562 patients. The injury group showed significantly elevated levels of MLR, SIRI, and AISI compared to the non-injury group, each of which independently associated with cardiac injury after multivariable adjustment. These inflammatory indices partially mediated the link between lower Glasgow Coma Scale (GCS) scores and cardiac injury. A significant chain mediation pathway was identified: lower GCS → elevated SIRI → increased hs-cTnT → higher 90-day mortality. The findings were robust in stratified and sensitivity analyses. Conclusion MLR, SIRI, and AISI serve as independent factors of acute cardiac injury after intracerebral hemorrhage and play a significant mediating role in the brain-heart axis.

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