# Prognostic significance of systemic inflammation response index, systemic immune-inflammation index and neutrophil-to-lymphocyte ratio in patients with chronic subdural hematoma after burr hole drainage

## TL;DR

This study finds that blood markers like SIRI and NLR can predict recovery outcomes in patients treated for chronic subdural hematoma.

## Contribution

This is the first study to examine the prognostic significance of SIRI in patients with chronic subdural hematoma.

## Key findings

- SIRI and NLR were independent risk factors for poor prognosis in CSDH patients.
- Adding SIRI to a basic model improved predictive accuracy and model-fitting compared to NLR.
- The combined model of SIRI and NLR showed the highest predictive accuracy (C-index 0.865).

## Abstract

Systemic Inflammation Response Index (SIRI), Systemic Immune-Inflammation Index (SII), and Neutrophil-to-Lymphocyte Ratio (NLR) are novel immune inflammatory markers that have been proven to have excellent predictive value for many diseases. The aim of this study was to investigate the prognostic value of SIRI, SII, and NLR for functional outcome at 1 month post-discharge in chronic subdural hematoma (CSDH) patients after burr hole draining.

This retrospective analysis used a database of CSHD patients who underwent burr hole drainage from the Department of Neurosurgery at Deyang People’s Hospital from June 1, 2019 to December 31, 2023. Poor prognosis was defined as a Modified Rankine Scale (mRS) score of 3–6 at 1 month post-discharge. Univariate analysis and multivariate logistic regression analysis were used to assess the correlation between the indicators and outcomes. Harrell’s concordance index (C-index), and Akaike information criterion (AIC) were used to assess the predictive accuracy and model-fitting of predictive models.

A total of 445 patients were enrolled in the final analysis, of whom 90 (20.22%) developed poor prognosis. SIRI (p = 0.019), and NLR (p = 0.045) were independent risk factors for poor prognosis. The Area Under the Curve (AUC) value of SIRI was 0.765 and the optimal cutoff point was 3.09 × 109/L. The AUC value of NLR was 0.771 and the optimal cutoff point was 5.53. The “Basic model + NLR” had the C-index value (0.861) and AIC value (325.61). The “Basic model + SIRI” had the C-index value (0.862) and AIC (321.98). The “Basic model + SIRI + NLR” had the C-index value (0.865) and AIC value (322.00).

To our knowledge, this is the first study to examine the prognostic significance of admission SIRI in CSDH patients. In this study, SIRI and NLR had prognostic significance in CSDH patients after burr hole drainage. When combined with the basic model (history of ischemic stroke, brain herniation, admission GCS, anticoagulant or antiplatelet therapy), the SIRI has better predictive accuracy (C-index 0.862 vs. 0.861) and model-fitting (AIC 321.98 vs. 325.61) than NLR.