Systemic immune-inflammation index, stress hyperglycemia ratio and triglyceride-glucose index in acute ischemic stroke: an integrated inflammation-stress-metabolism perspective.

BACKGROUND

Acute ischemic stroke (AIS) remains a major cause of mortality and long-term disability worldwide. Increasing evidence suggests that secondary brain injury after AIS is not driven by a single pathological process but results from the complex interaction among neuroinflammation, acute metabolic stress, and chronic metabolic dysfunction. The systemic immune-inflammation index (SII), stress hyperglycemia ratio (SHR), and triglyceride-glucose (TyG) index have emerged as readily available biomarkers reflecting these distinct yet interconnected pathophysiological pathways.

OBJECTIVE

To review the current evidence regarding the associations of SII, SHR, and TyG with disease severity, functional outcomes, and stroke-related complications in AIS, and to explore their complementary value within an integrated inflammation-stress-metabolism framework.

METHODS

This narrative review summarized relevant clinical and mechanistic studies investigating SII, SHR, and TyG in patients with AIS. Evidence was identified primarily through PubMed and supplemented by manual screening of reference lists.

RESULTS

Current evidence indicates that elevated SII is closely associated with inflammatory activation, stroke severity, poor functional outcomes, mortality, and various stroke-related complications. SHR reflects relative hyperglycemia induced by neuroendocrine stress and is associated with early neurological deterioration, hemorrhagic complications, cerebral edema, and adverse prognosis. As a surrogate marker of insulin resistance, TyG is associated with stroke severity, poor neurological recovery, recurrent stroke, and chronic vascular injury. Although these biomarkers originate from different biological pathways, inflammation, stress hyperglycemia, and insulin resistance interact extensively throughout the progression of AIS. Consequently, SII, SHR, and TyG provide complementary information regarding inflammatory burden, acute metabolic stress, and chronic metabolic vulnerability.

CONCLUSION

SII, SHR, and TyG represent three interrelated yet distinct dimensions of AIS pathophysiology. Integrating these biomarkers may provide a more comprehensive assessment of patient risk than any single indicator alone and may improve risk stratification and prognostic evaluation. Future prospective studies are warranted to validate their combined predictive value and establish integrated risk assessment models for AIS.