Systemic inflammatory indexes mediate cardiac injury following intracerebral hemorrhage.

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 (NLR, 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.