ORIGINAL RESEARCH article
Front. Neurol.
Sec. Neuroepidemiology
Volume 16 - 2025 | doi: 10.3389/fneur.2025.1603241
This article is part of the Research TopicFrom bench to bedside: Inflammation in Neurovascular Disorders and StrokeView all 12 articles
Systemic Inflammatory Response Index Mediates the Association between Stroke and Hypertension: a cross-sectional study from NHANES 2001 to 2016
Provisionally accepted
Mingzhu Tang1Fangming Diao1Yaxian Dong1Jianpeng Lin1Tiezhu Wang1Lihua Yang1Xuanming Lai1Xiaolian Chen1Jinxi Zuo1Junyang Xu1Yongyuan Chen2*
Hongting Shi1*- 1The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- 2Department of Neurology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong Province, China
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Background: Systemic inflammation plays a vital role in the development of hypertension and stroke. The systemic immune response index (SIRI), calculated from the numbers of neutrophils, monocytes, and lymphocytes, is a promising indicator of immune dysregulation. Yet, its role in mediating the link between hypertension and stroke remains underexplored.Methods: This study analysed data from 9,699 adults aged ≥20 years from the National Health and Nutrition Examination Survey (NHANES) 2001-2016. We used logistics regression analyses, Receiver Operating Characteristic (ROC) curve analyses, mediation analyses, trend tests, restricted cubic splines (RCS) and stratified by sex, to explore the associations between SIRI, hypertension, and stroke.Results: SIRI was significantly associated with stroke (adjusted OR = 1.10, 95% CI: 1.00-1.21, p = 0.047). Hypertension was independently linked to both stroke (adjusted OR = 2.06, 95% CI: 1.42-2.99, p < 0.001) and higher SIRI levels (adjusted β = 1.07, 95% CI: 1.03-1.12, p = 0.002). ROC analysis confirmed strong predictive power for hypertension and SIRI in stroke risk assessment. RCS analysis revealed a nonlinear U-shaped relationship between SIRI and stroke in the overall population and males, but a flatter trend in females. SIRI mediated 1.65% of the hypertension-stroke association (p < 2×10⁻¹⁶), with a stronger effect in males (3.38%) than females (1.16%).Hypertension, SIRI, and stroke were closely related, with SIRI partially mediating their association, particularly in males. SIRI might be potential as a biomarker and therapeutic target for stroke prevention in hypertensive individuals.
Keywords: Stroke, Hypertension, systemic immune response index, Inflammation, Crosssectional study, Mediation
Received: 01 Apr 2025; Accepted: 12 Jun 2025.
Copyright: © 2025 Tang, Diao, Dong, Lin, Wang, Yang, Lai, Chen, Zuo, Xu, Chen and Shi. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Yongyuan Chen, Department of Neurology, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, Guangdong Province, China
Hongting Shi, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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