J-shaped associations of panimmune inflammatory score and systemic inflammatory response index with stroke in American adults with hypertension: evidence from NHANES 1999–2020

Provisionally accepted

Introduction: Stroke, one of the leading causes of death and disability worldwide, is primarily ischemic and related to hypertension. Hypertension, characterized by systemic chronic inflammation, substantially increases the risk of stroke. This study examines the association between new systemic inflammatory markers (SII, PIV, SIRI) and stroke prevalence in hypertensive US adults using NHANES data. Methods: We analyzed data from hypertensive participants in the 1999–2020 NHANES survey and excluded individuals younger than 20 years, pregnant women, or those with missing data. This resulted in 18,360 individuals. Systemic inflammatory markers (SII, PIV, SIRI) were calculated from blood count data. Hypertension and stroke status were determined by self-report and clinical measurements. Covariates included sociodemographic, lifestyle, and medical history factors. Weighted statistical analyses and multivariate logistic regression models were used to examine associations, with adjustment for various covariates. Ethics approval was obtained from the NCHS Ethics Review Board. Results: In a cohort of 18,360 individuals with hypertension (mean age 56.652 years), 7.25% experienced a stroke. Stroke patients were older, had a lower PIR, and were more likely to be female, single, less educated, smokers, non-drinkers, physically inactive, and have diabetes and coronary artery disease. Multivariate logistic regression showed that SII was not significantly associated with stroke. However, PIV and SIRI were positively associated with stroke prevalence. Each unit increase in lnPIV increased the odds of stroke by 14% (OR = 1.140, p = 0.0022) and lnSIRI by 20.6% (OR = 1.206, p = 0.0144). RCS analyses confirmed J-shaped associations for lnPIV and lnSIRI with stroke. Stratified analyses identified gender and smoking as significant effect modifiers. Smoking was significantly associated with increased PIV, SIRI, and SII scores, particularly in current smokers. Conclusions: Increased PIV and SIRI scores significantly increase stroke prevalence in persons with hypertension, particularly in men and smokers. A prediction model including PIV, SIRI, and sociodemographic factors provides high clinical utility.