SIRI (Systemic Inflammation Response Index) sebagai Prediktor MACE (Major Adverse Cardiovascular Events) pada 1 Tahun pasca-Stroke Iskemik Akut: Studi Kohort Retrospektif

Ulinnuha Fitrianingrum, dr. Indarwati Setyaningsih, Sp.N, Subsp.NKI(K); Dr. dr. Abdul Gofir, M.Sc, Sp.N, Subsp.NIOO(K)

2026 | Tesis-Spesialis | S2 Ilmu Penyakit Saraf

Latar Belakang: Pasien stroke iskemik akut memiliki risiko mengalami MACE selama periode pascastroke. SIRI yang mengintegrasikan jumlah neutrofil, monosit, dan limfosit, berpotensi menjadi biomarker sederhana untuk stratifikasi risiko.

Tujuan: Mengetahui peran SIRI dalam memprediksi MACE pada 1 tahun pasca-stroke iskemik akut.

Metode: Penelitian kohort retrospektif dilakukan menggunakan Stroke Unit Registry RSUP Dr. Sardjito pada pasien stroke iskemik akut dewasa yang dirawat selama Januari–Desember 2023. SIRI dihitung berdasarkan pemeriksaan darah dalam 48 jam pertama. Kejadian MACE dipantau selama satu tahun melalui rekam medis dan/atau wawancara telepon.

Hasil: Sebanyak 253 pasien dianalisis, terdiri dari 117 pasien dengan SIRI >2,52 dan 136 dengan SIRI ?2,52. Nilai cut-off SIRI 2,52 memiliki sensitivitas 61,0%, spesifisitas 67,7%. SIRI >2,52 berhubungan dengan peningkatan risiko MACE pada satu tahun pascastroke iskemik akut (HR 1,56; 95% CI 1,05–2,32; p=0,027). Pasien dengan SIRI tinggi mengalami MACE lebih dini dibandingkan kelompok SIRI rendah (5,9 vs 9,2 bulan; p=0,001). Pada analisis multivariat, SIRI, komorbiditas kardiak, dan keparahan stroke merupakan prediktor independen MACE.

Kesimpulan: SIRI yang lebih tinggi saat admisi dapat menjadi prediktor independen MACE hingga satu tahun pasca-stroke iskemik akut. Prediktor independen lain yaitu komorbiditas kardiak dan keparahan stroke.

Background: Patients with acute ischemic stroke are at increased risk of major adverse cardiovascular events (MACE) during the post-stroke period. The Systemic Inflammation Response Index (SIRI), which integrates neutrophil, monocyte, and lymphocyte counts, may serve as a simple biomarker for risk stratification.

Objective: To determine the role of SIRI in predicting MACE within one year after acute ischemic stroke.

Method: This retrospective cohort study used data from the Stroke Unit Registry of Dr. Sardjito Hospital, Indonesia, including adult patients with acute ischemic stroke admitted between January and December 2023. SIRI was calculated from blood counts obtained within 48 hours of admission. MACE was assessed over one year using medical records and/or telephone interviews.

Results: A total of 253 patients were analyzed, including 117 patients with SIRI >2.52 and 136 with SIRI ?2.52. A SIRI cut-off value of 2.52 yielded a sensitivity of 61.0%, specificity of 67.7%. SIRI >2.52 was associated with an increased risk of MACE within one year after acute ischemic stroke (HR, 1.56; 95% CI, 1.05–2.32; p=0.027). Patients with high SIRI experienced MACE earlier than those with low SIRI (5.9 vs. 9.2 months; p=0.001). In multivariable analysis, SIRI, cardiac comorbidity, and stroke severity were independent predictors of MACE.

Conclusion: Higher SIRI at admission was independently associated with an increased risk of MACE within one year after acute ischemic stroke. Cardiac comorbidities and stroke severity were also identified as independent predictors of MACE.

Kata Kunci : systemic inflammation response index, major adverse cardiovascular events, stroke iskemik/ systemic inflammation response index, major adverse cardiovascular events, ischemic stroke.