Correlation Analysis Between Inflammatory Markers and Stroke Prevalence: A Cross- Sectional Analysis from NHANES 2017–2023

Abstract

Systemic chronic inflammation drives cerebrovascular disease, and composite hematological inflammatory indicators, including Neutrophil-to-Lymphocyte Ratio (NLR), Monocyte-to-Lymphocyte Ratio (MLR), Neutrophil + Monocyte-to-Lymphocyte Ratio (NMLR), Systemic Inflammatory Response Index (SIRI), and Systemic Immune-Inflammation Index (SII), have proven prognostic in acute stroke. However, their comparative value for predicting stroke risk in the general population remains unaddressed. We conducted a cross-sectional study using NHANES 2017–2023 data, including 15,253 adults (658 with self-reported stroke). Survey-weighted analyses compared baseline characteristics, while weighted univariate logistic regression assessed associations between inflammatory indices and stroke risk. Receiver operating characteristic (ROC) curves evaluated diagnostic performance, and a composite scoring system ranked the indicators. Subgroup analyses tested consistency across demographics and comorbidities. All five inflammatory markers were significantly higher in stroke patients (all P < 0.01). NLR, MLR, NMLR, and SIRI correlated positively with stroke risk (OR range: 1.04–1.06, all P < 0.05), but SII did not. SIRI had the largest area under the curve (AUC = 0.597) and the highest composite score (integrating AUC, OR, sensitivity, and specificity). Associations remained consistent across genders, age groups, and individuals with or without diabetes or hypertension. Composite inflammatory indicators, particularly SIRI, may serve as potential biomarkers for stroke risk assessment in the general population. Their moderate diagnostic performance, however, limits standalone use; they are best employed as auxiliary tools in comprehensive risk evaluation.