LAUSR

We have read with great interest the article by Liu et al, titled “Systemic Immune-Inflammation Index (SII) and Neutrophil-to-Lymphocyte Ratio (NLR): A Strong Predictor of Disease Severity in Large-Artery Atherosclerosis (LAA) Stroke Patients”. 1 This study provides valuable clinical insights into the predictive value of SII and NLR for assessing the severity of LAA stroke. However, upon reflection, we would like to highlight several limitations that were not addressed in the study and propose suggestions for improvement to enhance future research in this area. First, the study does not account for lifestyle factors, such as smoking, alcohol consumption, dietary habits, and physical activity, which can significantly influence systemic inflammatory responses. These lifestyle variables may confound the association between SII, NLR, and stroke severity. For example, smoking is known to elevate inflammation levels, 2 while regular physical activity may reduce it. 3 The absence of adjustment for these factors could lead to potential biases. Future studies should collect detailed information on lifestyle factors and control for their potential effects in statistical analyses to improve the reliability of the findings. Second, while the authors adjusted for certain clinical factors such as age and comorbidities, they did not adequately address the impact of medication use on the results. Drugs like anti-inflammatory agents (eg, aspirin), statins, 4 antiplatelet therapies, or corticosteroids can substantially influence inflammation levels or platelet counts, thereby affecting SII and NLR values. Failure to account for patients’ medication histories could result in biased interpretations. Future research should systematically collect data on medication use and