Objective　The purpose of this study was to investigate the correlation between systemic immune inflammation index (SII) and the total imaging burden of cerebral small vessel disease (CSVD),and to evaluate its predictive value,so as to provide valuable parameters for the early diagnosis and prevention of CSVD.Methods　A total of 268 patients who were admitted to the Department of Neurology of the Affiliated Hospital of Xuzhou Medical University from September 2020 to May 2022 were continuously collected.According to the CSVD total burden score,120 patients were divided into a no and light burden group (0-1 points) and 148 patients were divided into a medium-heavy burden group(2-4 points),and calculated the ratio of SII.Spearman correlation analysis and multivariate regression analysis were used to evaluate the relationship between SII and the total burden of CSVD,and the ROC curve was used to analyze the predictive value of SII for moderate to severe burden of CSVD.Results　Compared with the no and mild burden group,patients in the moderate to severe burden group had higher levels of SII (P<0.001),and results from multivariate regression analysis showed that SII was an independent factor for moderate to severe CSVD burden (OR=1.002,95%CI 1.000-1.004,P=0.028),the ROC curve analysis results showed that the area under the SII curve=0.702 (95%CI 0.640-0.765,P<0.001),the sensitivity was 73.6%,and the specificity was 60.8%.Conclusion　SII was an independent influencing factor of the total burden of moderate-severe CSVD,and was positively correlated with the severity of CSVD.SII had a certain predictive value for the total burden of moderate-severe CSVD.