Trifan Gabriela, Testai Fernando D
Department of Neurology and Rehabilitation, Chicago College of Medicine, University of Illinois, United States.
J Stroke Cerebrovasc Dis. 2020 Sep;29(9):105057. doi: 10.1016/j.jstrokecerebrovasdis.2020.105057. Epub 2020 Jun 26.
In experimental models, enhanced inflammation contributes to secondary brain injury in spontaneous intracerebral hemorrhage (ICH). Several inflammatory markers have investigated in humans with inconclusive results. Here, we report the relationship between Systemic Immune-Inflammation (SII) Index and outcome.
We reviewed the medical records of 239 supratentorial spontaneous ICH patients. Patients were dichotomized based on modified Rankin Scale (mRS) at discharge in good (mRS 0-3) and poor (mRS 4-6) outcome. Demographic, clinical, laboratory and imaging data at admission were compared for both groups. SII index was calculated as [(Platelet counts x Absolute Neutrophil Counts (ANC)/Absolute Lymphocyte Counts (ALC))/1000]. Logistic regression analyses were performed to determine the association between markers of inflammation (ANC, ALC, Platelets, SII index) and outcome adjusting for baseline differences.
Sixty-two percent of patients had poor outcome (median [IQR] age= 60 [52-71] years). Patients with poor outcome had lower Glasgow coma scale, larger hematoma volumes, and higher incidence of diabetes and intraventricular extension (p<0.05 for each variable). In univariate analysis, ANC and SII index were independently associated with poor outcome (p<0.05). In multivariate analysis, only SII index remained significantly associated with poor outcome (OR=1.34, 95% CI=1.04-1.72, p=0.02). ROC analysis showed that adjusted SII index is a good discriminator for poor outcome (AUC=0.89, 95% CI=0.84-0.93; P <0.0001), with the best cut-off value being 0.73 (Sensitivity 95%, Specificity 71%).
In patients with supratentorial spontaneous ICH early SII index is an independent predictor of poor outcome at time of hospital discharge.
在实验模型中，炎症增强会导致自发性脑出血（ICH）后的继发性脑损伤。已有多项研究对人类的几种炎症标志物进行了调查，但结果尚无定论。在此，我们报告全身免疫炎症（SII）指数与预后的关系。
我们回顾了239例幕上自发性ICH患者的病历。根据出院时改良Rankin量表（mRS）将患者分为预后良好（mRS 0 - 3）和预后不良（mRS 4 - 6）两组。比较两组患者入院时的人口统计学、临床、实验室和影像学数据。SII指数的计算方法为[(血小板计数×绝对中性粒细胞计数（ANC）/绝对淋巴细胞计数（ALC）)/1000]。进行逻辑回归分析，以确定炎症标志物（ANC、ALC、血小板、SII指数）与预后之间的关联，并对基线差异进行校正。
62%的患者预后不良（年龄中位数[四分位间距]=60[52 - 71]岁）。预后不良的患者格拉斯哥昏迷量表评分较低、血肿体积较大、糖尿病和脑室扩展的发生率较高（每个变量p<0.05）。在单因素分析中，ANC和SII指数与预后不良独立相关（p<0.05）。在多因素分析中，只有SII指数仍与预后不良显著相关（OR = 1.34，95%CI = 1.04 - 1.72，p = 0.02）。ROC分析表明，校正后的SII指数是预后不良的良好判别指标（AUC = 0.89，95%CI = 0.84 - 0.93；P <0.0001），最佳截断值为0.73（敏感性95%；特异性71%）。
幕上自发性ICH患者早期SII指数是出院时预后不良的独立预测指标。
