全身炎症反应指数作为急性缺血性脑卒中患者预后预测指标的倾向评分匹配分析

Systemic inflammation response index as a prognostic predictor in patients with acute ischemic stroke: A propensity score matching analysis.

作者信息

Dang Hui, Mao Wenjuan, Wang Shanshan, Sha Jing, Lu Mingjia, Cong Li, Meng Xuegang, Li Hongyan

机构信息

Department of Neurology, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.

Xinjiang Clinical Research Center for Stroke and Neurological Rare Disease, Urumqi, China.

出版信息

Front Neurol. 2023 Jan 10;13:1049241. doi: 10.3389/fneur.2022.1049241. eCollection 2022.

DOI:10.3389/fneur.2022.1049241

PMID:36703636

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9871574/

Abstract

BACKGROUND

Acute ischemic stroke (AIS), the most common type of stroke, is a major cause of morbidity and mortality worldwide. A growing number of studies have demonstrated that inflammation is a critical mechanism in AIS. Being an easily available and effective inflammatory marker, the systemic inflammation response index (SIRI) shows a high association with mortality in patients with cancer and intracerebral hemorrhage. In this study, we evaluated the potential prognostic role of SIRI in critically ill patients with AIS.

METHODS

Clinic data were extracted from the Medical Information Mart data for the Intensive Care IV (MIMIC-IV) database. The optimal cutoff value of SIRI was determined by X-tile software. The primary outcome was the 90-day all-cause mortality, and the secondary outcomes were 30-day and 1-year all-cause mortality of patients with AIS. Cox proportional hazards regression analyses were used to assess the association between SIRI levels and all-cause mortality, and survival curves were estimated using the Kaplan-Meier method. Furthermore, a 1:1 propensity score matching (PSM) method was performed to balance the influence of potential confounding factors.

RESULTS

A total of 2,043 patients were included in our study. X-tile software indicated that the optimal cutoff value of the SIRI for 90-day mortality was 4.57. After PSM, 444 pairs of score-matched patients were generated. Cox proportional hazard model showed that after adjusting for possible confounders, high SIRI level (≥4.57) was independently associated with the 90-day all-cause mortality in the cohort before PSM (HR = 1.56, 95% CI: 1.30-1.89, < 0.001) and the PSM subset (HR = 1.47, 95% CI: 1.16-1.86, = 0.001). The survival curves showed that patients with SIRI ≥4.57 had a significantly lower 90-day survival rate in the cohort before PSM (56.7 vs. 77.3%, < 0.001) and the PSM subset (61.0 vs. 71.8%, = 0.001). Consistently, AIS patients with high SIRI levels (≥4.57) presented a significantly high risk of 30-day and 1-year all-cause mortality before and after PSM.

CONCLUSION

A higher SIRI (≥4.57) was associated with a higher risk of 90-day, 30-day, and 1-year mortality and was an independent risk factor of mortality in patients with acute ischemic stroke.

摘要

背景

急性缺血性卒中（AIS）是最常见的卒中类型，是全球发病和死亡的主要原因。越来越多的研究表明，炎症是AIS的关键机制。全身炎症反应指数（SIRI）作为一种易于获取且有效的炎症标志物，与癌症和脑出血患者的死亡率高度相关。在本研究中，我们评估了SIRI在重症AIS患者中的潜在预后作用。

方法

从重症监护IV的医学信息集市数据（MIMIC-IV）数据库中提取临床数据。SIRI的最佳截断值由X-tile软件确定。主要结局是90天全因死亡率，次要结局是AIS患者的30天和1年全因死亡率。采用Cox比例风险回归分析评估SIRI水平与全因死亡率之间的关联，并使用Kaplan-Meier方法估计生存曲线。此外，采用1:1倾向评分匹配（PSM）方法来平衡潜在混杂因素的影响。

结果

我们的研究共纳入2043例患者。X-tile软件显示，SIRI预测90天死亡率的最佳截断值为4.57。PSM后，生成了444对评分匹配的患者。Cox比例风险模型显示，在调整可能的混杂因素后，高SIRI水平（≥4.57）与PSM前队列（HR = 1.56，95%CI：1.30-1.89，P<0.001）和PSM亚组（HR = 1.47，95%CI：1.16-1.86，P = 0.001）的90天全因死亡率独立相关。生存曲线显示，SIRI≥4.57的患者在PSM前队列中的90天生存率显著较低（56.7%对77.3%，P<0.001），在PSM亚组中也是如此（61.0%对71.8%，P = 0.001）。同样，SIRI水平高（≥4.57）的AIS患者在PSM前后30天和1年全因死亡风险均显著较高。