Xie Mengdi, Yuan Kang, Zhu Xinyi, Chen Jingjing, Zhang Xiaohao, Xie Yi, Wu Min, Wang Zhaojun, Liu Rui, Liu Xinfeng
Department of Neurology, Jinling Hospital, Nanjing Medical University, Nanjing, People's Republic of China.
Department of Neurology, Affiliated Jinling Hospital, Medical School of Nanjing University, Nanjing, People's Republic of China.
J Inflamm Res. 2023 Apr 17;16:1581-1593. doi: 10.2147/JIR.S399371. eCollection 2023.
Systemic immune inflammation has been investigated as a prognostic marker of different diseases. This study is designed to assess the association of systemic immune-inflammation index (SII) with long-term mortality of stroke-associated pneumonia (SAP) patients.
Patients aged ≥18 years with SAP were selected from the Nanjing Stroke Registry Program in China. We retrospectively evaluated systemic immune-inflammation response with SII and pneumonia severity with the pneumonia severity index and the confusion, uremia, elevated respiratory rate, hypotension, and aged 65 years or older score. To explore the correlation between SII and mortality in SAP patients, multivariable Cox regressions and competing risk regressions were conducted. Mediation analysis was also performed to assess the role of pneumonia severity.
Among 611 patients in the SAP population, death occurred in 164 patients (26.8%) during the median follow-up of 3.0 (1.2-4.6) years. In multivariate analysis, higher SII scores could predict increased mortality in patients with SAP (adjusted hazard ratio 2.061; 95% confidence interval, 1.256-3.383; = 0.004), and the association was mediated by pneumonia severity. Moreover, adding SII to traditional models improved their predictive ability for mortality.
Our study displayed that SII was characterized in SAP patients with different prognoses. Elevated SII scores increased the risk of mortality. Further research is required for the clinical practice of the index among SAP patients.
全身免疫炎症已被作为不同疾病的预后标志物进行研究。本研究旨在评估全身免疫炎症指数（SII）与卒中相关性肺炎（SAP）患者长期死亡率之间的关联。
从中国南京卒中登记项目中选取年龄≥18岁的SAP患者。我们回顾性地用SII评估全身免疫炎症反应，并用肺炎严重程度指数以及意识模糊、尿毒症、呼吸频率升高、低血压和年龄≥65岁评分评估肺炎严重程度。为探讨SII与SAP患者死亡率之间的相关性，进行了多变量Cox回归和竞争风险回归分析。还进行了中介分析以评估肺炎严重程度的作用。
在SAP队列的611例患者中，在3.0（1.2 - 4.6）年的中位随访期间，有164例患者（26.8%）死亡。在多变量分析中，较高的SII评分可预测SAP患者死亡率增加（调整后的风险比为2.061；95%置信区间为1.256 - 3.383；P = 0.004），且这种关联由肺炎严重程度介导。此外，将SII添加到传统模型中可提高其对死亡率的预测能力。
我们的研究表明SII在不同预后的SAP患者中具有特征性。SII评分升高会增加死亡风险。对于该指标在SAP患者中的临床应用，还需要进一步研究。
