Department of Cardiology, Chutoen General Medical Center, Kakegawa, Shizuoka, Japan.
Department of Cardiology, Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan.
PLoS One. 2023 Jul 13;18(7):e0288564. doi: 10.1371/journal.pone.0288564. eCollection 2023.
Immune-inflammatory processes are highly associated with the progression of atherosclerosis. The systemic immune-inflammation index (SII) is a potential predictor for clinical outcomes in patients with stroke and ischemic heart disease. Therefore, this study aimed to investigate whether SII can accurately predict the short- and long-term prognoses in patients who underwent carotid artery stenting (CAS) compared to that with C-reactive protein (CRP).
This study was a single-center retrospective investigation. Overall, 129 patients who underwent CAS were categorized into tertiles based on their SII levels. We primarily investigated the long-term major adverse cardiac and cerebrovascular events (MACCE) and secondarily the in-hospital and long-term stroke incidence, as well as all-cause death.
The in-hospital stroke rate tended to increase with a rise in SII (P = 0.13). Over the 5-year follow-up period, the Kaplan-Meier overall incidence of MACCE was 9.3%, 16.3%, and 39.5% in the lowest to highest tertiles, respectively (log-rank trend test, P<0.001). The rates of stroke and MACCE during the long-term follow-up were significantly higher with increasing SII. Cox regression analysis showed that the highest tertile of SII (>647) was a predictor of the incidence of long-term stroke (hazard ratio (HR), 21.3; 95% confidence interval (CI), 2.41-188; P = 0.006) and MACCE (HR, 3.98; 95% CI, 1.80-8.81; P<0.001). However, after adjusting for both SII and CRP, only SII remained a significant independent predictor, whereas CRP became less relevant. The receiver operating characteristic curve analysis of long-term MACCE showed that the area under the curve (AUC) for SII (AUC, 0.72; 95% CI, 0.60-0.84; P<0.001) was greater than that of CRP (AUC, 0.64; 95% CI, 0.51-0.77; P = 0.040).
SII was shown to be an independent predictor of long-term prognosis in patients who underwent CAS and was suggested to be superior to CRP as an inflammatory prognosis predictor.
免疫炎症过程与动脉粥样硬化的进展高度相关。全身性免疫炎症指数（SII）是预测中风和缺血性心脏病患者临床结局的潜在指标。因此，本研究旨在探讨 SII 是否能比 C 反应蛋白（CRP）更准确地预测颈动脉支架置入术（CAS）患者的短期和长期预后。
本研究为单中心回顾性研究。总体上，根据 SII 水平将 129 例行 CAS 的患者分为三分位组。我们主要研究了长期主要不良心脑血管事件（MACCE），其次是住院期间和长期卒中发生率以及全因死亡。
住院期间卒中发生率随 SII 升高而升高（P=0.13）。在 5 年随访期间，最低三分位至最高三分位的总体 MACCE 发生率分别为 9.3%、16.3%和 39.5%（对数秩趋势检验，P<0.001）。随着 SII 的升高，长期随访期间卒中发生率和 MACCE 发生率显著升高。Cox 回归分析显示，SII 最高三分位（>647）是长期卒中（风险比（HR），21.3；95%置信区间（CI），2.41-188；P=0.006）和 MACCE（HR，3.98；95%CI，1.80-8.81；P<0.001）发生的预测因素。然而，在调整 SII 和 CRP 后，只有 SII 仍然是独立的显著预测因素，而 CRP 则变得不那么相关。长期 MACCE 的受试者工作特征曲线分析显示，SII 的曲线下面积（AUC）（AUC，0.72；95%CI，0.60-0.84；P<0.001）大于 CRP（AUC，0.64；95%CI，0.51-0.77；P=0.040）。
SII 是 CAS 患者长期预后的独立预测因素，提示其作为炎症预后预测因子优于 CRP。
