Wang Yufei, Chen Hua
Graduate School, Inner Mongolia Medical University, Hohhot City, China.
Department of Cardiology, Inner Mongolia Autonomous Region People's Hospital, Hohhot City, China.
Front Cardiovasc Med. 2023 Jul 24;10:1208171. doi: 10.3389/fcvm.2023.1208171. eCollection 2023.
This investigation aimed to evaluate the efficacy of the Systemic Inflammatory Response Index (SIRI) in prognosticating short-term all-cause mortality among patients diagnosed with acute myocardial infarction (AMI) in the intensive care unit (ICU).
Clinical data were obtained from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. A total of 4,291 patients were included in the cohort. Results from multivariate regression analyses showed that the quartile of the natural logarithm of SIRI (ln-SIRI) was independently associated with mortality. Compared to patients in the first quartile (Q1), patients in the second quartile (Q2) and fourth quartile (Q4) were significantly associated with an increased risk of 30-day (HR = 2.031, 95% CI: 1.604-2.571, < 0.001 and HR = 1.703, 95% CI: 1.32-2.195, < 0.001) and 90-day all-cause mortality (HR = 2.063, 95% CI: 1.68-2.532, < 0.001 and HR = 1.788, 95% CI: 1.435-2.227, < 0.001), which is consistent with the results of the Kaplan-Meier analysis and the results of multivariate regression analyses by classifying into 12 groups based on dodeciles of SIRI. Curve fitting showed a curvilinear relationship and further threshold saturation effects showed that, for 90-day mortality, each unit increased in ln-SIRI, when the ln-SIRI level is less than 2.9, the patient's mortality increases by 23.2% (OR: 1.232; 95% CI: 1.111-1.367; < 0.001); when the ln-SIRI is greater than 2.9 and less than 4.6, the patient's mortality decreases by 44.4% (OR: 0.554; 95% CI: 0.392-0.789; = 0.001); when ln SIR > 4.6, the patient's mortality increases by 24.7% (OR: 1.247; 95% CI: 1.108-1.404; < 0.001). Moreover, the length of stay in the hospital was lower in patients in the third quartile (Q3) (coefficient: -1.999; 95% CI: -2.834 - -1.165, < 0.001). The length of stay in the ICU was higher in patients in Q2 and Q4 (coefficient: 0.685;95% CI: 0.243-1.128; = 0.0024 and coefficient: 0.989;95% CI: 0.528-1.451; < 0.001). Furthermore, SIRI may outperform NLR in predicting short-term mortality.
SIRI is an independent risk factor for 30- and 90-day mortality, and length of stay in ICU for critical AMI patients.
本研究旨在评估全身炎症反应指数（SIRI）对重症监护病房（ICU）中急性心肌梗死（AMI）患者短期全因死亡率的预测效能。
临床数据取自重症监护医学信息集市-IV（MIMIC-IV）数据库。该队列共纳入4291例患者。多因素回归分析结果显示，SIRI自然对数的四分位数（ln-SIRI）与死亡率独立相关。与第一四分位数（Q1）的患者相比，第二四分位数（Q2）和第四四分位数（Q4）的患者30天（HR = 2.031，95%CI：1.604 - 2.571，P < 0.001和HR = 1.703，95%CI：1.32 - 2.195，P < 0.001）和90天全因死亡率风险显著增加（HR = 2.063，95%CI：1.68 - 2.532，P < 0.001和HR = 1.788，95%CI：1.435 - 2.227，P < 0.001），这与Kaplan-Meier分析结果以及基于SIRI十分位数分为12组的多因素回归分析结果一致。曲线拟合显示呈曲线关系，进一步的阈值饱和效应表明，对于90天死亡率，ln-SIRI每增加一个单位，当ln-SIRI水平小于2.9时，患者死亡率增加23.2%（OR：1.232；95%CI：1.111 - 1.367；P < 0.001）；当ln-SIRI大于2.9且小于4.6时，患者死亡率降低44.4%（OR：0.554；95%CI：0.392 - 0.789；P = 0.001）；当ln SIR > 4.6时，患者死亡率增加24.7%（OR：1.247；95%CI：1.108 - 1.404；P < 0.001）。此外，第三四分位数（Q3）患者的住院时间较短（系数：-1.999；95%CI：-2.834 - -1.165，P < 0.001）。Q2和Q4患者的ICU住院时间较长（系数：0.685；95%CI：0.243 - 1.128；P = 0.0024和系数：0.989；95%CI：0.528 - 1.451；P < 0.001）。此外，在预测短期死亡率方面，SIRI可能优于中性粒细胞与淋巴细胞比值（NLR）。
SIRI是30天和90天死亡率以及重症AMI患者ICU住院时间的独立危险因素。
