Pan Xiaodong, Xu Junnan, Wu He, Wang Jie, Kong Wanquan
Emergency Department, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China.
Heliyon. 2024 Feb 16;10(4):e26569. doi: 10.1016/j.heliyon.2024.e26569. eCollection 2024 Feb 29.
Inflammation is critical in the etiology and progression of acute respiratory distress syndrome (ARDS). This study aims to rigorously assess the predictive capacity of systemic immune-inflammation index (SII) in determining the outcomes of patients with ARDS.
Patient data were extracted from version 2.2 of the Medical Information Mart for Intensive Care IV (MIMIC-IV). The Receiver Operating Characteristic (ROC) curve was deployed to determine the optimal cutoff value for the SII, facilitating the stratification of participants into distinct cohorts based on SII levels. The relationship between SII and survival outcomes was rigorously evaluated using Cox proportional hazards models. The association between SII and patient survival was rigorously examined using Cox proportional-hazard models. The impact of varying SII levels on mortality was quantitatively assessed through these models, with the results articulated as hazard ratios (HRs) and 95% confidence intervals (CIs). Three distinct models were formulated for this analysis: Model 1 employed univariate Cox regression to relate SII with mortality; Model 2 introduced adjustments for age and sex; and Model 3 extended these adjustments to include age, sex, race, SAPS II, APSIII, Hemoglobin, Albumin, Pneumonia, SpO2, and SBP.
Post-application of the inclusion criteria, a cohort of 976 eligible patients was delineated for detailed examination. Univariate analysis focusing on 30-day mortality within the SII ≥1694, the hazard ratio (HR) was 1.42 (95% confidence interval (CI): 1.11, 1.81). However, after adjusting for confounding factors such as age, sex, race, Simplified Acute Physiology Score II (SAPS II), Acute Physiology Score (APS) III, Hemoglobin, Albumin, Pneumonia, SpO2, and Systolic Blood Pressure (SBP), an SII value of ≥1694 was identified as an independent and significant risk factor for mortality in patients with ARDS, with an HR of 1.38 (95% CI: 1.08-1.77, = 0.0016). This trend was consistent for 90-day and one-year mortality rates.
SII surfaced as an autonomous determinant of mortality in ARDS patients, affirming its status as an accessible and dependable prognostic indicator for individuals newly diagnosed with this critical condition. Additional research is imperative to further elucidate the prognostic implications of SII in the therapeutic management of patients with ARDS.
炎症在急性呼吸窘迫综合征（ARDS）的病因和进展中起关键作用。本研究旨在严格评估全身免疫炎症指数（SII）在确定ARDS患者预后方面的预测能力。
从重症监护医学信息数据库第四版（MIMIC-IV）2.2版本中提取患者数据。采用受试者工作特征（ROC）曲线确定SII的最佳截断值，以便根据SII水平将参与者分层为不同队列。使用Cox比例风险模型严格评估SII与生存结果之间的关系。使用Cox比例风险模型严格检验SII与患者生存之间的关联。通过这些模型定量评估不同SII水平对死亡率的影响，结果以风险比（HRs）和95%置信区间（CIs）表示。为此分析制定了三个不同的模型：模型1采用单变量Cox回归将SII与死亡率相关联；模型2对年龄和性别进行了调整；模型3将这些调整扩展到包括年龄、性别、种族、简化急性生理学评分II（SAPS II）、急性生理学评分（APS）III、血红蛋白、白蛋白、肺炎、血氧饱和度（SpO2）和收缩压（SBP）。
应用纳入标准后，划定了一组976例符合条件的患者进行详细检查。单变量分析聚焦于SII≥1694时的30天死亡率，风险比（HR）为1.42（95%置信区间（CI）：1.11，1.81）。然而，在对年龄、性别、种族、简化急性生理学评分II（SAPS II）、急性生理学评分（APS）III、血红蛋白、白蛋白、肺炎、血氧饱和度（SpO2）和收缩压（SBP）等混杂因素进行调整后，SII值≥1694被确定为ARDS患者死亡的独立且显著的风险因素，HR为1.38（95%CI：1.08 - 1.77，P = 0.0016）。90天和1年死亡率也呈现出这种趋势。
SII是ARDS患者死亡率的一个独立决定因素，证实了其作为新诊断为此严重疾病患者的一个可获取且可靠的预后指标的地位。需要进一步的研究来进一步阐明SII在ARDS患者治疗管理中的预后意义。
