Qian Ao, Zheng Longyi, He Hui, Duan Jia, Tang Shuang, Xing Wenli
Department of Cerebrovascular Disease, Suining Central Hospital, Suining, China.
Department of Radiology, School of Medicine, Xiang'an Hospital of Xiamen University, Xiamen University, Xiamen, China.
Front Neurol. 2025 Jan 29;15:1516577. doi: 10.3389/fneur.2024.1516577. eCollection 2024.
The systemic immune-inflammation index (SII) is a composite and easily available inflammation index, which can quantitatively reflect the degree of inflammation. This study aims to investigate the predictive value of admission SII for outcomes of large artery occlusion treated with mechanical thrombectomy (MT).
This retrospective study was conducted at Suining Central Hospital, Sichuan, China. Patients were stratified into quartiles based on their SII. The investigating outcomes included hemorrhagic transformation (HT), malignant brain edema (MBE), 90-day functional outcome, and mortality. The adverse function was defined as the modified Rankin Scale (mRS) score > 2 at the 90-day follow-up. Multivariate analysis was performed to explore the relationships between SII and outcomes. In addition, cases (distinguished from the aforementioned patients) treated with MT + mild hypothermia (MH) were also included to elucidate the relationships between SII/MH and outcomes in a new cohort.
A total of 323 patients treated with MT were included. The observed HT, MBE, adverse function, and mortality rates were 31.9, 25.7, 59.4, and 27.9%, respectively. Multivariate analysis demonstrated that heightened SII was significantly related to HT (odds ratio [OR]: 1.061, 95% confidence interval [CI]: 1.035-1.086, < 0.001), MBE (OR: 1.074, 95% CI: 1.045-1.103, < 0.001), adverse function (OR: 1.061, 95% CI: 1.031-1.092, < 0.001), and mortality (OR: 1.044, 95% CI: 1.018-1.070, = 0.001), after adjusting sex, age, Glasgow Coma Scale (GCS) score at admission, initial National Institutes of Health Stroke Scale (NIHSS) score, baseline Alberta Stroke Program Early Computed Tomography Score (ASPECTS), present HMCAS, occluded vessel region, collateral score and successful revascularization. HT and MBE may partially account for patients with elevated SII's adverse function and mortality. In addition, with the criterion of baseline ASPECTS ≤ 7, a total of 42 patients treated with MT + MH were enrolled to build up a new cohort combined with 72 patients treated with mere MT. The risk role of SII and protect effect of MH were identified for HT (SII-OR: 1.037, 95% CI: 1.001-1.074; MH-OR: 0.361, 95% CI: 0.136-0.957), MBE (SII-OR: 1.063, 95% CI: 1.019-1.109; MH-OR: 0.231, 95% CI: 0.081-0.653), and mortality (SII-OR: 1.048, 95% CI: 1.011-1.087; MH-OR: 0.343, 95% CI: 0.118-0.994).
Elevated SII was related to HT, MBE, 90-day adverse function, and mortality after MT. The MH may improve prognosis under high inflammation status.
全身免疫炎症指数（SII）是一种综合且易于获取的炎症指数，可定量反映炎症程度。本研究旨在探讨入院时SII对机械取栓（MT）治疗大动脉闭塞结局的预测价值。
本回顾性研究在中国四川省遂宁市中心医院进行。根据患者的SII将其分为四分位数。研究结局包括出血性转化（HT）、恶性脑水肿（MBE）、90天功能结局和死亡率。不良功能定义为90天随访时改良Rankin量表（mRS）评分>2。进行多变量分析以探讨SII与结局之间的关系。此外，还纳入了接受MT+轻度低温（MH）治疗的病例（与上述患者区分），以阐明新队列中SII/MH与结局之间的关系。
共纳入323例接受MT治疗的患者。观察到的HT、MBE、不良功能和死亡率分别为31.9%、25.7%、59.4%和27.9%。多变量分析表明，在调整性别、年龄、入院时格拉斯哥昏迷量表（GCS）评分、初始美国国立卫生研究院卒中量表（NIHSS）评分、基线阿尔伯塔卒中项目早期计算机断层扫描评分（ASPECTS）、目前的HMCAS、闭塞血管区域、侧支评分和成功再灌注后，升高的SII与HT（比值比[OR]：1.061，95%置信区间[CI]：1.035-1.086，P<0.001）、MBE（OR：1.074，95%CI：1.045-1.103，P<0.001）、不良功能（OR：1.061，95%CI：1.031-1.092，P<0.001）和死亡率（OR：1.044，95%CI：1.018-1.070，P=0.001）显著相关。HT和MBE可能部分解释了SII升高患者的不良功能和死亡率。此外，以基线ASPECTS≤7为标准，共纳入42例接受MT+MH治疗的患者，与72例仅接受MT治疗的患者组成新队列。确定了SII对HT（SII-OR：1.037，95%CI：1.001-1.074；MH-OR：0.361，95%CI：0.136-0.957）、MBE（SII-OR：1.063，95%CI：1.019-1.109；MH-OR：0.231，95%CI：0.081-0.653）和死亡率（SII-OR：1.048，95%CI：1.011-1.087；MH-OR：0.343，95%CI：0.118-0.994）的风险作用以及MH的保护作用。
升高的SII与MT后的HT、MBE、90天不良功能和死亡率相关。MH可能改善高炎症状态下的预后。
