Increased Systemic Immune-Inflammation Index Is Associated With Delayed Cerebral Ischemia in Aneurysmal Subarachnoid Hemorrhage Patients.

Yi Xu,Sajan Pandey,Quanbin Zhang,Liuwei Chen,Rui Shen

doi:10.3389/fneur.2021.745175

Yi Xu, Sajan Pandey + Show 3 more

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https://doi.org/10.3389/fneur.2021.745175

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Abstract

Background: Systemic immune-inflammation index (SII) is a novel biomarker that reflects the state of a patient's inflammatory and immune status. This study aimed to determine the clinical significance of SII as a predictor of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH).Methods: Retrospective data were collected from aneurysmal SAH patients who had been admitted to our hospital between January 2015 and October 2019. Both univariate and multivariate analyses were performed to investigate whether SII was an independent predictor of DCI. In addition, the receiver operating characteristic (ROC) curve and area under the curve (AUC) were also evaluated.Results: There were 333 patients with aneurysmal SAH included in this study. Multivariate logistic analysis revealed that a modified Fisher grade 3 and 4 score [odds ratio (OR) = 7.851, 95% confidence interval (CI): 2.312–26.661, P = 0.001] and elevated SII (OR = 1.001, 95% CI: 1.001–1.002, P < 0.001) were independent risk factors for DCI. ROC curves showed that SII could predict DCI with an AUC of 0.860 (95% CI: 0.818–0.896, P < 0.001). The optimal cut-off value for SII to predict DCI was 1,424, and an SII ≥ 1,424 could predict DCI with a sensitivity of 93.1% and a specificity of 68.1%. Patients with higher SII value on admission tended to have higher incidence of acute hydrocephalus and DCI, greater modified Fisher and Hunt-Hess scales, and poorer outcomes.Conclusions: SII is an independent predictor of DCI in patients with aneurysmal SAH. The SII system can be implemented in a routine clinical setting to help clinicians diagnose patients with high risk of DCI.

Highlights

Aneurysmal subarachnoid hemorrhage (SAH) is a critical cerebrovascular accident with high financial and disease burdens [1, 2]
Univariate analysis revealed that aneurysmal SAH patients with Delayed cerebral ischemia (DCI) tended to have higher incidence of acute hydrocephalus, to have greater modified Fisher and Hunt-Hess scores, and to be treated by surgical clipping (Table 1)
Multivariate logistic regression analysis demonstrated that modified Fisher grade 3 and 4 score [odds ratio (OR) = 7.851, 95% confidence interval (CI): 2.312–26.661, P = 0.001] and Systemic immune-inflammation index (SII) (OR = 1.001, 95% CI: 1.001–1.002, P < 0.001) were independent risk factors for DCI development (Table 2)

Summary

Introduction

Aneurysmal subarachnoid hemorrhage (SAH) is a critical cerebrovascular accident with high financial and disease (mortality and morbidity) burdens [1, 2]. It is believed that the risks of inflammation and thrombosis may be increased after aneurysmal SAH [3, 4]. Delayed cerebral ischemia (DCI) is often associated with poor functional outcomes in patients who survived the first-time SAH [5, 6]. DCI can lead to poorer prognostic outcomes, greater disease severity, and higher mortality rates in patients with aneurysmal SAH [7]. Identifying aneurysmal SAH patients who are at high risk of DCI can improve the survival outcomes of these patients. This study aimed to determine the clinical significance of SII as a predictor of delayed cerebral ischemia (DCI) in patients with aneurysmal subarachnoid hemorrhage (SAH)

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