The Significance of Systemic Immune-Inflammatory Index for Mortality Prediction in Diabetic Patients Treated with Off-Pump Coronary Artery Bypass Surgery.

Tomasz Urbanowicz,Michał Rodzki,Piotr Buczkowski,Ahmed Al-Imam,Anna Olasińska-Wiśniewska,Marek Jemielity,Bartłomiej Perek,Michał Michalak,Anna Witkowska,Assad Haneya

doi:10.3390/diagnostics12030634

Abstract

Diabetes mellitus (DM) represents a complex carbohydrate metabolism disorder characterized by inflammatory over-reactivity. The study aimed to investigate the potential influence of postoperative inflammatory activation on mortality risk after off-pump coronary artery bypass grafting in diabetic patients. There were 510 patients treated with off-pump coronary artery bypass grafting due to stable complex coronary artery disease, including 175 patients with type-2 DM (T2DM.) The mean follow-up time was 3.7 +/− 1.5 years with a 9% all-cause mortality rate in the diabetic group. In multivariable analysis, preoperative comorbidities (stroke, peripheral artery disease, postoperative systemic inflammatory index >952, and postoperative left ventricle ejection fraction (LVEF) < 45%) were revealed as prognostic factors. The receiver operator characteristics curve analysis for postoperative calculations of systemic immune-inflammatory index (SII) appeared significant (AUC = 0.698, p = 0.008), yielding sensitivity of 68.75% and specificity of 71.07%. Systemic immune-inflammatory index (SII) can be regarded as a predictive marker for long-term prognosis in diabetic patients after off-pump coronary artery bypass grafting. The role of perioperative inflammatory activation may play a crucial role in mortality prediction.

Highlights

Diabetes mellitus (DM) is a complex carbohydrate metabolism disorder characterized by chronic hyperglycemia that eventually carries a high risk for cardiovascular morbidity [1]
Our study sample comprises 510 consecutive patients, including 175 (34%) with concomitant type 2 diabetes mellitus (T2DM) who are strictly on insulin, who were treated with off-pump coronary artery bypass grafting between January 2015 and December 2018 in our hospital
The univariate Cox regression analysis detected a significant effect of age (HR = 1.09, 95% confidence intervals (95% CI) 1.00–1.17, p = 0.027), and among comorbidities, including stroke (HR = 7.25, 95% CI 2.47–21.27, p < 0.001) and peripheral artery disease (PAD) (HR = 4.35, 95% CI 1.51–12.55, p = 0.050); these are significant factors for the long-term survival in T2DM patients

Summary

Introduction

Diabetes mellitus (DM) is a complex carbohydrate metabolism disorder characterized by chronic hyperglycemia that eventually carries a high risk for cardiovascular morbidity [1]. The most common type 2 diabetes mellitus (T2DM) may induce atherosclerotic plaque development and take part in their progression [2]. Diabetes mellitus is claimed to be related to subclinical inflammatory activation as an underlying primary cause [3]. Inflammatory processes represent a chain of mechanisms triggering its manifestation; this complex metabolic disorder is linked with proinflammatory factor upregulation [4], including interleukin-1 and -6 elevated levels [5], tumor necrosis factor (TNF-alpha) [6], and alpha-1-acid glycoprotein [7]. The endothelium damage markers are released locally or distributed with circulation inflammatory cells and are responsible for atherosclerosis development [8]. Vascular adhesion molecule (VCAM-1), intercellular adhesion molecule (ICAM-1), and e-selectins are involved in vascular permeability and inflammatory activation [9]

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