Evaluation of the Systemic Immune-Inflammatory Index (SII) and NAPLES Score (NS) in Patients with Non-ST-Elevation Myocardial Infarction (NSTEMI)

Year 2024, Volume: 51 Issue: 2, 199 - 206, 14.06.2024

Mesut Gitmez

https://doi.org/10.5798/dicletip.1501102

Abstract

Objective: Non-ST elevation myocardial infarction (NSTEMI) is the most common type of acute coronary syndrome and has a poor prognosis. The SII and NS are derived from blood cell counts and reflects the balance between inherited and acquired immunity and the association between the immune system and endothelial dysfunction. This study aimed to compare the prognostic value of two novel inflammatory biomarkers, the systemic immune-inflammatory index (SII) and the Naples score (NS), with that of other inflammatory markers and risk scores in patients with NSTEMI.
Methods: This was a retrospective cohort analysis of 50 NSTEMI patients and 50 controls matched by age and sex who were admitted to our hospital. We calculated the SII and NS scores and other ratios, indices, and risk scores for each patient. We used Pearson’s correlation coefficient and receiver operating characteristic (ROC) analysis to examine the correlations and predictive values of the SII index, NS score, and other biometric markers and risk scores.
Results: The SII and NS were significantly greater in the NSTEMI group than in the control group. They had strong positive correlations with the NLR, MHR, PLR, and TC/HDL ratio, and moderate positive correlations with TIMI and HEART scores (r>0.3, p<0.01 for both). The SII and NS also had higher AUC values than other biometric markers and risk scores (p<0.05 for both).
Conclusions: The SII and NS are inexpensive, widely available and easy to measure markers that may have utility for cardiac risk stratification in NSTEMI patients.

Keywords

Non ST-elevation myocardial infarction, NAPLES Score, Systemic immune-inflammatory index, Novel inflammatory biomarkers

References

• 1.Collet JP, Thiele H, Barbato E, et al. ESC ScientificDocument Group. 2020 ESC Guidelines for themanagement of acute coronary syndromes in patientspresenting without persistent ST-segment elevation.EurHeart J. 2021;42(14):1289–367.
• 2.Bhatt DL, Lopes RD, Harrington RA. Diagnosis andTreatment of Acute Coronary Syndromes: A Review.JAMA. 2022;327(7):662–75.
• 3.Timmis A. Acute coronary syndromes. BMJ (Clinicalresearch ed.). 2015;351, h5153.
• 4.Terkelsen CJ, Lassen JF, Nørgaard BL, et al. Mortalityrates in patients with ST-elevation vs. non-ST-elevationacute myocardial infarction: observations from anunselected. cohort Eur Heart J. 2005;26(1):18–26.
• 5. Keykhaei M, Ashraf H, Rashedi S, et al. Differences in the 2020 ESC Versus 2015 ESC and 2014 ACC/AHAGuidelines on the Management of Acute CoronarySyndromes in Patients Presenting Without Persistent ST-Segment Elevation. CurrAtheroscler Rep.2021;23(12):77.
• 6.Bursi F, Weston SA, Killian JM, et al. C-reactive proteinand heart failure after myocardial infarction in thecommunity. The Am J Med. 2007;120(7):616–22.
• 7.Fuster V, Lewis A. Conner memorial lecture.Mechanisms leading to myocardial infarction: insightsfrom studies of vascular biology. Circulation.1994;90(4):2126–46.
• 8.Ross R. Atherosclerosis an inflammatory disease. NEngl J Med. 1999;340(2):115–26.
• 9. Kounis NG, Soufras GD, Tsigkas G, et al. White blood cell counts, leukocyte ratios, and eosinophils as inflammatorymarkers in patients with coronary artery disease.ClinApplThrombHemost. 2015;21(2):139-43.
• 10.Yamamoto E, Sugiyama S, Hirata Y, et al. Prognosticsignificance of circulating leukocyte subtype counts inpatients with coronary artery disease. Atherosclerosis.2016;255:210-6.
• 11.Yuan C, Li N, Mao X, et al. Elevated pretreatmentneutrophil/white blood cell ratio and monocyte/lymphocyte ratio predict poor survival in patients with curatively resected non-small cell lung cancer: Results from a large cohort. Thorac Cancer. 2017;8(4):350-8.
• 12.Chen J, Chen MH, Li S, et al. Usefulness of theneutrophil-to-lymphocyte ratio in predicting the severityof coronary artery disease: aGensini score assessment. JAtherosclerThromb. 2014;21:1271–82.
• 13.Song H, Jeong MJ, Cha J, et al. Preoperative neutrophil-to-lymphocyte, platelet-to-lymphocyte and monocyte-to-lymphocyte ratio as a prognostic factor in non-endometrioid endometrial cancer. Int J Med Sci.2021;24;18(16):3712-7.
• 14.Xia Y, Xia C, Wu L, et al. Systemic ImmuneInflammation Index (SII), System Inflammation ResponseIndex (SIRI) and Risk of All-Cause Mortality andCardiovascular Mortality: A 20-Year Follow-Up CohortStudy of 42,875 US Adults. J Clin Med.2023;31;12(3):1128.
• 15.Karadeniz FÖ, Karadeniz Y, Altuntaş E. Systemicimmune-inflammation index, and neutrophilto-lymphocyte and platelet-to-lymphocyte ratios can predict clinical outcomes in patients with acute coronarysyndrome. Cardiovasc J Afr. 2023;5;34:1-7.
• 16. Wang P, Guo X, Zhou Y, et al. Monocyte-to-high-densitylipoprotein ratio and systemic inflammation responseindex are associated with the risk of metabolic disordersand cardiovascular diseases in general rural population.Front Endocrinol (Lausanne). 2022;9;13:944991.
• 17.Candemir M, Kiziltunç E, Nurkoç S, et al. RelationshipBetween Systemic Immune-Inflammation Index (SII) andthe Severity of Stable Coronary Artery Disease. Angiology.2021;72(6):575-581.
• 18.Erdogan A, Genc O, Ozkan E, et al. Impact of NaplesPrognostic Score at Admission on In-Hospital and Follow-Up Outcomes Among Patients with ST-Segment ElevationMyocardial Infarction. Angiology. 2023;9:33197231151559.
• 19.Şaylık F, Çınar T, Selçuk M, et al. Evaluation of NaplesScore for Long-Term Mortality in Patients With ST-Segment Elevation Myocardial Infarction UndergoingPrimary Percutaneous Coronary Intervention. Angiology.2023;14:33197231170982.
• 20.Antman EM, Cohen M, Bernink PJ, et al. The TIMI riskscore for unstable angina/non-ST elevation MI: A methodfor prognostication and therapeutic decision making. JAMA. 2000;16;284(7):835-42.
• 21.Dai S, Huang B, Zou Y, et al. The HEART score is usefulto predict cardiovascular risks and reduces unnecessarycardiac imaging in low-risk patients with acute chest pain.Medicine (Baltimore). 2018;97(22):e10844.
• 22.Galizia G, Lieto E, Auricchio A, et al. Naples PrognosticScore, Based on Nutritional and Inflammatory Status, isan Independent Predictor of Long-term Outcome inPatients Undergoing Surgery for Colorectal Cancer. DisColon Rectum. 2017;60(12):1273-1284.
• 23. Peng SM, Ren JJ, Yu N, et al. The prognostic value of the Naples prognostic score for patients with non-small-celllung cancer. Sci Rep. 2022;6;12(1):5782.
• 24.Orhan AL, Şaylık F, Çiçek V, et al. Evaluating thesystemic immune-inflammation index for in-hospital andlong-term mortality in elderly non-ST-elevationmyocardial infarction patients. Aging ClinExp Res.2022;34(7):1687-1695.
• 25.Eyüboğlu M. Predictive Value of Combination ofNeutrophil-Lymphocyte Ratio and Platelet-LymphocyteRatio for Prognosis. Angiology. 2016;67(2):195.
• 26.Zhang S, Diao J, Qi C, et al. Predictive value ofneutrophil to lymphocyte ratio in patients with acute STsegment elevation myocardial infarction afterpercutaneous coronary intervention: a meta-analysis.BMC Cardiovasc Disord. 2018;2;18(1):75.
• 27.Dong G, Huang A, Liu L. Platelet-to-lymphocyte ratioand prognosis in STEMI: A meta-analysis. Eur J ClinInvest. 2021;51(3):e13386.
• 28.Tang Y, Zeng X, Feng Y, et al. Association of SystemicImmune-Inflammation Index With Short-Term Mortalityof Congestive Heart Failure: A Retrospective CohortStudy. Front Cardiovasc Med. 2021;12;8:753133.
• 29.Kelesoglu S, Yilmaz Y, Elcık D, et al. Systemic ImmuneInflammation Index: A Novel Predictor of Contrast-Induced Nephropathy in Patients With Non-ST SegmentElevation Myocardial Infarction. Angiology.2021;72(9):889-95.
• 30.Güzel T, Kış M. Correlation Between Coronary LesionSeverity Detected in Fractional Flow Reserve withSystemic Immune Inflammation Index and AtherogenicPlasma Index. Bagcilar Med Bull. 2022;7(3):247-55.