Akut Koroner Sendromlu Hastalarda Sistemik İmmün İnflamasyon İndeksi ile Orta Dönem Mortalite Arasındaki İlişki

Year 2024, , 88 - 94, 29.04.2024

Süleyman Akkaya , Umit Cakmak

https://doi.org/10.35440/hutfd.1420567

Abstract

Amaç: Sistemik immün inflamasyon farklı hastalıklar için prognostik bir belirteç olarak araştırılmıştır. Akut koroner sendrom (AKS) patogenezinde inflamatuar basıncın önemli rolü göz önüne alındığında, AKS'li hastaların prognozunu tahmin etmek çok önemlidir. Bu nedenle, AKS hastalarında sistemik immün-inflamasyon indeksi (SII) ile ölçülen inflamatuar basınç ile orta dönem mortalite arasındaki ilişkiyi değerlendirdik.

Materyal ve Metod: Bu tek merkezli, retrospektif çalışmaya 18 yaş üstü 539 AKS hastası (139 USAP, 165 NSTEMI ve 235 STEMI) dahil edildi. Klinik ve laboratuvar parametre özellikleri ile 12 aylık mortalite arasındaki ilişkiyi incelemek için tanımlayıcı istatistikler ve çok değişkenli regresyonlar kullanıldı.

Bulgular: Hastaların ortanca yaşı 58 (IQR 50-67) idi ve hastaların %73,1'i erkekti. Toplam 20 hasta AKS olayından sonraki on iki ay içinde hayatını kaybetti. Ortanca SII düzeyleri STEMI (1301,96) hastalarında en yüksekti, bunu NSTEMI (955,50) ve USAP (595,32) izledi (p<0,001). SII, orta vadeli mortalitenin öngörülmesinde orta derecede başarılı olmuştur (AUC: 0,653, %95 GA: 0,526-0,779, p=0,024). Çok değişkenli analizlerde, SII'deki her 100 birimlik artış orta dönem mortalite riskinde yüzde iki artışla ilişkilendirilmiştir (HR: 1.020, %95 GA: 1.005-1.036, p=0.011).

Sonuç: Daha yüksek SII düzeylerine sahip AKS hastalarının on iki ayda daha yüksek mortalite riskine sahip olduğunu ve daha yüksek SII düzeylerinin altta yatan daha ciddi AKS etiyolojisi ile ilişkili olduğunu gösterdik. İleriye dönük kanıtlarla desteklenirse, SII indeksi hem AKS şiddeti hem de sonraki bir yıllık sağkalım oranları açısından klinisyenlere yol gösterebilir.

Keywords

akut koroner sendrom, sistemik immün-inflamasyon indeksi, mortalite, prognoz, inflamasyon

The Association Between Systemic Immune Inflammation Index and Intermediate-Term Mortality in Patients with Acute Coronary Syndromes

Abstract

Background: ic immune inflammation has been investigated as a prognostic marker for different disea-ses. Considering the pivotal role of inflammation in the pathogenesis of acute coronary syndrome (ACS), it is paramount to predict the prognosis of patients with ACS. Therefore, we evaluated the association between inflammation measured by the systemic immune-inflammation index (SII) and middle-term mortality in patients with ACS.

Materials and Methods: This single-center, retrospective study was composed of 539 patients with ACS (139 unstable angina pectoris [USAP], 165 non-ST-elevation myocardial infarction [NSTEMI], and 235 ST-elevation myocardial infarction [STEMI]) aged over 18 years. Descriptive statistics and multivari-ate regressions were used to examine the association between clinical and laboratory parameter characteristics and 12-month mortality.

Results: The median age of the patients was 58 (50-67) and 73.1% of the patients were male. A total of 20 patients died in the next twelve months after ACS event. The median SII levels were highest in patients with STEMI [1301.96 (816.81-2174.53)] , followed by NSTEMI [955.50 (619.99-1576-06] and USAP [595.32 (437.52-918.27)] (p<0.001). The SII had moderate success for the prediction of the intermediate-term mortality (AUC: 0.653, 95% CI: 0.526-0.779, p=0.024). In multivariate analyses, every 100-unit increase in SII was associated with a two percent increase in the risk of intermediate mortality (OR: 1.020, 95% CI: 1.004-1.037, p=0.016).

Conclusions: We demonstrated that ACS patients with higher SII levels had a higher risk of mortality at twelve months, and higher SII levels were associated with a more severe underlying ACS etiology. If supported by prospective evidence, the SII index may guide clinicians in terms of both ACS severity and subsequent one-year survival rates.

Keywords

acute coronary syndrome, systemic immune-inflammation index, mortality, prognosis, inflammation

References

• 1. Bhatt DL, Lopes RD, Harrington RA. Diagnosis and Treat-ment of Acute Coronary Syndromes: A Review. Jama. 2022;327(7):662-75. Epub 2022/02/16. doi: 10.1001/jama.2022.0358. PubMed PMID: 35166796.
• 2. Kolansky DM. Acute coronary syndromes: morbidity, mor-tality, and pharmacoeconomic burden. Am J Manag Care. 2009;15(2 Suppl):S36-41. Epub 2009/04/16. PubMed PMID: 19355807.
• 3. Nichols M, Townsend N, Scarborough P, Rayner M. Cardio-vascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014;35(42):2950-9. Epub 2014/08/21. doi: 10.1093/eurheartj/ehu299. PubMed PMID: 25139896.
• 4. Lloyd-Jones D, Adams RJ, Brown TM, Carnethon M, Dai S, De Simone G, et al. Executive summary: heart disease and stroke statistics-2010 update a report from the American Heart Association. Circulation. 2010;121(7):948-54.
• 5. Otsuka F, Yasuda S, Noguchi T, Ishibashi-Ueda H. Patholo-gy of coronary atherosclerosis and thrombosis. Cardiovas-cular Diagnosis and Therapy. 2016;6(4):396-408.
• 6. Jebari-Benslaiman S, Galicia-García U, Larrea-Sebal A, Olaetxea JR, Alloza I, Vandenbroeck K, et al. Pathophysiol-ogy of Atherosclerosis. Int J Mol Sci. 2022;23(6). Epub 2022/03/26. doi: 10.3390/ijms23063346. PubMed PMID: 35328769; PubMed Central PMCID: PMC8954705.
• 7. Hansson GK, Libby P, Tabas I. Inflammation and plaque vulnerability. J Intern Med. 2015;278(5):483-93. Epub 2015/08/12. doi: 10.1111/joim.12406. PubMed PMID: 26260307; PubMed Central PMCID: PMC5082111.
• 8. Song B, Bie Y, Feng H, Xie B, Liu M, Zhao F. Inflammatory Factors Driving Atherosclerotic Plaque Progression New In-sights. J Transl Int Med. 2022;10(1):36-47. Epub 2022/06/16. doi: 10.2478/jtim-2022-0012. PubMed PMID: 35702179; PubMed Central PMCID: PMC8997796.
• 9. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-22. Epub 2014/10/02. doi: 10.1158/1078-0432.Ccr-14-0442. PubMed PMID: 25271081.
• 10. Zheng PG, Chen P, Wang LJ, Zhang N. The association of the systemic immune-inflammation index and stent thrombosis in myocardial infarction patients after coronary stent implantation-a retrospectively study. J Thorac Dis. 2023;15(4):1726-33. Epub 2023/05/18. doi: 10.21037/jtd-23-363. PubMed PMID: 37197550; PubMed Central PMCID: PMC10183534.
• 11. Kim T, Sim J, Hong SY, Kim B-W. Systemic Immune-Inflammatory Marker of High Meld Patients Is Associated With Early Mortality After Liver Transplantation. Transplan-tation Proceedings. 2021;53(10):2945-52. doi: https://doi.org/10.1016/j.transproceed.2021.09.039.
• 12. Qin Z, Li H, Wang L, Geng J, Yang Q, Su B, et al. Systemic Immune-Inflammation Index Is Associated With Increased Urinary Albumin Excretion: A Population-Based Study. Front Immunol. 2022;13:863640. Epub 2022/04/08. doi: 10.3389/fimmu.2022.863640. PubMed PMID: 35386695; PubMed Central PMCID: PMC8977553.
• 13. Hong YM, Yoon KT, Cho M. Systemic immune-inflammation index predicts prognosis of sequential thera-py with sorafenib and regorafenib in hepatocellular carci-noma. BMC Cancer. 2021;21(1):569. Epub 2021/05/20. doi: 10.1186/s12885-021-08124-9. PubMed PMID: 34006248; PubMed Central PMCID: PMC8130266.
• 14. Huang J, Zhang Q, Wang R, Ji H, Chen Y, Quan X, et al. Systemic Immune-Inflammatory Index Predicts Clinical Outcomes for Elderly Patients with Acute Myocardial In-farction Receiving Percutaneous Coronary Intervention. Med Sci Monit. 2019;25:9690-701. Epub 2019/12/19. doi: 10.12659/msm.919802. PubMed PMID: 31849367; PubMed Central PMCID: PMC6930700.
• 15. Byrne RA, Rossello X, Coughlan JJ, Barbato E, Berry C, Chieffo A, et al. 2023 ESC Guidelines for the management of acute coronary syndromes: Developed by the task force on the management of acute coronary syndromes of the European Society of Cardiology (ESC). European Heart Journal. 2023;44(38):3720-826. doi: 10.1093/eurheartj/ehad191.
• 16. Kini V, Magid DJ, Luo Q, Masoudi FA, Black B, Moghtaderi A. Trends in Short-, Intermediate-, and Long-Term Mortali-ty Following Hospitalization for Myocardial Infarction Among Medicare Beneficiaries, 2008 to 2018. J Am Heart Assoc. 2023;12(13):e029550. Epub 2023/06/22. doi: 10.1161/jaha.122.029550. PubMed PMID: 37345751; Pub-Med Central PMCID: PMC10356090.
• 17. Shah PK, Lecis D. Inflammation in atherosclerotic cardio-vascular disease. F1000Res. 2019;8. Epub 2019/08/27. doi: 10.12688/f1000research.18901.1. PubMed PMID: 31448091; PubMed Central PMCID: PMC6694447.
• 18. Kong P, Cui ZY, Huang XF, Zhang DD, Guo RJ, Han M. In-flammation and atherosclerosis: signaling pathways and therapeutic intervention. Signal Transduct Target Ther. 2022;7(1):131. Epub 2022/04/24. doi: 10.1038/s41392-022-00955-7. PubMed PMID: 35459215; PubMed Central PMCID: PMC9033871.
• 19. Eisen A, Giugliano RP, Braunwald E. Updates on Acute Coronary Syndrome: A Review. JAMA Cardiol. 2016;1(6):718-30. Epub 2016/07/21. doi: 10.1001/jamacardio.2016.2049. PubMed PMID: 27438381.
• 20. Hennessy T, Soh L, Bowman M, Kurup R, Schultz C, Patel S, et al. The Low Dose Colchicine after Myocardial Infarction (LoDoCo-MI) study: A pilot randomized placebo controlled trial of colchicine following acute myocardial infarction. Am Heart J. 2019;215:62-9. Epub 2019/07/10. doi: 10.1016/j.ahj.2019.06.003. PubMed PMID: 31284074.
• 21. Ridker PM, Everett BM, Thuren T, MacFadyen JG, Chang WH, Ballantyne C, et al. Antiinflammatory Therapy with Canakinumab for Atherosclerotic Disease. New England Journal of Medicine. 2017;377(12):1119-31. doi: 10.1056/NEJMoa1707914. PubMed PMID: 28845751.
• 22. Fan W, Wei C, Liu Y, Sun Q, Tian Y, Wang X, et al. The Prognostic Value of Hematologic Inflammatory Markers in Patients With Acute Coronary Syndrome Undergoing Percu-taneous Coronary Intervention. Clin Appl Thromb Hemost. 2022;28:10760296221146183. Epub 2022/12/27. doi: 10.1177/10760296221146183. PubMed PMID: 36567485; PubMed Central PMCID: PMC9806387.
• 23. Li Q, Ma X, Shao Q, Yang Z, Wang Y, Gao F, et al. Prognos-tic Impact of Multiple Lymphocyte-Based Inflammatory In-dices in Acute Coronary Syndrome Patients. Front Cardio-vasc Med. 2022;9:811790. Epub 2022/05/21. doi: 10.3389/fcvm.2022.811790. PubMed PMID: 35592392; PubMed Central PMCID: PMC9110784.
• 24. Shiyovich A, Gilutz H, Plakht Y. White Blood Cell Subtypes Are Associated with a Greater Long-Term Risk of Death af-ter Acute Myocardial Infarction. Tex Heart Inst J. 2017;44(3):176-88. Epub 2017/08/02. doi: 10.14503/thij-16-5768. PubMed PMID: 28761398; PubMed Central PMCID: PMC5505396.
• 25. Toprak K, Kaplangoray M, Palice A, Taşcanov MB, Altıpar-mak İ H, Biçer A, et al. Ectodysplasin A is associated with the presence and severity of coronary artery disease and poor long-term clinical outcome in patients presenting with ST-elevation myocardial infarction. Acta Clin Belg. 2023;78(4):270-9. Epub 2022/10/28. doi: 10.1080/17843286.2022.2140246. PubMed PMID: 36300335.
• 26. Budzianowski J, Pieszko K, Burchardt P, Rzeźniczak J, Hiczkiewicz J. The Role of Hematological Indices in Pa-tients with Acute Coronary Syndrome. Dis Markers. 2017;2017:3041565. Epub 2017/11/08. doi: 10.1155/2017/3041565. PubMed PMID: 29109595; PubMed Central PMCID: PMC5646322.
• 27. Fest J, Ruiter R, Ikram MA, Voortman T, van Eijck CHJ, Stricker BH. Reference values for white blood-cell-based inflammatory markers in the Rotterdam Study: a popula-tion-based prospective cohort study. Sci Rep. 2018;8(1):10566. Epub 2018/07/14. doi: 10.1038/s41598-018-28646-w. PubMed PMID: 30002404; PubMed Central PMCID: PMC6043609.
• 28. Özkan U, Gürdoğan M, Öztürk C, Demir M, Akkuş Ö F, Yılmaz E, et al. Systemic Immune-Inflammation Index: A Novel Predictor of Coronary Thrombus Burden in Patients with Non-ST Acute Coronary Syndrome. Medicina (Kaunas). 2022;58(2). Epub 2022/02/26. doi: 10.3390/medicina58020143. PubMed PMID: 35208466; PubMed Central PMCID: PMC8875451.
• 29. Dziedzic EA, Gąsior JS, Tuzimek A, Paleczny J, Junka A, Dąbrowski M, et al. Investigation of the Associations of Novel Inflammatory Biomarkers&mdash;Systemic Inflam-matory Index (SII) and Systemic Inflammatory Response Index (SIRI)&mdash;With the Severity of Coronary Artery Disease and Acute Coronary Syndrome Occurrence. Interna-tional Journal of Molecular Sciences. 2022;23(17):9553. PubMed PMID: doi:10.3390/ijms23179553.
• 30. Toprak K, Kaplangöray M, Memioglu T, İnanir M. Is the predictive value of systemic immune-inflammation index superior to traditional markers in ST-elevation myocardial infarction patients? Coron Artery Dis. 2023;34(4):281. Epub 2023/04/27. doi: 10.1097/mca.0000000000001238. Pub-Med PMID: 37102231.
• 31. Özen Y, Erdöl A, Özbay MB, Erdoğan M. The Prognostic Role of the Systemic Inflammatory Index (SII) in Heart Failure Patients: Systemic Inflammatory Index and Heart Failure. International Journal of Current Medical and Bio-logical Sciences. 2023;3(1):45-50.
• 32. Esenboğa K, Kurtul A, Yamantürk YY, Tan TS, Tutar DE. Systemic immune-inflammation index predicts no-reflow phenomenon after primary percutaneous coronary inter-vention. Acta Cardiol. 2022;77(1):59-65. Epub 2021/02/23. doi: 10.1080/00015385.2021.1884786. PubMed PMID: 33612077.
• 33. Yang YL, Wu CH, Hsu PF, Chen SC, Huang SS, Chan WL, et al. Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur J Clin Invest. 2020;50(5):e13230. Epub 2020/04/16. doi: 10.1111/eci.13230. PubMed PMID: 32291748.
• 34. Dey S, Kashav R, Kohli JK, Magoon R, ItiShri, Walian A, et al. Systemic Immune-Inflammation Index Predicts Poor Outcome After Elective Off-Pump CABG: A Retrospective, Single-Center Study. J Cardiothorac Vasc Anesth. 2021;35(8):2397-404. Epub 2020/10/14. doi: 10.1053/j.jvca.2020.09.092. PubMed PMID: 33046365.
• 35. Tahto E, Jadric R, Pojskic L, Kicic E. Neutrophil-to-lymphocyte Ratio and Its Relation with Markers of Inflam-mation and Myocardial Necrosis in Patients with Acute Coronary Syndrome. Med Arch. 2017;71(5):312-5. Epub 2017/12/30. doi: 10.5455/medarh.2017.71.312-315. Pub-Med PMID: 29284896; PubMed Central PMCID: PMC5723203.
• 36. Tanriverdi Z, Gungoren F, Tascanov MB, Besli F, Altiparmak IH. Comparing the Diagnostic Value of the C-Reactive Pro-tein to Albumin Ratio With Other Inflammatory Markers in Patients With Stable Angina Pectoris. Angiology. 2019;71(4):360-5. doi: 10.1177/0003319719897490.