Prognostic value of systemic immune-inflammatory index in hospitalized adolescent COVID-19 patients

Yıl 2025, Cilt: 35 Sayı: 1, 123 - 128, 28.02.2025

Hanife Tuğçe Çağlar , Sevgi Pekcan , Gökçen Ünal , Fatih Ercan , Aslı İmran Yılmaz , Ozge Metin , Mustafa Gençeli , Mehmet Özdemir , Fatma Nur Ayman , Suat Savaş , Bahar Ece Tokdemir

https://doi.org/10.54005/geneltip.1544462

Öz

Background: A new parameter called systemic immune-inflammatory index (SII), which is based on neutrophil-lymphocyte ratio (NLR) and platelet count, is used to examine the inflammatory and immune status of patients. The aim of this study was to evaluate the prognostic value of SII in adolescents diagnosed with COVID-19 and to compare SII with other biomarkers such as C-reactive protein (CRP)/albumin (Alb) ratio, D-dimer, lactate and NLR.
Methods: The medical records of hospitalized adolescent COVID-19 patients between April 1, 2020, and March 31, 2022, were retrospectively reviewed. A cut-off value for SII was obtained to examine the predictive value of SII for intensive care unit (ICU) admission as the primary outcome.
Results: A total of 177 patients with a mean age of 165.89 ± 26.60 months were included in the study. 97 (54.8%) of the patients were male. The most common presenting symptom was fever (n:102, 57.6%). Median (IQR) SII was 799 (951), lactate 1.9 (1.53), NLR 10.19 ± 6.77 and CRP/Alb ratio 1.55 (2.61). The cut-off value for SII in predicting ICU admission was ≥1111 (sensitivity, 78.6%; specificity, 75.2%; +likelihood ratio, (3.32); -likelihood ratio, 0.30; AUC:0.768) (p<0.001). While SII and CRP/Alb ratio were better than lactate in predicting ICU admission (p = 0.03 and p = 0.04, respectively), there was no statistical difference between SII and CRP/Alb ratio (p > 0.05).
Conclusion: The results of this study suggest that a high SII during hospitalization is associated with an increased likelihood of ICU admission in patients hospitalized with COVID-19. Although additional studies are needed to confirm and validate these findings, the evidence of this study supports SII is a valuable prognostic predictor of hospitilized patients with COVID-19.

Anahtar Kelimeler

Adolescent, COVID-19, prognosis, systemic immune-inflammatory index

Hastanede yatan adölesan COVID-19 hastalarında sistemik immün-inflamatuvar indeksin prognostik değeri

Öz

Giriş: Nötrofil-lenfosit oranı (NLR) ve trombosit sayısına dayanan sistemik immün-inflamatuar indeks (SII) adı verilen yeni bir parametre, hastaların inflamatuar ve immün durumunu aynı anda değerlendirmek için kullanılmaktadır. Bu çalışmanın amacı COVID-19 tanısı alan adölesanlarda SII'nin prognostik değerini değerlendirmek ve SII'yi C-reaktif protein (CRP) / albümin (Alb) oranı, D-dimer, laktat ve NLR gibi diğer prognostik belirteçlerle karşılaştırmaktır.
Gereçler ve Yöntem: Hastanede yatan adölesan COVID-19 hastalarının 1 Nisan 2020 ve 31 Mart 2022 tarihleri arasındaki tıbbi kayıtları retrospektif olarak incelendi. Birincil sonlanım noktası olarak yoğun bakım ünitesine kabul kullanıldı. SII'nin yoğun bakım ünitesine kabul için öngörücü değeri hesaplandı ve diğer biobelirteçler ile karşılaştırıldı.
Bulgular: Yaş ortalaması 165,89 ± 26,60 ay olan 177 hasta çalışmaya dahil edilmiştir. Hastaların 97 (54,8%) tanesi erkekti. En sık görülen başvuru semptomu ateşti (n:102, %57,6). SII 799 (951), laktat 1.9 (1.53), NLR 10.19 ± 6.77 ve CRP/Alb oranı 1.55 (2.61) idi. Yoğun bakım kabulü öngörmede SII için cut-off değeri ≥1111 idi (sensitivite, 78,6%; spesivite, 75,2%; +Likelihood ratio, (3,32); -likelihood ratio, 0,30; AUC:0,768) (p<0,001). SII ve CRP/Alb oranı yoğun bakıma kabulü öngörmede laktattan daha iyi iken (sırasıyla p = 0,03 ve p = 0,04), SII ve CRP/Alb oranı arasında istatistiksel fark yoktu (p > 0,05).
Sonuç: Bu çalışmanın sonuçları, COVID-19 ile hastaneye yatırılan adölesan hastalarda hastaneye yatış sırasında yüksek SII'nin artmış yoğun bakım kabulü ile ilişkili olduğunu göstermektedir. Bu bulguları doğrulamak ve geçerli kılmak için ek çalışmalara ihtiyaç duyulmasına rağmen, bu çalışmadan elde edilen kanıtlar, COVID-19 hastalarında hastane içi sonuçların değerli bir prognostik göstergesi olarak SII'nin potansiyel faydasını desteklemektedir.

Anahtar Kelimeler

adölesan, COVID-19, prognoz, sistemik immün-inflamatuvar indeks

Kaynakça

• 1. World Health Organization Coronavirus (COVID-19) Dashboard. https://covid19.who.int/ (Accessed August 1, 2024).
• 2. Bi Q, Wu Y, Mei S, Ye C, Zou X, Zhang Z, et al. Epidemiology and transmission of COVID-19 in 391 cases and 1286 of their close contacts in Shenzhen, China: a retrospective cohort study. Lancet Infect Dis. 2020;20(8):911-919.
• 3. Hoang A, Chorath K, Moreira M, Evans M, Burmeister-Morton F, Burmeister F, et al. COVID-19 in 7780 pediatric patients: a systematic review. EClinicalMedicine. 2020;24(100433).
• 4. Morand A., Fabre A, Minodier P, Boutin A, Vanel N, Bosdure E, et al. COVID-19 virus and children: What do we know? Arch Pediatr 2020;27(3):117-8.
• 5. Sperotto F, Friedman KG, Son MBF, VanderPluym CJ, Newburger JW, Dionne A. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr. 2021;180(2):307-322.
• 6. Çağlar HT, Pekcan S, Yılmaz Aİ, Ünal G, Metin Akcan Ö, Ünsaçar MZ, et al. Delta variant effect on the clinical course of adolescent COVID-19 patients. Pediatr Pulmonol. 2023;58(1):115-121.
• 7. Alifano M. Systemic immune-inflammation index and prognosis of advanced non-small cell lung cancer. Ann Transl Med. 2020;8(11):667.
• 8. 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.
• 9. Trifan G, Testai FD. Systemic Immune-Inflammation (SII) index predicts poor outcome after spontaneous supratentorial intracerebral hemorrhage. J Stroke Cerebrovasc Dis. 2020;29(9):105057.
• 10. Seo M, Yamada T, Morita T, Frukawa Y, Tamaki S, Iwasaki Y, et al. Prognostic value of systemic immune-inflammation index in patients with chronic heart failure. Eur Heart J. 2018;39:ehy564.P589.
• 11. Yuan H, Tian J, Wen L. Meta-analysis of the systemic immune-inflammatory index and in-hospital mortality of COVID-19 patients. Heliyon. 2023;10(1):e23441.
• 12. Dong Y, Mo X, Hu Y, Qi X, Jiang F, Jiang Z, et al. Epidemiology of COVID-19 Among Children in China. Pediatrics. 2020;145(6):e20200702.
• 13. World Health Organization. Adolescent health topics. https://www.who.int/health-topics/adolescent-health/#tab=tab_1 (Accessed Jan 10, 2025).
• 14. Lagunas-Alvarado M, Mijangos-Huesca FJ, Terán-González JO, Lagunas-Alvarado MG, Martinez-Zavala N, Reyes-Franco, et al. Systemic immune inflammatory index in sepsis. Med Interna Méx. 2017;33(3):303-309.
• 15. Fois AG, Paliogiannis P, Scano V, Cau S, Babudieri S, Perra R, et al. The Systemic Inflammation Index on Admission Predicts In-Hospital Mortality in COVID-19 Patients. Molecules. 2020;25(23):5725.
• 16. Karimi A, Shobeiri P, Kulasinghe A, Rezaeni N. Novel Systemic Inflammation Markers to Predict COVID-19 Prognosis. Front Immunol. 2021;12:741061.
• 17. Xia W, Tan Y, Hu S, Li C, Jiang T. Predictive Value of Systemic Immune-Inflammation index and Neutrophil-to-Lymphocyte Ratio in Patients with Severe COVID-19. Clin Appl Thromb Hemost. 2022;28:10760296221111391.
• 18. Zhao Y, Yu C, Ni W, Shen H, Qiu M, Zhao Y, et al. Peripheral blood inflammatory markers in predicting prognosis in patients with COVID-19. Some differences with influenza A. J Clin Lab Anal. 2021;35(1):e23657.
• 19. Halmaciu I, Arbănași EM, Kaller R, Mureșan AV, Arbănași EM, Bacalbasa N, et al. Chest CT Severity Score and Systemic Inflammatory Biomarkers as Predictors of the Need for Invasive Mechanical Ventilation and of COVID-19 Patients' Mortality. Diagnostics (Basel). 2022;12(9):2089.
• 20. Mureșan AV, Hălmaciu I, Arbănași EM, Kaller R, Arbănași EM, Budișcă OA et al. Prognostic Nutritional Index, Controlling Nutritional Status (CONUT) Score, and Inflammatory Biomarkers as Predictors of Deep Vein Thrombosis, Acute Pulmonary Embolism, and Mortality in COVID-19 Patients. Diagnostics (Basel). 2022;12(11):2757.
• 21. Arbănași EM, Halmaciu I, Kaller R, Mureșan AV, Arbănași EM, Suciu BA et al. Systemic Inflammatory Biomarkers and Chest CT Findings as Predictors of Acute Limb Ischemia Risk, Intensive Care Unit Admission, and Mortality in COVID-19 Patients. Diagnostics (Basel). 2022;12(10):2379.
• 22. Kaçer İ, Çağlar A, Akıllı NB. The Prognostic Value of C-Reactive Protein/Albumin Ratio in Acute Mesenteric Ischemia. Am Surg. 2023;89(5):1661-1667.
• 23. Yilmaz N, Tosun F, Comert E, Duran M, Tuna VD. The Relationship of CRP/Albumin ratio level and prognosis in pregnant COVID-19 patients. Niger J Clin Pract. 2022;25(10):1745-1750.
• 24. Carpenè G, Onorato D, Nocini R, Fortunato G, Rizk JG, Henry BM, et al. Blood lactate concentration in COVID-19: a systematic literature review. Clin Chem Lab Med. 2021;60(3):332-337.
• 25. Mei Z, Shi L, Wang B, Yang J, Xiao Z, Du P, et al. Prognostic role of pretreatment blood neutrophil-to-lymphocyte ratio in advanced cancer survivors: A systematic review and meta-analysis of 66 cohort studies. Cancer Treat Rev. 2017;58:1-13.
• 26. Imtiaz F, Shafique K, Mirza SS, Ayoob Z, Vart P, Rao S. Neutrophil lymphocyte ratio as a measure of systemic inflammation in prevalent chronic diseases in Asian population. Int Arch Med. 2012;5(1):2.
• 27. Fu J, Kong J, Wang W, Wu M, Yao L, Wang Z, et al. The clinical implication of dynamic neutrophil to lymphocyte ratio and D-dimer in COVID-19: A retrospective study in Suzhou China. Thromb Res. 2020;192:3-8.
• 28. Liu J, Liu Y, Xiang P, Pu L, Xiong H, Li C, et al. Neutrophil-to-lymphocyte ratio predicts critical illness patients with 2019 coronavirus disease in the early stage. J Transl Med. 2020;18(1):206.