Dirençli hipertansiyon için yeni prediktif biyobelirteçler olarak Sistemik İmmün-Enflamasyon İndeksi ve Sistemik Enflamatuar Yanıt İndeksi: karşılaştırmalı kesitsel çalışma

Abstract

Amaç: Bu çalışma, sistemik bağışıklık-inflamasyon indeksi (SII) ve sistemik inflamatuar yanıt indeksi (SIRI) gibi bileşik inflamasyon indeksleri ile dirençli hipertansiyon arasındaki ilişkiyi araştırarak, bunların öngörücü performansını ve klinik yararını değerlendirmiştir. Materyal ve metod: Nisan 2022'den Ocak 2025'e kadar yürütülen bu karşılaştırmalı kesitsel çalışmaya, 256'sı kontrollü hipertansiyon (HT) ve 244'ü dirençli hipertansiyon (RHT) olan 500 hipertansif hasta dahil edilmiştir. SII ve SIRI, tam kan sayımlarından hesaplanmıştır. Çok değişkenli lojistik regresyon, çeyrek analiz, kısıtlı kübik spline modelleme ve alıcı işletim karakteristiği (ROC) eğrisi analizi gerçekleştirildi. Bulgular: RHT hastaları, anlamlı olarak yüksek SII (480,2'ye karşı 361,7, P<0,001) ve SIRI (0,73'e karşı 0,46, P<0,001) değerleri gösterdi. Çok değişkenli analiz, SIRI'yi RHT'nin en güçlü bağımsız öngörücüsü olarak belirledi (OR=25,954, %95 CI: 7,382-91,253, P<0,001). Çeyrek analizinde, RHT prevalansının SIRI çeyrekleri arasında %20,0'dan %84,0'a çıktığı (trend için P<0,001) bir doz-yanıt ilişkisi ortaya çıktı. SIRI, 0,6071'lik optimal kesme değeriyle (duyarlılık %68,0, özgüllük %75,8) mükemmel bir tanı performansı (AUC=0,780, %95 CI: 0,739-0,820) sergilemiştir. Cinsiyete göre tabakalandırılmış analiz, erkeklerin yüksek inflamatuar indekslere daha duyarlı olduğunu göstermiştir. Sonuç: SII ve SIRI, dirençli hipertansiyonda önemli ölçüde yükselir ve güçlü, maliyet etkin prediktif biyomarkerler olarak işlev görür. SIRI (kesme değeri ≥0,6071) mükemmel bir tanı performansı sergiler ve hipertansif hastalarda risk sınıflandırması, erken teşhis ve hedefe yönelik tedavi stratejilerine rehberlik edebilir.

Keywords

• Dirençli hipertansiyon
• sistemik immun-inflamasyon indeksi
• sistemik inflamatuar yanıt indeksi
• inlamatuar biyobelirteçler
• risk sınıflandırması

Supporting Institution

Yazarlar, bu çalışma için herhangi bir kurum veya kuruluştan finansal destek almadıklarını beyan ederler.

Ethical Statement

Bu çalışma için Ordu Üniversitesi Klinik Araştırmalar Etik Kurulu'ndan 25.03.2022 tarihinde, 2022/71 sayılı karar ile etik onay alınmıştır. Çalışma, Helsinki Bildirgesi prensiplerine uygun olarak yürütülmüştür. Tüm katılımcılardan bilgilendirilmiş onam formu alınmıştır.

Thanks

Yazarlar, bu çalışmaya katılımlarından dolayı tüm hastalara ve veri toplama sürecindeki katkıları için klinik personele teşekkür eder.

Systemic Immune-inflammation Index (SII) and Systemic Inflammatory Response Index (SIRI) as novel predictors of resistant hypertension

Abstract

Aims: Resistant hypertension (RHT) accounts for 10-15% of hypertensive patients, and diagnosis and treatment are more complex in these cases, which means a higher risk of cardiovascular complications. Although the effect of chronic systemic inflammation on the pathophysiology of RHT is known, the effective use of biomarkers is limited. This study investigated the relationship between the Systemic Immune-Inflammation Index (SII) and the Systemic Inflammatory Response Index (SIRI), which are composite inflammatory indices that can be used as markers of chronic inflammation, and RHT, testing their clinical utility and predictive value. Methods: Between April 2022 and January 2025, 256 hypertensive patients followed up at our clinic were defined as having controlled hypertension (CHT) and 244 as having RHT, for a total of 500 patients included in this cross-sectional study. SII and SIRI values were calculated from routine blood count results. Data were analyzed and compared using multivariate logistic regression, quartile analysis, limited cubic spline modeling, and receiver operating characteristic (ROC) curve analysis. Results: Significantly higher SII (480.2 vs. 361.7, p<0.001) and SIRI (0.73 vs. 0.46, p<0.001) values were observed in RHT patients. According to multivariate analysis, SIRI stood out as the strongest independent predictor of RHT (OR=25.954, 95% CI: 7.382-91.253, p<0.001). Quartile analysis showed a linear relationship, with RHT prevalence increasing from 20.0% to 84.0% across SIRI quartiles (p<0.001 for trend). SIRI showed attractive diagnostic performance (AUC=0.780, 95% CI: 0.739-0.820) with an optimal cutoff value of 0.6071 (sensitivity 68.0%, specificity 75.8%). Analysis stratified by gender suggested that males may be more sensitive to chronic inflammatory indices. Conclusion: SII and SIRI are significantly elevated in the RHT patient group. Furthermore, their cost-effectiveness may highlight the existence of biomarkers that can be used as markers of inflammation in the course of this disease. SIRI (cut-off value ≥0.6071), demonstrating superior diagnostic performance, may play a helpful role in the management of hypertensive patients, particularly in the diagnosis of RHT. Furthermore, risk classification may empower clinicians in early diagnosis and targeted treatment strategies.

Keywords

• Resistant hypertension
• systemic immune-inflammation index
• systemic inflammatory response index
• inflammation
• biomarkers
• cardiovascular risk

Supporting Institution

The authors declared that this study has received no financial support. Teşekkür (Türkçe):

Ethical Statement

The study protocol was approved by the Ordu University Clinical Research Ethics Committee (Date: 25.03.2022, Decision No: 2022/71). The study was conducted in accordance with the principles of the Declaration of Helsinki. Informed consent was obtained from all participants.

Thanks

The authors thank all the participants and the clinical staff for their contribution to data collection in this study.

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