Effect of systemic immune inflammation index on symptom development in patients with moderate to severe carotid stenosis

Abstract

Background/Aim: Recent studies have shown that various inflammatory parameters obtained from routine blood tests can be used in the diagnosis and follow-up of cardiovascular diseases. Stroke is the second most common cause of death in the world. In this study, we aimed to investigate the role of systemic immune inflammation index (SII) value in predicting symptom development in patients with moderate to severe carotid artery stenosis (CAS). Methods: Patients between the ages of 41 and 94 with moderate to severe CAS who were followed up and treated electively in our clinic between October 01, 2016 and October 31, 2021 were included in this retrospective observational cohort study. A total of 314 consecutive patients were included in the study. The patients were divided into two groups as asymptomatic (Group 1) and symptomatic group (Group 2). Results: There were 245 and 69 patients in Groups 1 and 2, respectively. The median ages of patients in Groups 1 and 2 were 62 (41-86) years and 69 (49-94) years, respectively (P<0.001). In multivariate analysis, advanced age (OR: 1.692 CI 95%: 1.150-2.398 P=0.012), hypertension (OR: 1.114, CI 95%: 1.080-1.866, P=0.036) and SII (OR: 1.954, CI 95%: 1.090-2.942, P<0.001) values were determined as independent predictors of symptom development in patients with moderate-serious carotis artery stenosis. There was no statistically significant difference between the groups in terms of body mass index, gender, smoking, diabetes mellitus and chronic obstructive pulmonary disease rates (P>0.05 for all). Conclusion: In this current study we demonstrated that high SII value detected in asymptomatic patients with stenosis of 50% or more in the carotid arteries may be a useful marker to predict symptom development.

Keywords

• Inflammation
• carotid artery
• stenosis
• cerebrovascular event
• blood cells

Kaynakça

1. 1. Naghavi M, Abajobir AA, Abbafati C, Abbas KM, Abd-Allah F, Abera SF. GBD 2016 Causes of Death Collaborators. Global, regional, and national age-sex specific mortality for 264 causes of death, 1980-2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017 Sep 16;390(10100):1151-210. doi: 10.1016/S0140-6736(17)32152-9.
2. 2. Barnett HJ, Gunton RW, Eliasziw M, Fleming L, Sharpe B, Gates P, et al. Causes and severity of ischemic stroke in patients with internal carotid artery stenosis. JAMA. 2000 Mar 15;283(11):1429-36. doi: 10.1001/jama.283.11.1429.
3. 3. Kurtul A, Ornek E. Platelet to Lymphocyte Ratio in Cardiovascular Diseases: A Systematic Review. Angiology. 2019 Oct;70(9):802-18. doi: 10.1177/0003319719845186.
4. 4. Steven S, Frenis K, Oelze M, Kalinovic S, Kuntic M, Bayo Jimenez MT, et al. Vascular Inflammation and Oxidative Stress: Major Triggers for Cardiovascular Disease. Oxid Med Cell Longev. 2019 Jun 23;2019:7092151. doi: 10.1155/2019/7092151.
5. 5. Haybar H, Pezeshki SMS, Saki N. Evaluation of complete blood count parameters in cardiovascular diseases: An early indicator of prognosis? ExpMolPathol. 2019 Oct;110:104267. doi: 10.1016/j.yexmp.2019.104267.
6. 6. Massiot N, Lareyre F, Voury-Pons A, Pelletier Y, Chikande J, Carboni J, et al. High Neutrophil to Lymphocyte Ratio and Platelet to Lymphocyte Ratio are Associated with Symptomatic Internal Carotid Artery Stenosis. J Stroke Cerebrovasc Dis. 2019 Jan;28(1):76-83. doi: 10.1016/j.jstrokecerebrovasdis.2018.09.001.
7. 7. Engin M, Ozsin KK, Savran M, Guvenc O, Yavuz S, Ozyazicioglu AF. Visceral Adiposity Index and Prognostic Nutritional Index in Predicting Atrial Fibrillation after On-Pump Coronary Artery Bypass Operations: a Prospective Study. Braz J Cardiovasc Surg. 2021 Aug 6;36(4):522-9. doi: 10.21470/1678-9741-2020-0044
8. 8. Engin M, Güvenç O. Investigation of the Predictive Values of Triglyceride/HDL Cholesterol Ratio and Whole Blood Viscosity with Regard to Severe Peripheral or Carotid Artery Disease in Patients Scheduled for Coronary Bypass. Heart Surg Forum. 2020 May 14;23(3):E310-E314. doi: 10.1532/hsf.2991.

9. 9. Erdolu B, Engin M. The effect of mean platelet volume-to-lymphocyte ratio on symptom onset in patients with carotid artery stenosis. Turk J Vasc Surg. 2021;30(1):7-12 doi: 10.9739/tjvs.2021.809
10. 10. Lanzino G, Rabinstein AA, Brown RD Jr. Treatment of carotid artery stenosis: medical therapy, surgery, or stenting? Mayo Clin Proc. 2009 Apr;84(4):362-87; quiz 367-8. doi: 10.1016/S0025-6196(11)60546-6.
11. 11. Libby P. Inflammation and cardiovascular disease mechanisms. Am J Clin Nutr. 2006 Feb;83(2):456S-460S. doi: 10.1093/ajcn/83.2.456S.
12. 12. Engin M, Goncu MT. The role of plateletcrit and neutrophil lymphocyte ratio in showing the clinical severity of the disease in patients with chronic venous insufficiency. Ann Med Res 2020;27(5):1385-90 doi: 10.5455/annalsmedres.2019.12.866
13. 13. Leclercq A, Houard X, Philippe M, Ollivier V, Sebbag U, Meilhac O et al. Involvement of intraplaque hemorrhage in atherothrombosis evolution via neutrophil protease enrichment. J Leukoc Biol. 2007 Dec;82(6):1420-9. doi: 10.1189/jlb.1106671.
14. 14. Nasr N, Ruidavets JB, Arnal JF, Sie P, Larrue V. Association of neutrophil count with microembolization in patients with symptomatic carotid artery stenosis. Atherosclerosis. 2009 Dec;207(2):519-23. doi: 10.1016/j.atherosclerosis.2009.05.003.
15. 15. Ionita MG, van den Borne P, Catanzariti LM, Moll FL, de Vries JP, Pasterkamp G, et al. High neutrophil numbers in human carotid atherosclerotic plaques are associated with characteristics of rupture-prone lesions. ArteriosclerThrombVasc Biol. 2010 Sep;30(9):1842-8. doi: 10.1161/ATVBAHA.110.209296.
16. 16. Akgül E, Engin M, Özyazıcıoğlu AF. Effects of mean platelet volume and platelet counts on peripheral biodegradable stent restenosis. J Surg Med. 2019;3(9):663-5. doi: 10.28982/josam.569158
17. 17. İnanır M. An investigation of platelet parameters in smoking patients with coronary slow flow detected during coronary angiography. J Surg Med. 2020;4(4):281-4 doi: 10.28982/josam.722658
18. 18. Arévalo-Lorido JC, Carretero-Gómez J, Villar-Vaca P. Mean platelet volume predicting carotid atherosclerosis in atherothrombotic ischemic stroke. Ir J Med Sci. 2012 Jun;181(2):179-83. doi: 10.1007/s11845-011-0755-8.
19. 19. Adam G, Kocak E, Özkan A, Reşorlu M, Çınar C, Bozkaya H, et al. Evaluation of platelet distribution width and mean platelet volume in patients with carotid artery stenosis. Angiology. 2015 Apr;66(4):375-8. doi: 10.1177/0003319714548682.
20. 20. İdil Soylu A, Arıkan Cortcu S, Uzunkaya F, Atalay YO, Bekçi T, Güngör L, et al. The correlation of the platelet-to-lymphocyte ratio with the severity of stenosis and stroke in patients with carotid arterial disease. Vascular. 2017 Jun;25(3):299-306. doi: 10.1177/1708538116673770.
21. 21. Akboga MK, Canpolat U, Yayla C, Ozcan F, Ozeke O, Topaloglu S, et al. Association of Platelet to Lymphocyte Ratio With Inflammation and Severity of Coronary Atherosclerosis in Patients With Stable Coronary Artery Disease. Angiology. 2016 Jan;67(1):89-95. doi: 10.1177/0003319715583186.
22. 22. Deşer SB, Yucel SM, Demirag MK, Guclu MM, Kolbakir F, Keceligil HT. The association between platelet/lymphocyte ratio, neutrophil/lymphocyte ratio, and carotid artery stenosis and stroke following carotid endarterectomy. Vascular. 2019 Dec;27(6):604-11. doi: 10.1177/1708538119847390.
23. 23. 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 Dec 1;20(23):6212-22. doi: 10.1158/1078-0432.CCR-14-0442.
24. 24. Yang R, Chang Q, Meng X, Gao N, Wang W. Prognostic value of Systemic immune-inflammation index in cancer: A meta-analysis. J Cancer. 2018 Sep 7;9(18):3295-302. doi: 10.7150/jca.25691.
25. 25. Zhong JH, Huang DH, Chen ZY. Prognostic role of systemic immune-inflammation index in solid tumors: a systematic review and meta-analysis. Oncotarget. 2017 Jun 29;8(43):75381-8. doi: 10.18632/oncotarget.18856.
26. 26. Agus HZ, Kahraman S, Arslan C, Yildirim C, Erturk M, Kalkan AK, et al. Systemic immune-inflammation index predicts mortality in infective endocarditis. J Saudi Heart Assoc. 2020 Apr 17;32(1):58-64. doi: 10.37616/2212-5043.1010.
27. 27. Karaüzüm K, Karauzum I, Celikyurt U, Vural A, Ağacdiken A. A lower systemic immune-inflammation index level is associated with response to cardiac resynchronization theraphy. Turkish Journal of Clinics and Laboratory, 11(3), 186-92. doi: 10.18663/tjcl.658350
28. 28. Seo M, Yamada T, Morita T, Furukawa Y, Tamaki S, Iwasaki Y, et al. Prognostic value of systemic immune-inflammation index in patients with chronic heart failure. European Heart Journal, 39(suppl_1), ehy564-P589. doi: 10.1093/eurheartj/ehy564.P589
29. 29. Randomised trial of endarterectomy for recently symptomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet. 1998 May 9;351(9113):1379-87. PMID: 9593407
30. 30. North American Symptomatic Carotid Endarterectomy Trial Collaborators, Barnett HJM, Taylor DW, Haynes RB, Sackett DL, Peerless SJ, Ferguson GG, et al. Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade carotid stenosis. N Engl J Med. 1991 Aug 15;325(7):445-53. doi: 10.1056/NEJM199108153250701.
31. 31. Saito H, Kuroda S, Hirata K, Magota K, Shiga T, Tamaki N et al. Validity of dual MRI and F-FDG PET imaging in predicting vulnerable and inflamed carotid plaque. Cerebrovasc Dis. 2013;35(4):370-7. doi: 10.1159/000348846.
32. 32. Kerwin W, Xu D, Liu F, Saam T, Underhill H, Takaya N et al. Magnetic resonance imaging of carotid atherosclerosis: plaque analysis. Top MagnReson Imaging. 2007 Oct;18(5):371-8. doi: 10.1097/rmr.0b013e3181598d9d.
33. 33. Underhill HR, Hatsukami TS, Fayad ZA, Fuster V, Yuan C. MRI of carotid atherosclerosis: clinical implications and future directions. Nat Rev Cardiol. 2010 Mar;7(3):165-73. doi: 10.1038/nrcardio.2009.246.
34. 34. Calcagno C, Ramachandran S, Izquierdo-Garcia D, Mani V, Millon A, Rosenbaum D et al. The complementary roles of dynamic contrast-enhanced MRI and 18F-fluorodeoxyglucose PET/CT for imaging of carotid atherosclerosis. Eur J Nucl Med Mol Imaging. 2013 Dec;40(12):1884-93. doi: 10.1007/s00259-013-2518-4.
35. 35. Chowdhury MM, Tarkin JM, Evans NR, Le E, Warburton EA, Hayes PD et al. 18F-FDG Uptake on PET/CT in Symptomatic versus Asymptomatic Carotid Disease: a Meta-Analysis. Eur J VascEndovasc Surg. 2018 Aug;56(2):172-9. doi: 10.1016/j.ejvs.2018.03.028.