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Association Between Systemic ImmuneInflammation Index and Long-Term Mortality in Patients with Critical Limb-Threatening Ischemia Undergoing Endovascular Therapy Below the Knee

Yıl 2022, Cilt: 25 Sayı: 3, 262 - 269, 01.12.2022

Öz

Introduction: Endovascular interventions have been increasingly used for the treatment of patients suffering from below-the-knee (BTK) ischemic lesions. Yet, there is a paucity of data regarding long-term adverse events in patients with critical limb ischemia (CLI) undergoing endovascular revascularization for BTK lesions. Recently introduced systemic immune-inflammation index (SII) is a reliable indicator of poor outcomes in various cardiovascular conditions. Herein, we aimed to investigate the prognostic role of the SII on mortality in patients with CLI undergoing endovascular revascularization for BTK lesions.

Patients and Methods: The records of 112 patients with symptomatic CLI undergoing endovascular revascularization for BTK lesions between January 2015 and December 2019 were analyzed. Patients were divided into groups with low and high SII values based on an SII cut-off value derived from a ROC analysis. For each group, procedural details and follow-up outcomes were analyzed.

Results: The mean follow-up time was 40.3 ± 19.9 months. According to our data, patients with high SII values had higher rates of mortality compared to patients with low SII values (65.2% vs 30.3%, p< 0.001). To determine the SII cut-off value for predicting mortality, the ROC curve was drawn, and the best cut-off value was determined as 966 by using the Youden index, (AUC= 0.658, 95% CI= 0.556-0.760, p= 0.004). Cox multivariate regression analysis also identified the SII score as an independent predictor of mortality.

Conclusion: SII is an independent predictor of mortality, especially among patients with CLI who underwent endovascular revascularization for BTK lesions.

Kaynakça

  • 1. Davies MG. Criticial limb ischemia: Epidemiology. Methodist Debakey Cardiovasc J 2012;8(4):10-4. [Crossref]
  • 2. Uccioli L, Meloni M, Izzo V, Giurato L, Merolla S, Gandini R. Critical limb ischemia: Current challenges and future prospects. Vasc Health Risk Manag 2018;14:63-74. [Crossref]
  • 3. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. Intersociety consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007;45:5-67. [Crossref]
  • 4. Agarwal S, Sud K, Shishehbor MH. Nationwide trends of hospital admission and outcomes among critical limb ischemia patients: From 2003-2011. J Am Coll Cardiol 2016;67(16):1901-13. [Crossref]
  • 5. Zeller T, Micari A, Scheinert D, Baumgartner I, Bosiers M, Vermassen FEG, et al. The IN.PACT DEEP clinical drug-coated balloon trial: 5-year outcomes. JACC Cardiovasc Interv 2020;13(4):431-43. [Crossref]
  • 6. 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. [Crossref]
  • 7. 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;9(18):3295-302. [Crossref]
  • 8. 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 infarction receiving percutaneous coronary intervention. Med Sci Monit 2019;25:9690-701. [Crossref]
  • 9. 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(1):ehy564.P589. [Crossref]
  • 10. 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):13230. [Crossref]
  • 11. Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-theknee arteries: A supplement to the Inter-Society consensus for the management of peripheral arterial disease (TASC II). Vasc Med 2015;20(5):465-78. [Crossref]
  • 12. Rathakrishnan B, Secemsky EA. Turning the tide: Evolution of below-the-knee endovascular intervention. Vasc Med 2021;26(1):26-7. [Crossref]
  • 13. Peregrin JH, Koznar B, Kovác J, Lastovicková J, Novotný J, Vedlich D, et al. PTA of infrapopliteal arteries: Long-term clinical follow-up and analysis of factors influencing clinical outcome. Cardiovasc Intervent Radiol 2010;33(4):720-5. [Crossref]
  • 14. Odink H, van den Berg A, Winkens B. Technical and clinical long-term results of infrapopliteal percutaneous transluminal angioplasty for critical limb ischemia. J Vasc Interv Radiol 2012;23(4):461-7. [Crossref]
  • 15. Schmidt A, Piorkowski M, Werner M, Ulrich M, Bausback Y, Bräunlich S, et al. First experience with drug-eluting balloons in infrapopliteal arteries: Restenosis rate and clinical outcome. J Am Coll Cardiol 2011;58(11):1105-9. [Crossref]
  • 16. Liistro F, Porto I, Angioli P, Grotti S, Ricci L, Ducci K, et al. Drug-eluting balloon in peripheral intervention for below the knee angioplasty evaluation (DEBATE-BTK): A randomized trial in diabetic patients with critical limb ischemia. Circulation 2013;128(6):615-21. [Crossref]
  • 17. Karnabatidis D, Spiliopoulos S, Diamantopoulos A, Katsanos K, Kagadis GC, Kakkos S, et al. Primary everolimus- eluting stenting versus balloon angioplasty with bailout bare metal stenting of long infrapopliteal lesions for treatment of critical limb ischemia. J Endovasc Ther 2011;18(1):1-12. [Crossref]
  • 18. Katsanos K, Karnabatidis D, Diamantopoulos A, Spiliopoulos S, Siablis D. Cost-effectiveness analysis of infrapopliteal drug-eluting stents. Cardiovasc Intervent Radiol 2013;36(1):90-7. [Crossref]
  • 19. Söderström MI, Arvela EM, Korhonen M, Halmesmäki KH, Albäck AN, Biancari F, et al. Infrapopliteal percutaneous transluminal angioplasty versus bypass surgery as first-line strategies in critical leg ischemia: A propensity score analysis. Ann Surg 2010;252(5):765-73. [Crossref]
  • 20. Alexandrescu VA, Hubermont G, Philips Y, Guillaumie B, Ngongang C, Vandenbossche P, et al. Selective primary angioplasty following an angiosome model of reperfusion in the treatment of Wagner 1-4 diabetic foot lesions: Practice in a multidisciplinary diabetic limb service. J Endovasc Ther 2008;15(5):580-93. [Crossref]
  • 21. Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: An update. Expert Rev Cardiovasc Ther 2016;14(5):573-7. [Crossref]
  • 22. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets 2015;26(7):680-1. [Crossref]
  • 23. Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 2012;225(2):456-60. [Crossref]
  • 24. Kurtul A, Murat SN, Yarlioglues M, Duran M, Ergun G, Acikgöz SK, et al. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes. Am J Cardiol 2014;114(7):972-8. [Crossref]
  • 25. Candemir M, Kiziltunc E, Nurkoç S, Sahinarslan A. Relationship between systemic immune-inflammation index (SII) and the severity of stable coronary artery disease. Angiology 2021;72(6):575-81. [Crossref]
  • 26. Tosu AR, Kalyoncuoglu M, Biter HB, Cakal S, Selcuk M, Çinar T, et al. Prognostic value of systemic immune-inflammation index for major adverse cardiac events and mortality in severe aortic stenosis patients after TAVI. Medicina (Kaunas) 2021;57(6):588. [Crossref]
  • 27. Angkananard T, Anothaisintawee T, McEvoy M, Attia J, Thakkinstian A. Neutrophil lymphocyte ratio and cardiovascular disease risk: A systematic review and meta-analysis. Biomed Res Int 2018;2018:2703518. [Crossref]
  • 28. Dale MA, Ruhlman MK, Baxter BT. Inflammatory cell phenotypes in AAAs; Their role and potential as targets for therapy. Arterioscler Thromb Vasc Biol 2015;35(8):1746-55. [Crossref]
  • 29. Simpson E, Cantor H. Regulation of the immune response by subclasses of T lymphocytes II. The effect of adult thymectomy upon humoral and cellular responses in mice. Eur J Inmunol 1975;5(5):337-43. [Crossref]
  • 30. Belaj K, Pichler M, Hackl G, Rief P, Eller P, Hafner F, et al. Association of the derived neutrophil-lymphocyte ratio with critical limb ischemia. Angiology 2016;67(4):350-4. [Crossref]
  • 31. Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, et al. Platelet-to-lymphocyte ratio: A novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One 2013;8(7):67688. [Crossref]
  • 32. Luo H, Yuan D, Yang H, Yukui M, Huang B, Yang Y, et al. Post-treatment neutrophil-lymphocyte ratio independently predicts amputation in critical limb ischemia without operation. Clinics 2015;70(4):273-7. [Crossref]
  • 33. Gonza’lez-Fajardo JA, Brizuela-Sanz JA, Aguirre-Gerva’s B, Merino-Díaz B, Del Río-Solá L, Martín-Pedrosa M, et al. Prognostic significance of an elevated neutrophil-lymphocyte ratio in the amputation-free survival of patients with chronic critical limb ischemia. Ann Vasc Surg 2014;28(4):999-1004. [Crossref]
  • 34. Pourafkari L, Choi C, Garajehdaghi R, Tajlil A, Dosluoglu HH, Nader ND. Neutrophil-lymphocyte ratio is a marker of survival and cardiac complications rather than patency following revascularization of lower extremities. Vasc Med 2018;23(5):437-44. [Crossref]
  • 35. Erdoğan SB, Selçuk ÜN, Baştopçu M, Arslanhan G, Çakmak AY, Kuplay H, et al. Critical limb ischemia patients clinically improving with medical treatment have lower neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. Vascular 2021;29(6):920-6. [Crossref]
  • 36. Zhang Z, Chen Z. Higher systemic immune-inflammation index is associated with higher likelihood of peripheral arterial disease. Ann Vasc Surg 2022;84:322-6. [Crossref]
Yıl 2022, Cilt: 25 Sayı: 3, 262 - 269, 01.12.2022

Öz

Kaynakça

  • 1. Davies MG. Criticial limb ischemia: Epidemiology. Methodist Debakey Cardiovasc J 2012;8(4):10-4. [Crossref]
  • 2. Uccioli L, Meloni M, Izzo V, Giurato L, Merolla S, Gandini R. Critical limb ischemia: Current challenges and future prospects. Vasc Health Risk Manag 2018;14:63-74. [Crossref]
  • 3. Norgren L, Hiatt WR, Dormandy JA, Nehler MR, Harris KA, Fowkes FGR. Intersociety consensus for the management of peripheral arterial disease (TASC II). J Vasc Surg 2007;45:5-67. [Crossref]
  • 4. Agarwal S, Sud K, Shishehbor MH. Nationwide trends of hospital admission and outcomes among critical limb ischemia patients: From 2003-2011. J Am Coll Cardiol 2016;67(16):1901-13. [Crossref]
  • 5. Zeller T, Micari A, Scheinert D, Baumgartner I, Bosiers M, Vermassen FEG, et al. The IN.PACT DEEP clinical drug-coated balloon trial: 5-year outcomes. JACC Cardiovasc Interv 2020;13(4):431-43. [Crossref]
  • 6. 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. [Crossref]
  • 7. 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;9(18):3295-302. [Crossref]
  • 8. 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 infarction receiving percutaneous coronary intervention. Med Sci Monit 2019;25:9690-701. [Crossref]
  • 9. 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(1):ehy564.P589. [Crossref]
  • 10. 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):13230. [Crossref]
  • 11. Jaff MR, White CJ, Hiatt WR, Fowkes GR, Dormandy J, Razavi M, et al. An update on methods for revascularization and expansion of the TASC lesion classification to include below-theknee arteries: A supplement to the Inter-Society consensus for the management of peripheral arterial disease (TASC II). Vasc Med 2015;20(5):465-78. [Crossref]
  • 12. Rathakrishnan B, Secemsky EA. Turning the tide: Evolution of below-the-knee endovascular intervention. Vasc Med 2021;26(1):26-7. [Crossref]
  • 13. Peregrin JH, Koznar B, Kovác J, Lastovicková J, Novotný J, Vedlich D, et al. PTA of infrapopliteal arteries: Long-term clinical follow-up and analysis of factors influencing clinical outcome. Cardiovasc Intervent Radiol 2010;33(4):720-5. [Crossref]
  • 14. Odink H, van den Berg A, Winkens B. Technical and clinical long-term results of infrapopliteal percutaneous transluminal angioplasty for critical limb ischemia. J Vasc Interv Radiol 2012;23(4):461-7. [Crossref]
  • 15. Schmidt A, Piorkowski M, Werner M, Ulrich M, Bausback Y, Bräunlich S, et al. First experience with drug-eluting balloons in infrapopliteal arteries: Restenosis rate and clinical outcome. J Am Coll Cardiol 2011;58(11):1105-9. [Crossref]
  • 16. Liistro F, Porto I, Angioli P, Grotti S, Ricci L, Ducci K, et al. Drug-eluting balloon in peripheral intervention for below the knee angioplasty evaluation (DEBATE-BTK): A randomized trial in diabetic patients with critical limb ischemia. Circulation 2013;128(6):615-21. [Crossref]
  • 17. Karnabatidis D, Spiliopoulos S, Diamantopoulos A, Katsanos K, Kagadis GC, Kakkos S, et al. Primary everolimus- eluting stenting versus balloon angioplasty with bailout bare metal stenting of long infrapopliteal lesions for treatment of critical limb ischemia. J Endovasc Ther 2011;18(1):1-12. [Crossref]
  • 18. Katsanos K, Karnabatidis D, Diamantopoulos A, Spiliopoulos S, Siablis D. Cost-effectiveness analysis of infrapopliteal drug-eluting stents. Cardiovasc Intervent Radiol 2013;36(1):90-7. [Crossref]
  • 19. Söderström MI, Arvela EM, Korhonen M, Halmesmäki KH, Albäck AN, Biancari F, et al. Infrapopliteal percutaneous transluminal angioplasty versus bypass surgery as first-line strategies in critical leg ischemia: A propensity score analysis. Ann Surg 2010;252(5):765-73. [Crossref]
  • 20. Alexandrescu VA, Hubermont G, Philips Y, Guillaumie B, Ngongang C, Vandenbossche P, et al. Selective primary angioplasty following an angiosome model of reperfusion in the treatment of Wagner 1-4 diabetic foot lesions: Practice in a multidisciplinary diabetic limb service. J Endovasc Ther 2008;15(5):580-93. [Crossref]
  • 21. Afari ME, Bhat T. Neutrophil to lymphocyte ratio (NLR) and cardiovascular diseases: An update. Expert Rev Cardiovasc Ther 2016;14(5):573-7. [Crossref]
  • 22. Balta S, Ozturk C. The platelet-lymphocyte ratio: A simple, inexpensive and rapid prognostic marker for cardiovascular events. Platelets 2015;26(7):680-1. [Crossref]
  • 23. Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 2012;225(2):456-60. [Crossref]
  • 24. Kurtul A, Murat SN, Yarlioglues M, Duran M, Ergun G, Acikgöz SK, et al. Association of platelet-to-lymphocyte ratio with severity and complexity of coronary artery disease in patients with acute coronary syndromes. Am J Cardiol 2014;114(7):972-8. [Crossref]
  • 25. Candemir M, Kiziltunc E, Nurkoç S, Sahinarslan A. Relationship between systemic immune-inflammation index (SII) and the severity of stable coronary artery disease. Angiology 2021;72(6):575-81. [Crossref]
  • 26. Tosu AR, Kalyoncuoglu M, Biter HB, Cakal S, Selcuk M, Çinar T, et al. Prognostic value of systemic immune-inflammation index for major adverse cardiac events and mortality in severe aortic stenosis patients after TAVI. Medicina (Kaunas) 2021;57(6):588. [Crossref]
  • 27. Angkananard T, Anothaisintawee T, McEvoy M, Attia J, Thakkinstian A. Neutrophil lymphocyte ratio and cardiovascular disease risk: A systematic review and meta-analysis. Biomed Res Int 2018;2018:2703518. [Crossref]
  • 28. Dale MA, Ruhlman MK, Baxter BT. Inflammatory cell phenotypes in AAAs; Their role and potential as targets for therapy. Arterioscler Thromb Vasc Biol 2015;35(8):1746-55. [Crossref]
  • 29. Simpson E, Cantor H. Regulation of the immune response by subclasses of T lymphocytes II. The effect of adult thymectomy upon humoral and cellular responses in mice. Eur J Inmunol 1975;5(5):337-43. [Crossref]
  • 30. Belaj K, Pichler M, Hackl G, Rief P, Eller P, Hafner F, et al. Association of the derived neutrophil-lymphocyte ratio with critical limb ischemia. Angiology 2016;67(4):350-4. [Crossref]
  • 31. Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, et al. Platelet-to-lymphocyte ratio: A novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS One 2013;8(7):67688. [Crossref]
  • 32. Luo H, Yuan D, Yang H, Yukui M, Huang B, Yang Y, et al. Post-treatment neutrophil-lymphocyte ratio independently predicts amputation in critical limb ischemia without operation. Clinics 2015;70(4):273-7. [Crossref]
  • 33. Gonza’lez-Fajardo JA, Brizuela-Sanz JA, Aguirre-Gerva’s B, Merino-Díaz B, Del Río-Solá L, Martín-Pedrosa M, et al. Prognostic significance of an elevated neutrophil-lymphocyte ratio in the amputation-free survival of patients with chronic critical limb ischemia. Ann Vasc Surg 2014;28(4):999-1004. [Crossref]
  • 34. Pourafkari L, Choi C, Garajehdaghi R, Tajlil A, Dosluoglu HH, Nader ND. Neutrophil-lymphocyte ratio is a marker of survival and cardiac complications rather than patency following revascularization of lower extremities. Vasc Med 2018;23(5):437-44. [Crossref]
  • 35. Erdoğan SB, Selçuk ÜN, Baştopçu M, Arslanhan G, Çakmak AY, Kuplay H, et al. Critical limb ischemia patients clinically improving with medical treatment have lower neutrophil-to-lymphocyte and platelet-to-lymphocyte ratios. Vascular 2021;29(6):920-6. [Crossref]
  • 36. Zhang Z, Chen Z. Higher systemic immune-inflammation index is associated with higher likelihood of peripheral arterial disease. Ann Vasc Surg 2022;84:322-6. [Crossref]
Toplam 36 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Klinik Tıp Bilimleri
Bölüm Orijinal Araştırmalar
Yazarlar

Yalçın Avcı Bu kişi benim 0000-0002-2334-5007

Mustafa Duran Bu kişi benim 0000-0001-5937-235X

Ali Rıza Demir Bu kişi benim 0000-0002-3776-0228

Gökhan Demirci Bu kişi benim 0000-0003-2835-7530

Ömer Taşbulak Bu kişi benim 0000-0002-6307-5136

Arda Güler Bu kişi benim 0000-0002-5763-6785

Ahmet Arif Yalçın Bu kişi benim

Sezgin Atmaca 0000-0002-0103-5905

Mehmet Ertürk Bu kişi benim 0000-0002-2468-2793

Yayımlanma Tarihi 1 Aralık 2022
Yayımlandığı Sayı Yıl 2022 Cilt: 25 Sayı: 3

Kaynak Göster

Vancouver Avcı Y, Duran M, Demir AR, Demirci G, Taşbulak Ö, Güler A, Yalçın AA, Atmaca S, Ertürk M. Association Between Systemic ImmuneInflammation Index and Long-Term Mortality in Patients with Critical Limb-Threatening Ischemia Undergoing Endovascular Therapy Below the Knee. Koşuyolu Heart Journal. 2022;25(3):262-9.