ASSOCIATION BETWEEN SYSTEMIC IMMUNEINFLAMMATION INDEX AND MORTALITY IN PATIENTS WITH NON-ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Öz

Objective Acute coronary syndrome (ACS) is a disease associated with high mortality and morbidity. It is essential to identify high-risk patients during hospitalization and to implement early revascularization strategies if necessary. There is a clear need for a simple, effective and cost-effective index for rapid identification of these patients in clinical practice. The aim of this study was to investigate the clinical significance of the systemic immune inflammation index (SII) in non-ST-segment elevation myocardial infarction (NSTEMI), a subgroup of ACS, and to evaluate its association with mortality. Material and Method Patients who underwent coronary angiography at the Coronary Angiography Unit of Aydın Adnan Menderes University Faculty of Medicine Research and Training Hospital between January and December 2022 were retrospectively reviewed. Individuals with a diagnosis of NSTEMI were included as group I, and individuals with normal coronary arteries during coronary angiography were included as group II (control group). Clinical variables and calculated SII values of the groups were recorded. The role of SII in predicting all-cause mortality and its effect on expected survival were evaluated. Results The median value of the SII index was significantly higher in the NSTEMI group (group I) than in the control group (group II) (p<0.001). The mean neutrophil and SII index values of the mortality group were significantly higher than those of the survival group (p=0.002 and p=0.019, respectively). Multivariate logistic regression showed that the presence of NSTEMI (odds ratio [OR]: 9.891; 95% CI: 2.096-46.671, p<0.001) and SII index (odds ratio [OR]: 1.001; 95% CI: 1.000-1001, p=0.039) independently predicted all-cause mortality. The cutoff point for the SII index was 609.98 using ROC curve analysis. Survival expectancy at 18 months was 68.1% for group I patients with SII >609.98 and 79.3% for group I patients with SII <609.98, but the difference was not statistically significant (p=0.426). Conclusion The SII score can help predict all-cause mortality in NSTEMI patients, but it is unsuitable for predicting survival.

Anahtar Kelimeler

• SII
• mortality
• myocardial infarction

ST SEGMENT YÜKSELMESİZ MİYOKART ENFARKTÜS HASTALARINDA SİSTEMİK İMMÜN ENFLAMASYON İNDEKSİ VE MORTALİTE İLİŞKİSİ

Öz

Amaç Akut koroner sendrom mortalitesi ve morbiditesi yüksek bir sendromdur. Yüksek riskli hastaların hastane yatışı esnasında belirlenmesi ve gerekli durumlarda erken revaskülarizasyon stratejilerinin uygulanması hastalarda hayati önem arz etmektedir. Klinik pratikte bu hastaların hızlıca belirlenmesine yönelik basit, etkili, maliyeti ucuz bir indeks ihtiyacı olduğu aşikardır. Tüm bu nedenlerden dolayı bu çalışmada tarafımızca SII’nın, AKS alt grubu olan NSTEMI geçiren hastalarda mortaliteyi ön görmedeki yerinin araştırılması amaçlanmıştır. Gereç ve Yöntem 01.01.2022-31.12.2022 tarihleri arasından Aydın Adnan Menderes Üniversitesi Tıp Fakültesi Uygulama ve Araştırma Hastanesi koroner anjiyografi ünitesinde koroner anjiyografi işlemi uygulanan hastalar geçmişe dönük olarak tarandı. St segment yükselmesiz miyokart enfarktüsü geçiren hastalarda ve normal koroner arterler saptanan hastalarda SII [(nötrofil x platelet) / lenfosit] hesaplandı. Bu indeks ile tüm nedenlere bağlı mortalite gelişimi arasında ilişki olup olmadığı araştırıldı. Bulgular Grup 1 olarak değerlendirilen NSTEMI grubu SII indeks ortancası Grup II’ye göre anlamlı düzeyde yüksek bulundu (p<0.001). Mortalite gözlenen gruba ait nötrofil ve SII indeksi değerleri ortalaması, sağkalım grubuna göre istatistiksel olarak anlamlı derecede yüksek bulundu (sırasıyla p=0.002 ve p=0.019). Çok yönlü lojistik regresyon sonucunda, NSTEMI varlığı yaş (odds ratio [OR]: 9.891; 95% CI: 2.096-46.671, p<0.001) ve SII indeksinin (odds ratio [OR]: 1.001; 95% CI: 1.000-1001, p=0.039) tüm nedenlere bağlı mortaliteyi bağımsız olarak öngördüğü saptandı. NSTEMI grubunda SII indeksi 609.98 değerinden yüksek olguların sağkalım beklentisi 18 ay için %68.1, SII indeksi 609.98 değerinden düşük olgular için ise %79.3 olarak hesaplandı ancak fark istatistiksel olarak anlamlı bulunmadı (p=0.426). Sonuç SII, NSTEMI hasta grubunda mortaliteyi ön görmede faydalı bir indeks olmasına rağmen sağ kalımı öngörmede yeterli değildir.

Anahtar Kelimeler

• SII
• mortalite
• miyokart enfarktüsü

Kaynakça

1. 1. Yeh RW, Sidney S, Chandra M, Sorel M, Selby JV, Go AS. Population Trends in the Incidence and Outcomes of Acute Myocardial Infarction. N. Engl. J. Med. 2010;362: 2155–65.
2. 2. Miranda GF, Rossi A, Serra A, Garcia B, Rumoroso JR, Iniguez A, Vaquerizo B, Triano JL, Sierra G, Bruguera J. Angiographic quantification of thrombus in ST- elevation acute myocardial i nfarction presenting with an occluded infarct- related artery and its relationship with results of percutaneous intervention. J. Interv. Cardiol. 2009; 22:207–15.
3. 3. Jeremias A, Davies JE, Maehara A, Matsumura M, Schneider J, Tang. Blinded physiological assessment of Residual ischemia after successful angiographic percutaneous coronary intervention: the DEFINE PCI study. JACC Cardiovasc Interv. 2019; 12:1991–1. doi: 10.1016/j.jcin.2019.05.054
4. 4. Biswas S, Dinh D, LucasM, Duffy SJ, Brennan AL, Liew D, et al. Incidence and predictors of unplanned hospital readmission after percutaneous coronary intervention. J Clin Med. 2020; 9: 32-2. doi: 10.3390/jcm9103242.
5. 5. Petrone AB, Eisenman RD, Steele KN, Mosmiller LT, Urhie O, Zdilla MJ. Temporal dynamics of peripheral neutrophil and lymphocytes following acute ischemicstroke. Neurol Sci. 2019; 40:1877–85. doi: 10.1007/s10072-019-03919
6. 6. Ikeda U, Ikeda M, Oohara T, Kano S, Yaginuma T. Mitogenicaction of interleukin-1a on vascular smooth muscle cells mediatedby PDGF. Atherosclerosis. 1990;84: 183–88. doi: 10.1016/0021- 9150(90)90089-2
7. 7. Mulholland M, Jakobsson G, Lei Y, Sundius L, Ljungcrantz I, Rattik S, et al. IL-2Rbg signalling in lymphocytes promotes systemic inflammation and reduces plasmacholesterol in atherosclerotic mice. Atherosclerosis. 2021; 326-31. doi: 10.1016/j.atherosclerosis.2021.04.010
8. 8. Kumbul YÇ, Yasan H, Tüz M, Okur E, Sivrice ME, Büyükçelik B. Prognostic Evaluation of Systemic Immune Inflammation Index in Sudden Idiopathic Sensorineural Hearing Loss. SDÜ Tıp Fakültesi Dergisi. 2020; 27(4): 455-461.

9. 9. Jickling GC, Liu DZ, Ander BP, Stamova B, Zhan X, Sharp FR. Targeting neutrophils in ischemic stroke: translational insights from experimental studies. J Cereb Blood FlowMetab. 2015; 35:888–01. doi: 10.1038/jcbfm.2015.45.
10. 10. Liu Y, Ye T, Chen L, Jin T, Sheng Y, Wu G, et al. Systemic immüne inflammation index predicts the severity of coronary stenosis in patients with coronary heart disease. CoronArteryDis. 2021; 32:715–20. doi: 10.1097/MCA.0000000000001037
11. 11. Xu M, Chen R, Liu L, Liu X, Hou J, et al. Systemic immuneinflammation index and incident cardiovascular diseases among middle- aged and elderly Chinese adults: The Dongfeng-Tongji cohort study. Atherosclerosis 2021; 323: 20–9.
12. 12. Zhen Y, Tingyi H, Jin W, Ruoyi X, Xibei L, Mengsi L, Zhen S. Systemic immune- inflammation index as a potential biomarker of cardiovascular diseases: A systematic review and metaanalysis. Journal Frontiers in Cardiovascular Medicine. 2022; 9:913-933. doi: 10.3389/fcvm.2022.933913
13. 13. Li J, He D, Yu J, et al. Dynamic Status of SII and SIRI Alters the Risk of Cardiovascular Diseases: Evidence from Kailuan Cohort Study. J. Inflamm. Res. 2022; 15:5945–57.
14. 14. Yiyuan X, Chunlei X, Lida W, Zheng L, Huili JZ. Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All- Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults. J. Clin Med. 2023; 12: 11-28.
15. 15. Ugur Ö, Muhammet G., Cihan Ö., Melik D., Ömer F.A., Efe Y., Servet A. Systemic Immune-Inflammation Index: A Novel Predictor of Coronary Thrombus Burden in Patients with Non- ST Acute Coronary Syndrom. Medicina 2022; 58: 143.
16. 16. Dziedzic EA, Gasior JS, Tuzimek A, Paleczny J, Junka A, Dabrowski M, Jankowski P. Investigation of the Associations of Novel Inflammatory Biomarkers-Systemic Inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI)-With the Severity of Coronary Artery Disease and Acute Coronary Syndrome Occurrence. Int. J. Mol. Sci. 2022; 23: 9553.
17. 17. Dziedzic EA, Gąsior JS, Tuzimek A, Kochman W. Blood Count- Derived Inflammatory Markers and Acute Complications of Ischemic Heart Disease in Elderly Women. J. Clin. Med. 2023; 12(4):1369.
18. 18. Yang YL, Wu CH, Hsu PF, et al. Systemicimmune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease. Eur. J. Clin. Investig. 2020; 50: 1–5.
19. 19. Jiabao H, Qing Z, Runchang W, Hongyan J, Yusi C, Xiaoqing Q, Cuntai Z. Systemic Immune-Inflammatory Index Predicts Clinical Outcomes for Elderly Patients with Acute Myocardial Infarction Receiving Percutaneous Cor onary Intervention. MedSciMonit, 2019; 25: 9690-01
20. 20. Warnatsch A, Ioannou M, Wang Q, Papayannopoulos V. Inflammation. Neutrophil extracellular traps license macrophages for cytokine production in atherosclerosis. Science. 2015;349(6245):316-20. doi: 10.1126/science. aaa8064.
21. 21. Fernández-Ruiz I. Neutrophil-driven SMC death destabilizes atherosclerotic plaques. Nat. Rev. Cardiol. 2019;16:455.
22. 22. Sheridan FM, Cole PG, Ramage D. Leukocyte adhesion to the coronary microvasculature during ischemia and reperfusion in an in vivo canine model. Circulation 1996; 93: 1784–87.
23. 23. Sezer M, Okcular I, Goren T. Association of haematologica lindices with the degree of microvascular injury in patients with acute anterior all myocardial infarction treated with primary percutaneous coronary intervention. Heart, 2007; 93(3): 313– 18.
24. 24. Milan-Mattos J, Anibal F, Perseguini N, et al. Effects of natural aging and gender on pro- inflammatory markers. Braz. J. Med. Biol. Res. 2019; 52(9): 73-3.