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Resumo Fundamento A carga de fibrilação atrial (FA) é definida como a proporção de tempo que o paciente permanece em FA durante um determinado período de tempo; portanto, é teoricamente mais elevado na FA permanente e mais baixo na FA paroxística. A inflamação está associada ao início e à manutenção da FA. No entanto, a relação entre o índice de inflamação imune sistêmica (SII, do inglês systemic immune-inflammation index) e a carga de FA é desconhecida. Objetivo No presente estudo, investigamos a relação entre o SII e a carga de FA. Métodos O presente estudo é uma análise transversal de 453 pacientes (252 do sexo feminino e 201 do sexo masculino, com idade entre 44 e 94 anos) com FA (138 com FA paroxística e 315 com FA permanente) atendidos no ambulatório de cardiologia entre outubro de 2022 e junho de 2023. O SII foi calculado como (neutrófilos × plaquetas/linfócitos). O papel preditivo do SII e de outros marcadores inflamatórios na probabilidade do padrão de FA foi avaliado por análises de regressão logística, sendo considerado estatisticamente significativo o valor de p < 0,05. Resultados Idade, pressão arterial diastólica, frequência cardíaca, diabetes mellitus, neutrófilos, relação plaquetas-linfócitos, relação neutrófilos-linfócitos, SII, proteína C reativa, largura de distribuição de glóbulos vermelhos, hemoglobina A1c e diâmetro do átrio esquerdo foram significativamente maiores no grupo com FA permanente. De acordo com a análise de regressão logística, idade (p = 0,038), diabetes mellitus (p = 0,024), largura de distribuição de glóbulos vermelhos (p = 0,023), proteína C reativa (p = 0,010), SII (p = 0,001) e o diâmetro do átrio esquerdo (p < 0,001) contribuíram significativamente para a predição da probabilidade de FA permanente. Conclusão O SII está independentemente associado à carga de FA. Estudos prospectivos são necessários para determinar se o SII pode ser útil na identificação de pacientes com alto risco de progressão da FA.
Abstract Background Atrial fibrillation (AF) burden is defined as the proportion of time the patient remains in AF over a given period of time; thus, it is theoretically highest in permanent AF and lowest in paroxysmal AF. Inflammation is associated with the initiation and maintenance of AF. However, the relationship between systemic immune-inflammation index (SII) and AF burden is unknown. Objective In the present study, we investigated the relationship between SII and AF burden. Methods The present study is a cross-sectional analysis of 453 patients (252 females and 201 males, aged 44 to 94 years) with AF (138 with paroxysmal AF and 315 with permanent AF) who visited the cardiology outpatient clinic between October 2022 and June 2023. SII was calculated as (neutrophils × platelets/lymphocytes). The predictive role of SII and other inflammatory markers in the likelihood of AF pattern was evaluated by logistic regression analyses, and p value < 0.05 was considered statistically significant. Results Age, diastolic blood pressure, heart rate, diabetes mellitus, neutrophil, platelet-to-lymphocyte ratio, neutrophil-to-lymphocyte ratio, SII, C-reactive protein, red blood cell distribution width, hemoglobin A1c, and left atrial diameter were significantly higher in the permanent AF group. According to the logistic regression analysis, age (p = 0.038), diabetes mellitus (p = 0.024), red blood cell distribution width (p = 0.023), C-reactive protein (p = 0.010), SII (p = 0.001), and left atrial diameter (p < 0.001) significantly contributed to the prediction of the likelihood of permanent AF. Conclusion SII is independently associated with the AF burden. Prospective studies are needed to determine whether SII may be useful in identifying patients at high risk for AF progression.
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Objective:To investigate the factors influencing the short-term prognosis of patients with acute diquat poisoning (ADQP).Methods:Patients with ADQP admitted to the Affiliated Hospital of Xuzhou Medical University and Xuzhou Occupational Disease Prevention Hospital from August 2015 to July 2022 were retrospectively selected. Patients were divided into survival group and death group according to 30-day survival status after poisoning. The general data and the results of the first laboratory examination after admission were compared between the two groups. Logistic regression analysis was used to analyze the independent risk factors associated with prognosis. And the receiver operating characteristic (ROC) curve was drawn to evaluate the prognostic value of risk factors in patients with ADQP.Results:A total of 79 ADQP patients were included in this study, including 40 patients in the survival group and 39 patients in the death group. There were statistically significant differences in the age, poisoning dose, white blood cell, alanine aminotransferase, aspartate aminotransferase, serum creatinine, blood urea, neutrophil to lymphocyte ratio, monocyte to lymphocyte ratio, and systemic immune inflammation index (SII) between survival and death groups (all P<0.05). Multivariate logistic regression analysis showed that the poisoning dose ( OR=1.018, 95% CI: 1.001-1.035, P=0.033), serum creatinine ( OR=1.049, 95% CI: 1.005-1.095, P=0.028), and SII ( OR=1.001, 95% CI: 1.000-1.002, P=0.029) were independent risk factors for the prognosis of patients with diquat poisoning. The areas under the curves of the combined detection of poisoning dose, serum creatinine and SII was 0.968, the sensitivity was 0.949, and the specificity was 0.900, which were higher than those of the single index. Conclusions:The poisoning dose, serum creatinine and SII are independent prognostic predictors of patients with ADQP. The combination of three independent factors has higher sensitivity and specificity in evaluating the prognosis of ADQP, which could be used as a reliable indicator to predict the prognosis of patients with ADQP.
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Objective@#To investigate the associations of multiple immunoinflammatory markers in peripheral blood before and after operation, such as the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI), with postoperative recurrence and metastasis in oral squamous cell carcinoma (OSCC) patients, to provide a reference for predicting the prognosis of OSCC patients.@*Methods@#This study was approved by the hospital ethics committee, and informed consent was obtained from the patients. A total of 160 patients with primary OSCC who underwent radical surgery were grouped according to preoperative lymph node metastasis, degree of differentiation, clinical T stage, and postoperative recurrence and metastasis. The last preoperative and 1-month postoperative routine blood test results of all the patients were collected to analyze the relationship between peripheral blood inflammatory indicators, including the NLR, PLR, LMR, SII, and SIRI, before and after surgery.The above clinicopathological indicators and postoperative recurrence and metastasis were evaluated in OSCC patients.@*Results@#Among the 160 patients, there was a significant difference in the preoperative SII between the preoperative lymph node metastasis group and the no metastasis group (P<0.05); the preoperative NLR, LMR, SII and SIRI were significantly different among the different differentiation degree groups (P<0.05); and the preoperative SIRI in the different clinical T stage groups were significantly different (P<0.05). The preoperative NLR, SII and SIRI were significantly different between the postoperative recurrence and metastasis group and the no recurrence and metastasis group (P<0.05). Postoperative peripheral blood inflammatory markers were not associated with postoperative metastasis and recurrence. Univariate Cox analysis revealed that among the preoperative peripheral blood inflammatory indicators, the preoperative NLR, PLR, SII and SIRI were the factors influencing recurrence and metastasis in OSCC patients. Multivariate Cox analysis revealed that the preoperative NLR was the only independent risk factor for recurrence and metastasis in OSCC patients among the preoperative peripheral blood inflammatory indicators.@*Conclusion@#Among the peripheral blood inflammatory indicators, the preoperative NLR is an independent risk factor for postoperative recurrence and metastasis in OSCC patients and has certain predictive value.
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Objective To investigate the predictive value of systemic immune-inflammation index(SII)and N-terminal pro-brain natriuretic peptide(NT-proBNP)level in elderly patients with acute ST-segment elevation myocardial infarction(STEMI)developing contrast-induced acute kidney injury(CIAKI)after PCI.Methods A total of 1085 elderly STEMI patients undergoing emergency PCI in the Affiliated Hospital of Xuzhou Medical University from January 2018 to March 2023 were consecutively recruited as a training set,and another 287 elderly STEMI pa-tients receiving emergency PCI in the East Branch of the Affiliated Hospital from January 2021 to June 2023 were included as a verification set.According to the diagnostic criteria of CIAKI,they were divided into CIAKI group(n=95)and non-CIAKI group(n=990).Based on the results of restricted cubic spline(RCS)analysis,the patients from the training set were assigned into low-risk subgroup(n=292),moderate-risk group(n=515)and high-risk group(n=278).Multivari-ate logistic regression analysis was used to analyze the independent risk factors of CIAKI in elder-ly STEMI patients after PCI,and ROC curve was plotted to analyze the predictive value of combi-nation of SII and NT-proBNP.The risk of CIAKI was compared among the patients at different risk grades.Results Age,SII,baseline serum creatinine,NT-proBNP,fasting blood glucose and use of diuretics were independent risk factors for CIAKI after primary PCI in elderly STEMI patients(P＜0.05,P＜0.01).The AUC value of SII combined with NT-proBNP in predicting CIAKI was 0.801(95％CI:0.761-0.842,P＜0.01),with a sensitivity of 83.2％and a specificity of 67.5％,both superior to that of SII or NT-proBNP alone.RCS analysis revealed an increased risk of CIAKI at SII ≥1084.97 × 109/L and NT-proBNP ≥296.12 ng/L.The incidence of CIAKI was increased with the increase of risk grades(1.71％vs 6.41％vs 20.50％).Conclusion SII and NT-proBNP are independent risk factors for CIAKI after emergency PCI in elderly STEMI pa-tients.And their combination has better predictive value for CIAKI.
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Objective To investigate the clinical significance of neutrophil to albumin ratio(NAR),neutrophil to lymphocyte ratio(NLR),monocyte to lymphocyte ratio(MLR),platelet to lymphocyte ratio(PLR)and systemic immune-inflammation index(SII)in schizophrenia.Methods A total of 215 patients with schizophrenia admitted to Nanning Social Welfare Hospital from January 2019 to June 2021 were included in schizophrenia group,and 113 healthy people who underwent physical examination in hospital during the same period were included in control group.NAR,NLR,MLR,PLR,SII of two groups were compared,and the correlation between them and the clinical symptom score of schizophrenia and changes after taking antipsychotic drugs were analyzed.Results The levels of NAR,NLR,PLR,MLR and SII in schizophrenia group were significantly higher than those in control group(P<0.05).Spearman correlation analysis showed that NAR,NLR,SII and scale for the assessment of positive symptom scores were negatively correlated(P<0.05).After treatment with antipsychotic drugs,all inflammatory indexes were decreased in schizophrenia group,but NAR and MLR were still significantly higher than those in control group(P<0.05).Conclusion There is an active state of immune inflammation in schizophrenia,and the levels of NAR and MLR do not decrease significantly after treatment with antipsychotic drugs,which may be related to the persistence of schizophrenia symptoms.
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SUMMARY OBJECTIVE: Clinical diagnosis of acute appendicitis is often difficult and involves a synthesis of clinical, laboratory, and radiological findings. The aim of this study was to investigate whether the systemic immune inflammation index can be used as an effective parameter in the diagnosis of acute appendicitis and its reliability in the differentiation of complicated vs. non-complicated appendicitis. METHODS: The study was conducted retrospectively with patients admitted to the emergency department with abdominal pain and diagnosed with acute appendicitis. In total, 150 patients and 150 control cases were included in the study. Demographic data, medical history, white blood cell count, platelet count, neutrophil count, systemic immune inflammation index values, Alvarado score, adult appendicitis score, and pathology result of appendectomy material were retrieved from the hospital automation system and recorded in the data form. RESULTS: Neutrophil-lymphocyte ratio and systemic immune inflammation index were significantly higher, and platelet-neutrophil ratio and lymphocyte-neutrophil ratio were significantly lower in the patient group compared to the control group (p<0.001). Receiver operating characteristic analysis revealed that the sensitivity and specificity of systemic immune inflammation index with a cutoff value of 840.13 was 82 and 66.7%, respectively, for the diagnosis of acute appendicitis. Correlation analysis revealed that systemic immune inflammation index, Alvarado score, and adult appendicitis score were positively correlated, and this correlation was statistically significant. CONCLUSION: Systemic immune inflammation index may be used to promote the diagnosis of acute appendicitis and may reduce the need for radiation exposure and diagnostic imaging tests such as contrast-enhanced abdominal computed tomography. It can also be used to differentiate between complicated and non-complicated acute appendicitis cases.
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Objective To discuss the clinical value of systemic immune-inflammation index(SII)in predicting the prognosis of patients with extrahepatic cholangiocarcinoma(ECCA)treated with biliary stenting combined with 125I seeds implantation.Methods A total of 128 patients with unresectable ECCA,who received biliary stenting combined with 125I seeds implantation at the Interventional Department of the Affiliated Hospital of Xuzhou Medical University of China between August 2018 and August 2021,were enrolled in this study.The peripheral blood routine testing was performed within 3 days before operation,based on which the SII was calculated.Receiver operating characteristic(ROC)curve was applied to determine the optimal cut-off value of SII,based on which the patients were divided into high-SII group and low-SII group.Cox regression model was used to analyze the independent factors affecting patient prognosis.The Kaplan-Meier curve was plotted to analyze the one-year survival.Results The optimal cut-off value of SII was 1 050,the sensitivity was 66.0％,the specificity was 69.3％,and the area under ROC curve of SII was 0.676.The one-year survival rate of patients with ECCA in the high-SII group was significantly lower than that in the low-SII group(P＜0.05).Univariate Cox regression analysis indicated that vascular invasion,T stage,adjuvant chemotherapy,CA19-9,and preoperative SII were the important factors affecting the prognosis of patients with ECCA.Multivariate Cox regression analysis revealed that T stage,CA19-9,and preoperative SII were the independent risk factors for patient prognosis,while adjuvant chemotherapy was a protective factor.The Kaplan-Meier curves showed that the one-year survival rate in high-SII group was remarkably lower than that in the low-SII group.Conclusion Preoperative SII has an important value in evaluating the prognosis of patients with ECCA who are treated with biliary stenting combined with 125I seed implantation.(J Intervent Radiol,2023,32:1221-1225)
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Systemic immune-inflammation index is an effective index reflecting the inflammation and immune state of the body. The calculation formula is platelet count×neutrophil count/lymphocyte count. Because the test of SII is simple and does not increase the burden of patients, SII has been applied to the prognosis assessment of patients with various types of tumors. There are many studies on SII for predicting the prognosis of esophageal cancer, gastric cancer and colorectal cancer after treatment. The patients with higher SII have poorer prognosis. The combination of SII and other inflammatory index will have higher clinical application value.
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Objective:To investigate the prognostic value of systemic immune-inflammation index (SII) in patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF).Methods:The clinical data, including age, gender, complications, laboratory examination results post-admission, SII, model for end-stage liver disease (MELD) score, MELD-Na score, Child-Turcotte Pugh (CTP) score of HBV-ACLF patients treated in Huashan Hospital, Fudan University from January 2016 to August 2021 were retrospectively analyzed. The patients were divided into survival group and death group according to the outcome at 90 days of follow-up.Paired sample t test, Mann-Whitney U test and chi-square test were used for statistical analysis.Pearson correlation was used to analyze the correlation between SII and the prognosis prediction model of HBV-ACLF. The area under the curve (AUC) was used to analyze the clinical efficacies of SII, MELD score, MELD-Na score and CTP score in predicting the prognosis of HBV-ACLF patients, and the optimal cut-off value of SII for predicting the prognosis of HBV-ACLF was calculated. Kaplan-Meier method was used for survival analysis. Results:A total of 140 patients with HBV-ACLF were included. There were 88 patients in the survival group, including 65 males and 23 females, with the age of (47.69±11.96) years. There were 52 cases in the death group, including 40 males and 12 females, with the age of (52.73±12.22) years. The age, aspartate aminotransferase, total bilirubin, serum creatinine, international normalized ratio, neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, SII, MELD score, MELD-Na score, CTP score and the incidence of infection in the death group were all significantly higher than those in the survival group, and albumin, lymphocyte count, platelet count, prognostic nutritional index in the death group were all significantly lower than those in the survival group, and the differences were all statistically significant ( t=-2.39, Z=-2.84, t=-4.81, Z=-2.15, Z=-4.91, Z=-3.47, Z=-3.36, Z=-3.83, Z=-4.69, Z=-4.56, Z=-6.31, χ2=24.96, t=3.06, t=3.03, Z=-7.57 and t=4.12, respectively, all P<0.05). Pearson correlation analysis showed that SII was positively correlated with CTP score ( r=0.272 7, P=0.001), MELD score ( r=0.365 8, P<0.001) and MELD-Na score ( r=0.381 1, P<0.001). The AUC of SII was the largest of 0.80, and 0.76 for MELD score, 0.74 for MELD-Na score and 0.73 for CTP score. The optimal cut-off value of SII was 447.49. Kaplan-Meier analysis showed that the 90 days survival rate of patients with SII≥447.49(38.60%(22/57)) was lower than that of SII<447.49 group (79.52%(66/83)), and the difference between the two groups was significant ( χ2=23.80, P<0.001). Conclusions:SII can be used to assess the severity and prognosis of HBV-ACLF patients. SII ≥447.49 indicates poor prognosis.
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Objective:To explore the predictive value of lipoprotein-associated phospholipase A2 (Lp-PLA2) combined with systemic immune-inflammation index (SII) for coronary heart disease risk in patients with type 2 diabetes mellitus.Methods:A prospective study was performed, 130 patients with type 2 diabetes mellitus from May 2018 to May 2021 in the People′s Hospital of Pengzhou were selected. All patients underwent coronary angiography examination, and 49 cases were complicated with coronary heart disease (coronary heart disease group), 81 cases were not complicated with coronary heart disease (non-coronary heart disease group). The clinical data were recorded; the white blood cell, monocyte, platelet, neutrophils, lymphocyte, hemoglobin, total cholesterol (TC), triacylglycerol (TG), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), fasting blood glucose, C-reactive protein (CRP), glycated hemoglobin and Lp-PLA2 were detected; and the SII was calculated. Multivariate Logistic regression analysis was used to analyze the independent risk factors of coronary heart disease in patients with type 2 diabetes mellitus; the efficacy of Lp-PLA2 and SII in predicting the coronary heart disease in patients with type 2 diabetes mellitus was evaluated using the receiver operating characteristics (ROC) curve.Results:There were no statistical differences in white blood cell, hemoglobin, TC, TG, LDL-C, fasting blood glucose, glycated hemoglobin and CRP between two groups ( P>0.05); the monocyte, platelet, neutrophils, Lp-PLA2 and SII in coronary heart disease group were significantly higher than those in the non-coronary heart disease group: (0.55 ± 0.22) × 10 9/L vs. (0.40 ± 0.11) × 10 9/L, (227.84 ± 40.76) × 10 9/L vs. (205.81 ± 39.04) × 10 9/L, (6.78 ± 1.45) × 10 9/L vs. (6.30 ± 1.18) × 10 9/L, (240.67 ± 41.48) μg/L vs. (214.83 ± 36.35) μg/L and 1 245.76 ± 383.08 vs. 929.84 ± 260.27, the lymphocyte and HDL-C were significantly lower than those in the non-coronary heart disease group: (1.26 ± 0.17) × 10 9/L vs. (1.41 ± 0.19) × 10 9/L and (1.15 ± 0.14) mmol/L vs. (1.23 ± 0.21) mmol/L, and there were statistical differences ( P<0.01 or <0.05). Multivariate Logistic regression analysis result showed that monocyte, HDL-C, Lp-PLA2 and SII were the independent risk factors of coronary heart disease in patients with type 2 diabetes mellitus ( OR = 1.812, 1.013, 1.013 and 2.004; 95% CI 4.430 to 6.801, 0.992 to 1.013, 1.001 to 1.026 and 0.004 to 0.855; P<0.01 ore <0.05). ROC curve analysis result showed that the area under the curve of Lp-PLA2 combined with SII to predict the coronary heart disease in patients with type 2 diabetes mellitus was significantly larger than Lp-PLA2 and SII alone: 0.783 (95% CI 0.702 to 0.851) vs. 0.681 (95% CI 0.593 to 0.760) and 0.744 (95% CI 0.660 to 0.816), and there was statistical difference ( P<0.05). Conclusions:Lp-PLA2 and SII are independent risk factors for coronary heart disease in patients with type 2 diabetes mellitus, and their combined detection can improve the predictive value of coronary heart disease.
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Objective:To explore the predictive value of C-reactive protein/albumin ratio (CAR) and systemic immune-inflammation index (SII) for opportunistic infection among acquired immune deficiency syndrome (AIDS) patients.Methods:From March 2020 to March 2022, a total of 220 AIDS patients treated in Honghu Center for Disease Control and Prevention were enrolled and they were divided into opportunistic infection group (178 cases) and non-infection group (42 cases) according to whether infection occurred; they were also assigned to bacterial infection group (22 cases), fungal infection group (63 cases) and mixed infection group (93 cases) according to different etiological characteristics. The general data were collected and CAR, SII were calculated according to laboratory indicators. Logistic regression was used to screen the risk factors affecting opportunistic infections or different etiological infections. The predictive value of CAR and SII on opportunistic infection and different etiological infections were compared by using receiver operating characteristic (ROC) curve.Results:The CD 4+T cell count, lymphocyte count were lower in the opportunistic infection group and the CRP, CAR, white blood cell count, neutrophil count, SII were higher in the opportunistic infection group compared with non-infection group, there were statistical differences ( P<0.05). The results of Logistic regression analysis showed that CAR and SII were the independent risk factors of opportunistic infection ( P<0.05). The area under the curve (AUC) of CAR to predict opportunistic infection was 0.886(95% CI 0.837 - 0.925), the specificity and sensitivity was 97.0% and 69.1%; the AUC of SII to predict opportunistic infection was 0.743(95% CI 0.680 - 0.799), the specificity and sensitivity was 52.4% and 88.2%. The results of Logistic regression analysis showed that CAR, monocyte count and SII were the independent risk factors for bacterial infection ( P<0.05). CAR and SII were the independent risk factors for fungal infection ( P<0.05). CD 4+ T cell count, CAR and SII were the independent risk factors for mixed infection ( P<0.05). The AUC of CAR to predict bacterial, fungal and mixed infection were 0.898(95% CI 0.797 - 0.960), 0.828(95% CI 0.742 - 0.895) and 0.923(95% CI 0.864 - 0.962), the optimum critical value were 0.49, 0.43, 0.40, the specificity were 98.7%, 95.2% and 92.9%, the sensitivity were 72.7%, 66.7% and 80.6%. The AUC of SII to predict bacterial, fungal and mixed infections were 0.627(95% CI 0.497 - 0.744), 0.782 (95% CI 0.633 - 0.811) and 0.780(95% CI 0.700 - 0.847), the optimum critical value were 385.13, 379.27, 390.10, the specificity were 55.4%, 52.4% and 54.8%, the sensitivity were 77.3%, 85.7% and 90.3%. Conclusions:CAR and SII can be used as predictors of AIDS opportunistic infection.
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@#Objective To evaluate the relationship between the systemic immune-inflammation (SII) index,systemic inflammation response index (SIRI),and the severity and functional prognosis of patients with cervicocranial arterial dissection (CCAD). Methods A total of 101 patients with CCAD were enrolled and divided into the acute mild stroke group (n=48) and moderate to severe stroke group (n=15) caused by CCAD,and CCAD without stroke group (n=38). The SII index and SIRI were compared across the three groups. Logistic regression and receiver operating curve (ROC) analysis were performed to identify independent predictors of an unfavorable outcome and predictive power. Results Compared with CCAD without stroke group,patients with stroke had higher SII index and SIRI,and significantly higher values of these biomarkers were observed in patients with moderate/severe stroke than those with minor stroke (P<0.05). SII index and SIRI were associated with the NIHSS score at admission (rSII=0.306,PSII=0.002; rSIRI=0.271,PSIRI=0.006) and the mRS score at discharge (rSII=0.264,PSII=0.008; rSIRI=0.240,PSIRI =0.016). In multivariate analysis,elevated SII index,but not SIRI,was independently associated with poor short-term outcomes after CCAD (P<0.05). NIHSS score played a full mediation effect between SII index level and poor prognosis. The sensitivity of the SII index in predicting unfavorable clinical outcomes was 66.7%,the specificity was 82.6%,and the best critical value was 1 160.63×109/L. Conclusion Elevated SII index and SIRI values are associated with the severity and clinical outcomes of patients with CCAD. An elevated SII index,but not SIRI,could be an independent predicting factor for a poor short-term outcome after CCAD.
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Lung cancer remains the leading cause of cancer deaths worldwide and is the most common cancer in males. Immune-checkpoint inhibitors (ICIs) that target programmed cell death protein-1 (PD-1) or programmed cell death-ligand 1 (PD-L1) have achieved impressive efficacy in the treatment of non-small-cell lung cancer (NSCLC) (Pardoll, 2012; Champiat et al., 2016; Gao et al., 2022). Although ICIs are usually well tolerated, they are often accompanied by immune-related adverse events (irAEs) (Doroshow et al., 2019). Non-specific activation of the immune system produces off-target immune and inflammatory responses that can affect virtually any organ or system (O'Kane et al., 2017; Puzanov et al., 2017). Compared with adverse events caused by chemotherapy, irAEs are often characterized by delayed onset and prolonged duration and can occur in any organ at any stage of treatment, including after cessation of treatment (Puzanov et al., 2017; von Itzstein et al., 2020). They range from rash, pneumonitis, hypothyroidism, enterocolitis, and autoimmune hepatitis to cardiovascular, hematological, renal, neurological, and ophthalmic irAEs (Nishino et al., 2016; Kumar et al., 2017; Song et al., 2020). Hence, we conducted a retrospective study to identify validated factors that could predict the magnitude of the risk of irAEs in patients receiving PD-1/PD-L1 inhibitors; our approach was to analyze the correlation between the clinical characteristics of patients at the start of treatment and relevant indicators such as hematological indices and the risk of developing irAEs. Then, we developed an economical, practical, rapid, and simple model to assess the risk of irAEs in patients receiving ICI treatment, as early as possible.
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Male , Humans , Carcinoma, Non-Small-Cell Lung/drug therapy , Lung Neoplasms/drug therapy , Immune Checkpoint Inhibitors/adverse effects , Programmed Cell Death 1 Receptor , Retrospective Studies , ApoptosisABSTRACT
Objective To analyze the serological markers and surgical indicators associated with biliary complications after orthotopic liver transplantation, explore their influencing factors and predictive indicators. Methods A retrospective analysis was performed for the clinical data of 101 patients who underwent orthotopic liver transplantation in Renmin Hospital of Wuhan University from January 2016 to June 2022, according to the presence or absence of biliary complication (BC) at 6 months after surgery, they were divided into BC group with 21 patients and non-BC group with 80 patients.The t -test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.Univariate and multivariate Logistic regression analyses were performed, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive performance of combined indicators. Results Among the 101 patients, 21(20.8%) experienced BC.The multivariate Logistic regression analysis showed that MELD score (odds ratio[ OR ]=0.134, 95% confidence interval[ CI ]: 0.031-0.590, P =0.008), SⅡ/Alb ( OR =1.415, 95% CI : 1.181-1.696, P =0.001), and plasma transfusion volume ( OR =1.001, 95% CI : 1.000-1.002, P =0.032) were independent risk factors for the development of BC in patients after liver transplantation.MELD score, SⅡ/Alb, plasma transfusion volume, MELD+SⅡ/Alb, and MELD+SⅡ/Alb+plasma transfusion volume had an area under the ROC curve of 0.712, 0.870, 0.712, 0.900, and 0.918, respectively, in predicting BC after liver transplantation. Conclusion SⅡ/Alb, plasma transfusion volume and MELD score are independent risk fators for BC after liver transplantation.The combination of three indicators has good predictive value and clinical guiding significance for BC after liver transplantation.
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@#Objective To explore the association between the preoperative systemic immune-inflammation index (SII) and prognosis in non-small cell lung cancer (NSCLC) patients. Methods A comprehensive literature survey was performed on PubMed, Web of Science, EMbase, The Cochrane Library, Wanfang, and CNKI databases to search the related studies from inception to December 2021. The hazard ratio (HR) and 95% confidence interval (CI) were combined to evaluate the correlation of the preoperative SII with overall survival (OS), disease-free survival (DFS), and recurrence-free survival (RFS) in NSCLC patients. Results A total of 11 studies involving 9 180 patients were eventually included. The combined analysis showed that high SII levels were significantly associated with worse OS (HR=1.61, 95%CI 1.36-1.90, P<0.001), DFS (HR=1.50, 95%CI 1.34-1.68, P<0.001), and RFS (HR=1.17, 95%CI 1.04-1.33, P<0.001). Subgroup analyses also further verified the above results. Conclusion Preoperative SII is a powerful prognostic biomarker for predicting outcome in patients with operable NSCLC and contribute to prognosis evaluation and treatment strategy formulation. However, more well-designed and prospective studies are warranted to verify our findings.
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Objective To investigate the predictive value of preoperative fibrinogen/albumin ratio (FAR) and systemic immune inflammation index (SII) on the postoperative prognosis of patients with pancreatic ductal adenocarcinoma. Methods An ROC curve was used in determining the best cutoff values of FAR and SII and then grouped. The Cox proportional hazards model was used in analyzing the prognostic factors of radical pancreatic cancer surgery, and then a Nomogram prognostic model was established. C-index, AUC, and calibration curve were used in evaluating the discrimination and calibration ability of the Nomogram. DCA curves were used in assessing the clinical validity of the Nomograms. Results The optimal cutoff values for preoperative FAR and SII were 0.095 and 532.945, respectively. FAR≥ 0.095, SII≥ 532.945, CA199≥ 450.9 U/ml, maximum tumor diameter≥ 4 cm, and the absence of postoperative chemotherapy were independent risk factors for the poor prognosis of pancreatic cancer (P<0.05). The discrimination ability, calibration ability, and clinical effectiveness of Nomogram prognostic model were better than those of the TNM staging system. Conclusion The constructed Nomogram prognostic model has higher accuracy and level of discrimination and more clinical benefits than the TNM staging prognostic model.
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Objective:To explore the predictive value of neutrophil to lymphocyte ratio (NLR) and systemic immune-inflammation index (SII) of inflammatory markers of peripheral blood cells on the prognosis in the advanced non-small cell lung cancer (NSCLC) patients with immune therapy.Methods:The hematologic and clinical data of 58 patients with advanced non-small cell lung cancer who received the treatment of immune therapy in the First People's Hospital of Chuzhou of Anhui Province from January 2018 to June 2022 were retrospectively analyzed. X-tile software was used to calculate the optimal cut-off values of NLR and SII. All patients were divided into high and low groups according to the optimal cut-off values. The relationship between different NLR, SII and clinicopathological features, clinical efficacy, prognosis of the advanced non-small cell lung cancer patients with immune therapy were analyzed. Cox regression models were used to perform univariate and multivariate analyses of factors affecting patient prognosis.Results:The optimal cut-off values for NLR and SII were 3.2 and 546.5, respectively. There were statistically significant differences in regional lymph node metastasis ( χ2=5.03, P=0.025) and the number of metastatic sites ( χ2=11.60, P=0.001) between patients in the low-NLR group (NLR<3.2, n=26) and the high-NLR group (NLR≥3.2, n=32). There were statistically significant differences in location of the primary site ( χ2=8.34, P=0.004) between patients in the low-SII group (SII<546.5, n=28) and the high-SII group (SII≥546.5, n=30). The objective response rate (ORR) of the low-NLR group [50.00% (13/26) ] was higher than that of the high-NLR group [21.88% (7/32) ], and there was a statistically significant difference ( χ2=5.02, P=0.025) ; the disease control rate (DCR) of the low-NLR group [69.23% (18/26) ] was higher than that of the high-NLR group [50.00% (16/32) ], but there was no statistically significant difference ( χ2=2.19, P=0.139). The ORR of the low-SII group [53.57% (15/28) ] was higher than that of the high-SII group [26.67% (8/30) ]; The DCR of the low-SII group [67.86% (19/28) ] was higher than that of the high-SII group [33.33% (10/30) ], and there were statistically significant differences ( χ2=4.38 , P=0.036; χ2=6.91 , P=0.009). The median overall survival (OS) of patients in the low-NLR group (17.6 months) was longer than that of the high-NLR group (11.7 months), and there was a statistically significant difference ( χ2=11.07, P=0.001). The median OS of patients in the low-SII group (16.5 months) was longer than that of the high-SII group (12.3 months), and there was a statistically significant difference ( χ2=5.53, P=0.019). Univariate analysis showed that Eastern Cooperative Oncology Group (ECOG) score ( HR=2.20, 95% CI: 1.10-4.39, P=0.025), brain metastases ( HR=3.24, 95% CI: 1.61-6.50, P=0.001), the number of transferred sites ( HR=2.83, 95% CI: 1.44-5.57, P=0.003), NLR ( HR=3.22, 95% CI: 1.56-6.66, P=0.002) and SII ( HR=2.18, 95% CI: 1.12-4.24, P=0.021) were all independent influence factors affecting the prognosis of the advanced non-small cell lung cancer patients with immune therapy; multivariate analysis showed that brain metastases ( HR=2.91, 95% CI: 1.22-6.94, P=0.016), NLR ( HR=2.88, 95% CI: 1.17-7.13, P=0.022) and SII ( HR=3.63, 95% CI: 1.40-9.39, P=0.008) were all independent risk factors affecting the prognosis of the advanced non-small cell lung cancer patients with immune therapy. Conclusion:NLR and SII can be used as important indicators for predicting the efficacy of immunotherapy in the advanced NSCLC and elevated NLR and SII can indicate poor prognosis of patients.
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Objective:To investigate the value of immune inflammatory index in predic-ting the therapeutic efficacy of neoadjuvant chemoradiotherapy for esophageal squamous cell carci-noma (ESCC).Methods:The retrospective case-control study was conducted. The clinicopatholo-gical data of 163 patients with ESCC who were admitted to Zhongshan Hospital of Fudan University from December 2015 to December 2020 were collected. There were 135 males and 28 females, aged (62±8)years. All 163 patients underwent neoadjuvant chemoradiotherapy and radical resection for ESCC. Observation indicators: (1) relationship between immune inflammatory index and clinical characteristic in patients; (2) relationship between immune inflammatory index and efficacy of neoadjuvant chemoradiotherapy in patients; (3) influencing factor analysis for pathologic complete response and good response of tumor regression grade after neoadjuvant chemoradiotherapy; (4) efficiency of immune inflammatory index in predicting efficacy of neoadjuvant chemoradiotherapy. Measurement data with normal distribution were represented as Mean± SD. Count data were described as absolute numbers, and comparison between groups was conducted using chi-square test. Comparison of ordinal data was conducted using the rank sum test. The receiver operating characteristic (ROC) curve was used to determine the optimal cut-off value. Univariate and multi-variate analyses were conducted using the Logistic regression model. The area under the curve (AUC) of ROC curve was used to evaluate the efficiency of predictive model. Results:(1) Relationship between immune inflammatory index and clinical characteristic in patients. ① Optimal cut-off value of systemic immune-inflammation index (SII), neutrophil-lymphocyte ratio (NLR), platelet-lympho-cyte ratio (PLR). Results of ROC curve analysis showed that the AUC of SII, NLR, PLR in predicting efficacy of neoadjuvant chemoradiotherapy for patients with ESCC was 0.70(95% confidence interval as 0.61?0.77), 0.78(95% confidence interval as 0.69?0.84), 0.79(95% confidence interval as 0.70?0.85), respectively, with the maximum value of Youden index and the optimal cut-off value as 0.25, 0.32, 0.52 and 446×10 9/L, 2.09, 138. ② Relationship between SII, NLR, PLR and clinical charac-teristic in patients. According to the optimal cut-off value of SII, NLR, PLR, all 163 patients were divided into cases with SII <446×10 9/L as 99, cases with SII ≥446×10 9/L as 64, cases with NLR <2.09 as 107, cases with NLR ≥2.09 as 56, cases with PLR<138 as 88, cases with PLR ≥138 as 75, respectively. There was a significant difference in clinical N staging of tumor in patients with SII <446×10 9/L and SII ≥446×10 9/L ( P<0.05). There were significant differences in clinical N staging and clinical TNM staging of tumor in patients with NLR<2.09 and NLR≥2.09 ( P<0.05). (2) Relationship between immune inflammatory index and efficacy of neoadjuvant chemoradiotherapy in patients. Of 163 patients undergoing neoadjuvant chemoradiotherapy, there were 54 cases with pathologic complete response and 109 cases without pathologic complete response, 94 cases with good response of tumor regression grade and 69 cases with poor response of tumor regression grade. Of the 54 patients with pathologic complete response, cases with SII <446×10 9/L and SII ≥446×10 9/L, cases with NLR <2.09 and NLR ≥2.09, cases with PLR <138 and PLR ≥138 before neoadjuvant chemoradiotherapy were 42 and 12, 47 and 7, 48 and 6, respectively. The above indicators were 57 and 52, 60 and 49, 40 and 69 in the 109 cases without pathologic complete response. There were significant differences in the above indicators between patients with pathologic complete response and without pathologic complete response ( χ2=9.83, 16.39, 39.60, P<0.05). Of the 94 cases with good response of tumor regression grade, cases with SII <446×10 9/L and SII ≥446×10 9/L, cases with NLR <2.09 and NLR ≥2.09, cases with PLR <138 and PLR ≥138 before neoadjuvant chemoradiotherapy were 59 and 35, 78 and 16, 56 and 38, respectively. The above indicators were 40 and 29, 29 and 40, 32 and 37 in the 69 cases with poor response of tumor regression grade. There was no significant difference in the SII and PLR ( χ2=0.38, 2.79, P>0.05) and there was a significant difference in the NLR ( χ2=29.59, P<0.05) between patients with good response of tumor regression grade and poor response of tumor regre-ssion grade. (3) Influencing factor analysis for pathologic complete response and good response of tumor regression grade after neoadjuvant chemoradiotherapy. Results of multivariate analysis showed that PLR <138 before neoadjuvant chemoradiotherapy was an independent protective factor for pathologic complete response in ESCC patients undergoing neoadjuvant chemoradiotherapy ( odds ratio=1.98, 95% confidence interval as 1.56?2.51, P<0.05) and NLR <2.09 before neoadjuvant chemo-radiotherapy was an independent protective factor for good response of tumor regression grade ( odds ratio=2.50, 95% confidence interval as 1.40?4.46, P<0.05). (4) Efficiency of immune inflam-matory index in predicting efficacy of neoadjuvant chemoradio-therapy. The AUC of PLR <138 before neoadjuvant chemoradiotherapy in predicting pathologic complete response of ESCC patients undergoing neoadjuvant chemoradiotherapy was 0.79(95% confidence interval as 0.64?0.87, P<0.05), with the sensitivity, specificity and Youden index as 0.89, 0.63 and 0.52, respectively. The AUC of NLR <2.09 before neoadjuvant chemoradiotherapy in predic-ting good response of tumor regression grade of ESCC patients undergoing neoadjuvant chemoradio-therapy was 0.76 (95% confidence interval as 0.64?0.81, P<0.05), with the sensitivity, specificity and Youden index as 0.83, 0.58 and 0.41, respectively. Conclusion:The PLR<138 and NLR <2.09 before neoadjuvant chemoradiotherapy are independent protective factors for the pathologic complete response and good response of tumor regression grade, respectively, of ESCC patients undergoing neoadjuvant chemoradiotherapy, and both of them can predict the curative effect of neoadjuvant chemoradiotherapy well.
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Objective:To investigate the predictive value of systematic immune-inflammation index(SII) in severity and prognosis of the patients with acute pulmonary embolism(APE).Methods:By retrospective research methods, the clinical data of 120 APE patients from June 2020 to January 2022 in Hubei University of Medicine Affiliated Dongfeng General Hospital were analyzed. The pulmonary embolism-related deaths within 6 months was the end point events. The influence factors were explored by multivariate Logistic regression analysis, the predictive value of pulmonary embolism severity index (PESI) and SII on the end point events of patients were assessed by receiver operating characteristic(ROC) curve.Results:According to the pulmonary embolism-related deaths within 6 months as the end point events they were divided into the survival group (96 cases) and the death group (24 cases). The age, systolic blood pressure, heart rate, respiratory rate, incidence of congestive heart failure, level of B-type natriuretic peptide, PESI score, and SII in the death group were higher than those in the survival group: (66.00 ± 8.85) years vs. (61.21 ± 5.99) years, (129.83 ± 14.76) mmHg (1 mmHg = 0.133 kPa) vs. (122.77 ± 10.21) mmHg, (102.04 ± 9.43) beats/min vs. (92.54 ± 11.34) beats/min, (20.83 ± 2.37) beats/min vs. (19.72 ± 1.77) beats/min, 41.67%(10/24) vs. 14.58%(14/96), (211.67 ± 85.38) ng/L vs. (167.86 ± 71.88) ng/L, (110.17 ± 19.13) scores vs. (89.09 ± 12.63) scores, (1 068.58 ± 230.65) × 10 9/L vs. (784.22 ± 233.98)×10 9/L, there were statistical differences ( P<0.05). Multivariate Logistic regression analysis showed that age, heart rate, PESI score and SII were the independent risk factors of death related to pulmonary embolism in APE patients ( P<0.05). The results of ROC curve showed that the area under curve of PESI and SII for the prediction of pulmonary embolism related death was 0.816 and 0.791, respectively, there was no statistical difference ( P>0.05). According to the cut-off of SII (882.40 × 10 9/L), they also assigned to the SII<882.40 × 10 9/L group (61 cases) and the SII≥882.40 × 10 9/L group (59 cases), The results of Kaplan-Meier survival analysis showed that the 6-month survival rate in the SII<882.40 × 10 9/L group was higher than that in the SII≥882.40 × 10 9/L group, there was statistical difference ( P<0.05). Conclusions:SII can effectively evaluate the survival prognosis of acute pulmonary embolism patients, and it can be used as one of the indicators for evaluating the prognosis of patients.
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【Objective】 To investigate the predictive value of nutritional risk index (NRI), systemic immune inflammatory index (SⅡ) and triglyceride glucose (TyG) index on the condition and prognosis of patients with acute pancreatitis (AP). 【Methods】 A total of 173 AP patients were divided into mild acute pancreatitis (MAP) group (n=79), moderate acute pancreatitis (MSAP) group (n=44), and severe acute pancreatitis (SAP) group (n=50) according to their severity. All the 50 SAP patients were divided into death group (19 cases) and survival group (31 cases) according to the death situation. The NRI, SⅡ and TyG indexes of each group were recorded and compared. The values of NRI, SⅡ and TyG index in predicting the occurrence and death of SAP were analyzed with ROC curve. Pearson correlation analysis of the correlation between NRI, SⅡ, and TyG index in SAP patients was made. 【Results】 NRI was significantly lower in SAP group (89.25±4.50) than in MSAP group (93.40±6.25) and MAP group (97.62±8.60), while SⅡand TyG index in SAP group (2 706.30±1 052.74, 7.84±1.21) were significantly higher than those in MSAP group (1 937.24±983.48, 6.52±1.05) and MAP group (1 280.58±717.36, 4.65±0.58) (P<0.001). NRI in death group (86.40±3.70) was significantly lower than that in survival group (91.46±5.28), while SⅡ and TyG index in death group (3 085.73±1 192.48, 9.05±1.37) were significantly higher than those in survival group (2 270.26±994.53, 6.70±1.10) (P<0.001). The ROC curve showed that the AUC of NRI, SⅡ and TyG index jointly predicting SAP occurrence and death was 0.850 (95% CI: 0.792-0.908) and 0.905 (95% CI: 0.843-0.966), respectively. Correlation analysis showed that NRI was negatively correlated with SⅡ and TyG index in SAP patients (r=-0.761, P<0.001, r=-0.813, P<0.001), while SⅡ was positively correlated with TyG index (r=0.842, P<0.001). 【Conclusion】 NRI, SⅡ and TyG index are related to the severity and death of AP patients, and the combination of the three indexes has good value in predicting the occurrence and prognosis of SAP.