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Published on: January 28, 2020
Systemic Immune-Inflammation Index Predicts Poor Outcome After Elective Off-Pump CABG: A Retrospective, Single-Center
Souvik Dey1, Ramesh Kashav1, Jasvinder Kaur Kohli1
1Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India.
Insights
The Systemic Immune-Inflammation Index (SII) effectively predicts poor short-term outcomes in patients undergoing off-pump coronary artery bypass grafting (OPCABG). Higher SII levels correlate with increased complications and longer recovery times after OPCABG surgery.
Area of Science:
- Cardiovascular Surgery
- Inflammatory Biomarkers
- Surgical Risk Prediction
Background:
- Off-pump coronary artery bypass grafting (OPCABG) is a complex procedure.
- Identifying patients at high risk for adverse outcomes is crucial for optimizing surgical care.
- Preoperative hematologic indices are increasingly recognized as potential predictors of surgical outcomes.
Purpose of the Study:
- To evaluate the predictive value of preoperative hematologic indices, specifically the neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and Systemic Immune-Inflammation Index (SII), for short-term outcomes following OPCABG.
- To determine if SII can serve as an independent predictor of poor outcomes after OPCABG.
Main Methods:
- A retrospective, single-center study involving 1,007 patients undergoing elective OPCABG.
- Analysis of preoperative hematologic indices including NLR, PLR, and SII.
- Multivariate logistic regression was used to identify independent predictors of poor postoperative outcomes.
Main Results:
- 20.4% of patients experienced poor postoperative outcomes.
- Preoperative SII was identified as an independent predictor of poor outcomes after OPCABG.
- An SII cutoff of 878.06 × 10^3/mm^3 demonstrated high sensitivity (97.6%) and specificity (91%) in predicting adverse events.
- Higher SII values correlated significantly with longer mechanical ventilation duration and intensive care unit stay.
Conclusions:
- The Systemic Immune-Inflammation Index (SII) is a valuable, parsimonious, and reproducible biomarker for predicting short-term adverse outcomes in patients undergoing OPCABG.
- SII integrates inflammatory and thrombotic components, offering a comprehensive assessment of patient vulnerability.
- The findings suggest that SII can aid in identifying patients at higher risk for complications, enabling tailored perioperative management.
Objectives:
To investigate the role of preoperative hematologic indices (neutrophil-lymphocyte ratio [NLR], platelet-lymphocyte ratio [PLR], systemic immune-inflammation index [SII; neutrophil × platelet/lymphocyte) in predicting short-term outcomes after off-pump coronary artery bypass grafting (OPCABG).
Design:
A single-center, retrospective, risk-prediction study.
Setting:
A tertiary cardiac center.
Participants:
1,007 patients undergoing elective OPCABG.
Interventions:
No specific intervention.
Measurements And Main Results:
Two hundred five patients out of 1,007 (20.4%) manifested poor postoperative outcome (defined by ≥1 of: major adverse cardiac and cardiovascular events, duration of mechanical ventilation (DO-MV) >24 hours, new-onset renal failure, sepsis, and death). On univariate analysis, age, diabetes mellitus (DM), European System for Cardiac Operative Risk Evaluation II (EuroSCORE II), left-main disease, recent myocardial infarction, poor left ventricular ejection fraction, hemoglobin, NLR, PLR, and SII significantly predicted poor outcome. However, DM, EuroSCORE II, and SII emerged as independent predictors on multivariate analysis (odds ratio 0.136; 0.035-0.521, 3.377; 95% confidence interval 2.373-4.806, 1.01, 1.003-1.016). The SII cutoff of 878.06 × 103/mm3 predicted poor outcome with 97.6% sensitivity, 91%, specificity, and area under the curve 0.984. There was a significant positive correlation between the SII values and DO-MV and length of intensive care unit stay (R = 0.676; 0.527, p < 0.001). The incidence of complications, such as atrial fibrillation, intra-aortic balloon pump requirement, vasoactive-ionotropic score >20 for >6 hours, and other infections, was also significantly higher in patients with SII ≥878.06 × 103/mm3.
Conclusions:
SII constitutes a parsimonious and reproducible parameter demonstrating the potential of delineating the patients vulnerable to poor outcomes after OPCABG given the combined contribution of pro-inflammatory and pro-thrombotic corpuscular lines in computing the novel index.
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