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Systemic immune-inflammation index for predicting poor outcome after carotid endarterectomy: A novel hematological
Ahmet Yuksel1, Yusuf Velioglu1, Ufuk Turan Kursat Korkmaz2
1Department of Cardiovascular Surgery, Bursa City Hospital, Bursa, Turkey.
Insights
The systemic immune-inflammation index (SII) can predict poor outcomes after carotid endarterectomy (CEA). A higher SII indicates an increased risk of complications such as stroke, heart attack, or death within 30 days post-surgery.
Area of Science:
- Vascular Surgery
- Inflammatory Biomarkers
- Surgical Outcomes Prediction
Background:
- Carotid endarterectomy (CEA) is a crucial procedure for stroke prevention.
- Identifying reliable predictors of postoperative complications is essential for patient management.
- The systemic immune-inflammation index (SII) is an emerging hematological marker.
Purpose of the Study:
- To evaluate the predictive value of the systemic immune-inflammation index (SII) for poor outcomes following CEA.
- To determine if SII can serve as an independent predictor of postoperative complications.
Main Methods:
- A multicenter retrospective observational cohort study included 347 patients undergoing elective CEA.
- Poor outcome was defined as stroke, myocardial infarction, or death within 30 days.
- Multivariate logistic regression and ROC curve analyses were performed to assess SII's predictive capability.
Main Results:
- A total of 6.6% of patients experienced poor outcomes.
- Univariate analysis showed higher SII in the poor outcome group.
- Multivariate analysis identified SII as a significant independent predictor of poor outcome (OR = 1.0008; p = 0.002).
- An SII cutoff of 1356 × 10^3/mm^3 predicted poor outcome with 78.3% sensitivity and 64.5% specificity (AUC = 0.746).
Conclusions:
- The systemic immune-inflammation index (SII) is a significant and independent predictor of poor outcomes after carotid endarterectomy.
- This is the first study to demonstrate the predictive role of SII in patients undergoing CEA.
- SII may aid in risk stratification and perioperative management of CEA patients.
Objective:
To investigate the predictive role of systemic immune-inflammation index (SII) on postoperative poor outcome in patients undergoing carotid endarterectomy (CEA).
Methods:
A total of 347 patients undergoing elective isolated CEA between March 2010 and April 2022 were included in this multicenter retrospective observational cohort and risk-prediction study and were divided into two groups as poor outcome group (n = 23) and favorable outcome group (n = 324). Poor outcome was defined as the presence of at least one of the complications within 30 days of surgery including stroke, myocardial infarction, and death. The patients' baseline clinical characteristics, comorbidities, and hematological indices were derived from the complete blood count (CBC) analysis, and perioperative data, outcomes, and complications were screened, recorded, and then compared between the groups. Multivariate logistic regression and receiver-operating characteristic (ROC) curve analyses were conducted following univariate analyses to detect the independent predictors of poor outcome as well as the cutoff values with sensitivity and specificity rates.
Results:
A total of 23 patients out of 347 (6.6%) manifested poor outcome; and stroke, myocardial infarction, and death occurred in 13, 3, and 7 cases, respectively. There were no significant differences between the groups in terms of basic clinical characteristics, comorbidities, and perioperative data, except for lengths of intensive care unit and hospital stays. Although the median values of PLT, PLR, NLR, and SII of the poor outcome group were found to be significantly higher than the favorable outcome group in univariate analysis, only SII was detected to be a significant and independent predictor of poor outcome in multivariate logistic regression analysis (OR = 1.0008; 95% CI: 1.0004-1.0012; p = 0.002). ROC curve analysis revealed that SII of 1356 × 103/mm3 constituted the cutoff value for predicting poor outcome with 78.3% sensitivity and 64.5% specificity (AUC = 0.746; 95% CI: 0.64-0.851).
Conclusions:
Our study revealed for the first time in the literature that SII significantly predicted poor outcome after CEA.
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