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High Preoperative Systemic Immune-Inflammation Index Values Significantly Predicted Poor Outcomes After on-Pump
I Made Adi Parmana1, Cindy Elfira Boom1, Herdono Poernomo1
1Department of Anesthesiology and Intensive Care, National Cardiovascular Center Harapan Kita, Jakarta, Indonesia.
Insights
A high preoperative systemic immune-inflammation index (SII) predicts increased complications and mortality in patients undergoing on-pump coronary artery bypass grafting (CABG) surgery. This finding aids in risk stratification for cardiac surgery patients.
Area of Science:
- Cardiovascular Surgery
- Immunology
- Critical Care Medicine
Background:
- On-pump coronary artery bypass grafting (CABG) is a standard treatment for coronary artery disease (CAD).
- The cardiopulmonary bypass used in on-pump CABG can trigger a systemic inflammatory response, increasing morbidity and mortality risks.
- Identifying predictive markers for adverse outcomes is crucial for optimizing patient management.
Purpose of the Study:
- To evaluate the association between the preoperative systemic immune-inflammation index (SII) and perioperative outcomes in patients undergoing on-pump CABG.
- To determine if SII can serve as a predictive marker for complications and mortality following on-pump CABG.
Main Methods:
- A retrospective study of 1056 patients who underwent on-pump CABG between January 2019 and December 2022.
- Preoperative lymphocyte, neutrophil, and platelet counts were used to calculate the SII.
- Patients were divided into two groups based on an SII cutoff value of 528.715 × 103/mm3 for comparative analysis.
Main Results:
- A high preoperative SII (≥528.715 × 103/mm3) was observed in 46% of patients.
- High SII was significantly associated with prolonged surgery duration, cardiopulmonary bypass time, mechanical ventilation, ICU stay, and hospital stay.
- Elevated SII independently predicted increased risks of postoperative atrial fibrillation, cardiac arrest, acute myocardial infarction, and mortality.
Conclusions:
- Preoperative SII is a significant predictor of adverse perioperative outcomes in patients undergoing on-pump CABG.
- Elevated SII levels indicate a higher risk of morbidity and mortality, suggesting its utility in risk stratification and patient management strategies.
Purpose:
On-pump coronary artery bypass grafting (CABG) is one of the most common revascularization surgical therapies for coronary artery disease (CAD). However, owing to the use of cardiopulmonary bypass ("on-pump"), the body develops systemic inflammatory response syndrome, which leads to the risk of morbidity and mortality. This study aimed to determine the perioperative outcomes of patients who underwent on-pump CABG surgery using the systemic immune-inflammation index (SII).
Patients And Methods:
This single-center retrospective study used secondary data from patients' electronic medical records and medical records archives at the National Cardiovascular Center Harapan Kita, who underwent on-pump CABG from January 2019 to December 2022. A total of 1056 on-pump CABG procedures were performed after exclusion. Lymphocyte, segmental neutrophil, and platelet counts from the preoperative data were used to calculate the SII values. An SII cutoff value of 528.715 × 103/mm3 divided the patients into two groups.
Results:
The SII value of 1056 patients were calculated, among which 490 (46%) patients had a preoperative SII value of ≥528.715 × 103/mm3. Multivariate analysis showed that a high SII significantly prolonged the duration of surgery (OR 1.005, 95% CI 1.003-1.006) and cardiopulmonary bypass (CPB) time (OR 1.007, 95% CI 1.005-1.009). High SII values significantly predicted prolonged mechanical ventilation (OR 6.154, 95% CL 3.938-9.617), intensive care unit (ICU) stay (OR 6.332, 95% CL 4.232-9.474), and hospital stay (OR 3.517, 95% CL 2.711-4.562). Regarding other perioperative outcomes, a high SII significantly predicted the risk of postoperative atrial AF, cardiac arrest, acute myocardial infarction, and mortality.
Conclusion:
A high preoperative SII value can predict morbidity and mortality in patients undergoing on-pump CABG surgery.
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