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Systemic Immune-inflammation Index Is Associated with Symptomatic Cerebral Hyperperfusion after Revascularization
Taiji Yamamoto1, Haruto Uchino1, Masaki Ito1
1Department of Neurosurgery, Hokkaido University Graduate School of Medicine.
Abstract:
Revascularization surgery for moyamoya disease poses risks of complications, requiring appropriate management. Although precise prediction is difficult, the systemic immune-inflammation index is a calculable marker that reflects systemic inflammatory conditions. We aimed to investigate the association between postoperative complications and the systemic immune-inflammation index. We included 91 hemispheres from 71 patients who underwent combined revascularization surgery for moyamoya disease. Symptomatic cerebral hyperperfusion, radiological ischemic and hemorrhagic complications, and temporal muscle swelling that caused brain shift were assessed. The systemic immune-inflammation index ratio was calculated from blood test results from the preoperative day and the day after surgery. The association between the systemic immune-inflammation index ratio and postoperative complications was assessed using univariate and multivariate analyses. A receiver operating characteristic analysis was performed to evaluate the diagnostic value of the systemic immune-inflammation index ratio for postoperative complications. The frequencies of postoperative symptomatic cerebral hyperperfusion, ischemic and hemorrhagic complications, and temporal muscle swelling were detected in 24 (26%), 15 (16%), 11 (12%), and 5 (5%) hemispheres, respectively. The systemic immune-inflammation index ratio was higher in the group with postoperative complications than in the group without (median 4.6 vs. 2.7). Multivariate analysis demonstrated the systemic immune-inflammation index ratio as an independent factor associated with symptomatic cerebral hyperperfusion (odds ratio 2.4, 95% confidence interval 1.5-4.0). The receiver operating characteristic analysis demonstrated that the optimal threshold of the systemic immune-inflammation index ratio was 4.3, with a specificity of 0.96 and sensitivity of 0.63. The systemic immune-inflammation index ratio is an indicator of postoperative complications, including symptomatic cerebral hyperperfusion in moyamoya disease, and can be used for effective postoperative management.
Insights
The systemic immune-inflammation index ratio may predict postoperative complications after moyamoya disease revascularization surgery. This inflammatory marker can aid in managing patients and preventing adverse events like cerebral hyperperfusion.
Area of Science:
- Neurosurgery
- Vascular Surgery
- Inflammation Markers
Background:
- Revascularization surgery for moyamoya disease carries risks of complications.
- Predicting these complications is challenging.
- The systemic immune-inflammation index (SII) reflects systemic inflammation and may be a useful predictor.
Purpose of the Study:
- To investigate the association between the SII ratio and postoperative complications following revascularization surgery for moyamoya disease.
- To assess the diagnostic value of the SII ratio for predicting complications.
Main Methods:
- Retrospective analysis of 91 hemispheres from 71 moyamoya disease patients undergoing revascularization.
- Calculation of the SII ratio from preoperative and postoperative blood tests.
- Assessment of complications including symptomatic cerebral hyperperfusion, ischemic/hemorrhagic events, and temporal muscle swelling.
- Statistical analysis using univariate, multivariate, and ROC analyses.
Main Results:
- The SII ratio was significantly higher in patients with postoperative complications (median 4.6 vs. 2.7).
- The SII ratio was an independent predictor of symptomatic cerebral hyperperfusion (OR 2.4).
- An SII ratio threshold of 4.3 showed high specificity (0.96) for predicting complications.
Conclusions:
- The SII ratio serves as a valuable indicator for postoperative complications in moyamoya disease surgery.
- This marker can assist in effective patient management and risk stratification.
- Utilizing the SII ratio may improve outcomes for patients undergoing revascularization procedures.
