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Development and Validation of the Systemic Inflammatory Response Index-Based Nomogram for Predicting Short-Term
Yasong Wang1,2, Xuan Wu2, Yue Wang2
1Graduate School of Dalian Medical University, Dalian Medical University, Dalian, 116044, People's Republic of China.
Purpose:
This study aims to develop and validate a nomogram based on the Systemic Inflammatory Response Index (SIRI) to predict short-term aortic-related adverse events (ARAEs) in patients with acute uncomplicated Type B intramural hematoma (IMH).
Patients And Methods:
We retrospectively analyzed 332 patients diagnosed with acute uncomplicated Type B IMH between April 2018 and April 2024. Patients were categorized into the stable group (N=225) and the exacerbation group (N=107) based on the occurrence of ARAEs within 30-day observation period. SIRI was calculated using neutrophil, monocyte, and lymphocyte counts. ARAEs were defined as death related to aortic disease, and the progression of IMH to aortic dissection or penetrating aortic ulcer. The nomogram was developed incorporating SIRI and other significant clinical variables. The model's performance was evaluated using the area under the curve (AUC), calibration curves, decision curve analysis (DCA), and net reclassification index (NRI).
Results:
Among the 332 patients, 217 were male (65.4%), with a mean age of 64.3±9.4 years. Multivariate logistic regression and LASSO regression analyses identified SIRI, anemia, diabetes, maximum diameter of aortic diameter (MDAD), and ulcer like projection (ULP) as independent predictors of ARAEs. Two nomogram models were developed: the Clinical model, including anemia, diabetes, MDAD, and ULP; and the Clinical-SIRI model, incorporating SIRI to the Clinical model. The Clinical-SIRI model demonstrated higher predictive accuracy, with an AUC of 0.788 (95% CI: 0.740-0.831), compared to the Clinical model's AUC of 0.742 (95% CI: 0.691-0.788, P = 0.012). SIRI improved predictive accuracy, as shown by a continuous NRI of 0.521 (95% CI: 0.301-0.743). Calibration curves and DCA further supported the clinical utility of the Clinical-SIRI model.
Conclusion:
The SIRI-based nomogram is a valuable prognostic tool for predicting short-term ARAEs in patients with acute uncomplicated Type B IMH.
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