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The systemic immune-inflammation index is an independent predictive factor in predicting major amputation in chronic

Ahmet Can Çakmak1, Mehmet Bülent Vatan2, Betul Sarıbıyık Çakmak2

  • 1Department of Cardiology, Sakarya University Education and Research Hospital, Sakarya, Turkey.

Vascular
|March 13, 2025
PubMed

Insights

High systemic immune-inflammation index (SII) predicts major amputation risk in patients with lower extremity peripheral arterial disease (LEAD). This straightforward marker aids in guiding treatment decisions for limb salvage.

Area of Science:

  • Vascular Surgery
  • Inflammatory Biomarkers
  • Amputation Prevention

Background:

  • Lower extremity peripheral arterial disease (LEAD) encompasses arterial narrowing and occlusion, with chronic limb-threatening ischemia (CLTI) representing its most severe form.
  • CLTI significantly increases the risk of major amputation.
  • The systemic immune-inflammation index (SII), derived from neutrophil, lymphocyte, and platelet counts, reflects a patient's inflammatory and immunothrombotic state.

Purpose of the Study:

  • To investigate the association between an elevated systemic immune-inflammation index (SII) and the likelihood of major limb amputation in patients with LEAD.
  • To evaluate SII as a predictive biomarker for major amputation in this patient population.

Main Methods:

  • A cohort of 140 patients with Rutherford 5 or 6 LEAD and foot wounds undergoing endovascular intervention was analyzed.
  • Demographic and laboratory data, including neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and SII, were collected.
  • Receiver operating characteristic (ROC) curve analysis and logistic regression were employed to assess SII's predictive value for major amputation.

Main Results:

  • Major amputation was required in 19.2% (27/140) of the patients.
  • Patients undergoing major amputation exhibited significantly higher neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and SII values.
  • ROC analysis identified an SII cut-off of 1018 as optimal for predicting major amputation (AUC: 0.84, sensitivity: 81%, specificity: 73%).
  • Logistic regression confirmed high SII as an independent predictor of major amputation (OR = 1.001, p = .009).

Conclusions:

  • Elevated SII is significantly associated with an increased risk of major amputation in patients suffering from LEAD with foot wounds.
  • SII serves as a valuable and easily accessible biomarker for predicting major amputation risk.
  • The findings suggest SII can aid clinicians in making informed treatment decisions for limb preservation in LEAD patients.

Keywords:
Systemic immune-inflammation indexchronic limb-threatening ischemiamajor amputation

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