AISI, SIRI, and MLR in Predicting Surgical Outcomes After Radical Cystectomy: Revisiting Inflammatory Risk Markers

Area of Science:

• Urology
• Surgical Oncology
• Inflammation Biomarkers

Background:

• Radical cystectomy is a major surgery with significant complication rates.
• Predictive markers for post-operative complications are crucial for patient management.
• Systemic inflammatory response markers like SIRI, AISI, and MLR warrant investigation for their prognostic value.

Purpose of the Study:

• To evaluate the predictive capability of Systemic Inflammatory Response Index (SIRI), Aggregate Index of Systemic Inflammation (AISI), and Monocyte-to-Lymphocyte Ratio (MLR) for major complications post-radical cystectomy.
• To assess the incremental value of SIRI when added to a baseline clinical model.

Main Methods:

• Retrospective analysis of 200 patients undergoing open radical cystectomy with ileal conduit diversion.
• Calculation of preoperative SIRI, AISI, and MLR from blood counts.
• Multivariable logistic regression, ROC analysis, calibration, and decision-curve analysis (DCA) were employed.

Main Results:

• Major complications occurred in 28.5% of patients.
• Higher SIRI values were associated with increased major complications (p=0.006).
• SIRI independently predicted complications (OR 1.37) and showed improved calibration and net clinical benefit in DCA.

Conclusions:

• Systemic Inflammatory Response Index (SIRI) is an independent predictor of major complications following open radical cystectomy.
• Adding SIRI to clinical models offers modest improvements in discrimination and significant gains in net clinical benefit.
• Further external validation is necessary before widespread clinical adoption of SIRI for predicting post-cystectomy complications.