The correlation between systemic inflammatory index and rebleeding after bronchial artery embolization: a...

Inflammation and immune-related factors may play a crucial role in recurrent hemoptysis after bronchial artery embolization (BAE). This study aimed to investigate the relationship between inflammatory markers such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), lymphocyte-to-monocyte ratio (LMR), neutrophil-to-monocyte ratio (NMR), systemic immune-inflammatory index (SII), and pan-immune- inflammatory value (PIV) and recurrent hemoptysis after BAE.

A retrospective cohort study was conducted on 420 patients with massive hemoptysis who underwent BAE in our hospital between January 2015 and January 2023. The demographic characteristics, laboratory test results (white blood cell count, platelet count, lymphocyte count, NLR, PLR, LMR, NMR, SII, PIV, etc.), and postoperative follow-up data of the patients were collected. The primary endpoint was recurrent hemoptysis after BAE, and the patients were divided into Recurrent Hemoptysis group and Recurrent Severe Hemoptysis group according to the hemoptysis volume. The levels of inflammatory indicators in patients with and without recurrent hemoptysis were compared in each group, and univariate and multivariate Cox regression analysis was performed to determine the independent risk factors for recurrent hemoptysis. The receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive ability of inflammatory indicators for recurrent hemoptysis, and the area under the curve (AUC) was calculated.

Among the 420 patients with massive hemoptysis who underwent BAE, 51.4% were male. The average duration of bronchiectasis before BAE was 14.8 years, and the average duration of embolization before BAE was 2.3 days. The most common underlying cause was bronchiectasis (42.5%). Compared to the non-recurrent group (N = 233), patients in the Recurrent Hemoptysis group (N = 187) exhibited significantly lower platelet counts, but higher levels of monocytes, neutrophils, NLR, and PLR (P < 0.0001). In the Recurrent Severe Hemoptysis group (N = 89), compared to the non-recurrent group (N = 331), significantly higher levels of monocytes, neutrophils, NLR, PLR, MLR, SII, and PIV were observed (P < 0.05). Multivariate Cox analysis identified that elevated PIV was an independent predictor for any recurrent hemoptysis (HR = 2.238, 95% CI: 1.765-3.256, P = 0.038), while elevated PLR independently predicted severe recurrent hemoptysis (HR = 1.289, 95% CI: 1.192-1.350, P = 0.027). The AUCs of PIV for predicting recurrent hemoptysis at 1 year and 3 years after surgery were 0.780 and 0.671, respectively, while the AUC of PLR for predicting recurrent severe hemoptysis at 1 year and 3 years after surgery were 0.863 and 0.824, respectively.

Elevated PIV before embolization is associated with an increased risk of recurrent hemoptysis, and increased PLR is independently associated with an increased risk of recurrent severe hemoptysis. These markers could serve as potential biomarkers for predicting rebleeding after BAE.