Systemic Immune-Inflammation Index and Perioperative Risk Scores: A Cross-Sectional Analysis in Elective Surgical
Nirupa Ramakumar1, Gurjeet Khurana1, Priya Ramakrishnan1
1Department of Anaesthesiology, Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand, India.
Asian Journal of Anesthesiology
|May 20, 2026
Summary
The systemic immune-inflammation index (SII) correlates strongly with medication count, a marker of multimorbidity, in surgical patients. While SII showed weak links to established risk scores, its association with polypharmacy warrants further investigation for clinical utility.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Inflammatory Biomarkers
- Health Services Research
Background:
- The systemic immune-inflammation index (SII) is an emerging biomarker reflecting immune and inflammatory status.
- Preoperative assessment of patient health status is crucial for surgical risk stratification.
- Multimorbidity, often indicated by medication count and polypharmacy, significantly impacts surgical outcomes.
Purpose of the Study:
- To examine the correlations between preoperative SII, medication count (as a marker of multimorbidity), and established perioperative risk scores.
- To identify predictors of elevated SII in patients undergoing elective noncardiac surgery.
Main Methods:
- Cross-sectional study of 300 adult patients undergoing elective noncardiac surgery.
- Calculation of SII from preoperative blood counts (platelet, neutrophil, lymphocyte counts).
- Assessment of correlations using Spearman's rank correlation coefficient with ASA PS, RCRI, SORT mortality, and medication count.
- Multivariable regression analysis to identify predictors of elevated SII (≥ 754 × 10^9 cells/L).
Main Results:
- Median SII was 633 × 10^9/L.
- SII demonstrated weak correlations with Revised Cardiac Risk Index (RCRI) (ρ = 0.15) and Surgical Outcome Risk Tool (SORT) mortality (ρ = 0.12).
- A strong correlation was observed between SII and medication count (ρ = 0.77), indicating shared multimorbidity burden.
- Polypharmacy (OR, 6.82), higher SORT mortality (OR, 1.69), and RCRI (OR, 1.48) were significant predictors of elevated SII.
Conclusions:
- Preoperative SII shows a strong association with medication count, suggesting it reflects multimorbidity burden.
- The clinical advantage of SII over simple medication count for risk stratification remains unclear.
- Further prospective studies are needed to validate SII's role in perioperative risk stratification and clinical decision-making.
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