Systemic Inflammation Response Index (SIRI) and contrast-associated AKI in neurointerventional/peri-procedural...

Contrast-associated acute kidney injury (CA-AKI) remains clinically relevant in neurointerventional/peri-procedural pathways, yet bedside-feasible risk markers are limited. We evaluated whether the systemic inflammation response index (SIRI) is independently associated with CA-AKI and whether it provides incremental, exploratory risk stratification value beyond pragmatic clinical variables.

We performed a single-center retrospective cohort study of consecutive patients undergoing neurointerventional or time-sensitive neurovascular pathways with iodinated contrast exposure (typically CTA/CTP and/or DSA with endovascular treatment) during the study period. CA-AKI was defined as an absolute rise in serum creatinine ≥ 26.5 µmol/L from the pre-procedural value to the highest post-procedural value measured within 72 h after contrast exposure during the index hospitalization. SIRI was calculated as neutrophils × monocytes / lymphocytes and modeled as ln(SIRI) per 1 SD. We fitted prespecified logistic models (Model 1: SIRI; Model 2: age + sex+SIRI; Model 3: age + sex+atrial fibrillation+hypertension+diabetes+baseline creatinine+SIRI). Discrimination (AUC), bootstrap optimism-corrected calibration (B = 600), and decision curve analysis (DCA; threshold probability 0.05-0.40) were assessed.

CA-AKI incidence was 17.9% (40/223). Median SIRI was higher in CA-AKI (3.13 [1.98-4.29]) than Non-AKI (1.54 [0.99-2.78], P < 0.001). In Model 3, ln(SIRI) per SD remained independently associated with CA-AKI (aOR 1.87, 95% CI 1.27-2.75; P = 0.002); atrial fibrillation (OR 3.96) and hypertension (OR 2.96) were also independent predictors. A parsimonious clinical model (age+atrial fibrillation+hypertension) yielded AUC 0.675, which improved to 0.732 after adding SIRI (ΔAUC + 0.057). The optimal SIRI cutoff was 1.80 (sensitivity 0.800, specificity 0.617). The combined model showed acceptable optimism-corrected calibration (slope ≈ 0.88, intercept ≈ - 0.15) and higher net benefit mainly across lower clinically relevant threshold probabilities, particularly 0.05-0.26; at higher thresholds, the advantage over the clinical model was less consistent.

Admission SIRI was independently associated with creatinine-defined CA-AKI and provided a modest improvement in risk discrimination when added to pragmatic clinical variables. Its clinical use should be considered exploratory and requires external validation, particularly because decision-curve benefit appeared threshold-dependent.