Prognostic value of inflammatory markers for in-hospital mortality in intensive care patients with acute ischemic stroke: a retrospective observational study based on MIMIC-IV

Association between systemic inflammatory indicators on admission and mortality in critically ill patients with diabetic kidney disease based on the MIMIC-IV database: a cohort study

Introduction

Diabetic kidney disease (DKD) is linked to immunity and inflammation. We aimed to investigate if systemic inflammatory indicators can predict mortality in DKD patients in intensive care units (ICUs) and determine potential associations between them.

Methods

This study included a cohort of 840 adults with DKD in the ICU. Three systemic inflammatory indicators were evaluated by peripheral blood tests: systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), neutrophil-to-lymphocyte ratio (NLR). Cox regression analysis, restricted cubic spline (RCS), and Kaplan-Meier curves were used to evaluate the associations between the inflammatory indicators and the mortality of the DKD population. Receiver operating characteristic (ROC) was employed to ascertain the predictive accuracy of varied systemic inflammatory indicators.

Results

After adjusting for all covariates, Cox regression analysis showed that inflammatory indicators were all significantly positively associated with 28-day mortality (SII: HR 1.39, 95% CI, 1.16-1.67, P<0.001; SIRI: HR 1.36, 95% CI, 1.14-1.62, P=0.001; NLR: HR 1.48, 95% CI, 1.20-1.84, P<0.001). Compared with the lowest tertile (tertile 1), participants in the highest tertile (tertile 3) had significantly increased risk of 28-day mortality (SII: HR 2.46, 95% CI, 1.51-4.02, P<0.001; SIRI: HR 3.31, 95% CI, 1.87-5.84, P<0.001; NLR: HR 3.42, 95% CI, 1.94-6.03, P<0.001). Furthermore, ROC curves showed that NLR and SIRI had higher predictive values than SII (NLRAUC vs. SIIAUC: 0.681 vs. 0.633, P=0.006; SIRIAUC vs. SIIAUC: 0.675 vs. 0.633, P=0.041) in predicting 28-day mortality.

Conclusions

Our study demonstrated that systemic inflammatory indicators (SII, SIRI, and NLR) were positively associated with 28-day and 365-day mortality in critically ill patients with DKD. Inflammatory indicators may serve as predictors of mortality in critically ill DKD patients.

Could De Ritis score be a useful predictor of mortality in COVID-19 patients who require intensive care?

Introduction/Aim. Inflammatory markers are being investigated as possible predictors of mortality in intensive care population. COVID-19 infection causes significant amount of inflammatory burden. De Ritis score has been suggested as a novel disease marker in conditions characterized with inflammation. In the present work, we aimed to compare De Ritis scores of deceased and survived COVID-19 patients in an institutional intensive care unit. Methods. Patients treated in intensive care unit with a diagnosis of COVID-19 infection were enrolled in the study. De Ritis scores of the deceased and survived subjects were compared. Results. The De Ritis score among survivors and non-survivors was 1.12 (range: 0.3-6.9)% and 1.43 (range: 0.2-16)%, respectively, with a statistically significant difference (p = 0.03). Additionally, the De Ritis score exhibited significant positive correlations with lactate dehydrogenase (LDH) (r = 0.37, p < 0.001), D-dimer (r = 0.38, p < 0.001), and C-reactive protein (CRP) (r = 0.19, p = 0.01) levels. When the De Ritis score exceeded the 1.32% threshold, its sensitivity and specificity in predicting mortality were 60% and 61%, respectively, with an area under the curve (AUC) of 0.61 (p = 0.03, 95% confidence interval: 0.52-0.7). Furthermore, each unit increase in the De Ritis score was associated with a 96% increase in the odds of mortality among COVID-19 patients treated in the intensive care unit (p = 0.03, OR: 0.96, 95% confidence interval: 0.86-0.98). Conclusion. De Ritis score can be a useful marker of poor prognosis in COVID-19 patients in intensive care units.

Relationship between systemic immune-inflammation index and long-term all-cause and cause-specific mortality among adult asthma patients: a population-based study

BACKGROUND

Persistent inflammation in the airways is a hallmark of asthma, and researchers have extensively explored various inflammatory indicators that contribute to the condition. Despite this, there is limited research on the relationship between the systemic immune-inflammation index (SII), a novel marker of inflammation, and overall mortality rates as well as mortality rates due to specific causes in individuals with asthma.

METHODS

We analyzed data from the National Health and Nutrition Examination Survey (NHANES) covering a 20-year period, from 1999 to 2018. To examine the association between SII and mortality rates in asthma patients, we used a combination of statistical methods, including weighted Kaplan-Meier analysis and multivariate-adjusted Cox analysis. Additionally, we applied restricted cubic spline (RCS) analysis to investigate the potential non-linear relationship between these variables. To further validate our findings, we performed subgroup and sensitivity analyses to ensure the reliability of the results.

RESULTS

This study analyzed data from 5,384 individuals with asthma, finding a link between increased SII levels and a higher risk of death from all-cause, cardiovascular disease and respiratory disease, but no association with cancer mortality. There were J-shaped non-linear relationships between SII and all-cause, cardiovascular and respiratory diseases mortality in asthma patients. The inflection points were 326, 350 and 355, respectively. Below these inflection points, each 100-unit increase in SII was associated with a decrease in mortality by 8%, 11% and 10%, while above these thresholds, mortality rates increased by 4%, 4%, and 3%, respectively. Subgroup analyses showed that SII was a significant predictor of all-cause mortality across various subgroups, and sensitivity analyses confirmed these findings, with the highest SII group consistently showing higher mortality rates for all-cause, cardiovascular, and respiratory disease mortality in the fully adjusted model.

CONCLUSIONS

Our study initially demonstrated a strong link between elevated SII levels and a higher risk of death from all-cause, cardiovascular disease, and respiratory disease in individuals with asthma. Furthermore, our analysis showed that the relationship between SII and mortality rates in asthma patients followed a non-linear, J-shaped pattern for all-cause, cardiovascular, and respiratory disease mortality.

CLINICAL TRIAL NUMBER

Clinical trial number not applicable.

Systemic immune inflammation index and risk of stroke: a cross-sectional study of the National Health and Nutrition Examination Survey 2005-2018

Background

The incidence of stroke has increased globally, resulting in medical expenditures and social burdens over the past few decades. We aimed to explore the relationship between systemic immune inflammatory index (SII) and stroke using the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2018.

Methods

Based on NHANES data, 902 stroke patients and 27,364 non-stroke patients were included in this study. SII was the independent variable and stroke was the dependent variable. Univariate and multivariate logistic regression analyses were used to explore the association between SII and stroke. Restricted cubic spline (RCS) method was used to test the nonlinear association between SII and stroke.

Results

Weighted logistic regression analysis showed a significant association between SII and stroke (OR: 1.985, 95% CI: 1.245-3.166, p = 0.004). The interaction test showed that the association between SII and stroke was not significant between strata (p > 0.05). A significant positive association between SII and stroke risk (OR >1, p < 0.05) was observed in the crude model, model I and model II. RCS analysis showed no nonlinear positive association between SII and stroke risk after adjusting for all confounders.

Conclusion

Our study determined that SII is associated with stroke risk. Given the inherent limitations of cross-sectional studies, further research is necessary to validate the causality of this association and to demystify the underlying mechanisms between inflammation and stroke.

Association of the systemic immune-inflammation index with all-cause and cardiovascular mortality in individuals with rheumatoid arthritis

The systemic immune-inflammation index (SII), a metric reflecting systemic inflammatory response and immune activation, remains underexplored concerning its correlation with mortality among rheumatoid arthritis (RA) patients. This study aimed to delineate the association between SII and both all-cause and cardiovascular mortality within the cohort of American adults diagnosed with RA, utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. The investigation extracted data from NHANES cycles between 1999 and 2018, identifying RA patients through questionnaire responses. The SII was computed based on complete blood counts, employing the formula: (platelets × neutrophils) / lymphocytes. The optimal SII cutoff value for significant survival outcomes was determined using maximally selected rank statistics. Multivariable Cox proportional hazards models assessed the relationship between SII levels and mortality (all-cause and cardiovascular) among RA patients, with subgroup analyses examining potential modifications by clinical confounders. Additionally, restricted cubic spline (RCS) analyses were conducted to explore the linearity of the SII-mortality association. The study encompassed 2070 American adults with RA, among whom 287 exhibited a higher SII (≥ 919.75) and 1783 a lower SII (< 919.75). Over a median follow-up duration of 108 months, 602 participants died. After adjustments for demographic, socioeconomic, and lifestyle variables, a higher SII was associated with a 1.48-fold increased risk of all-cause mortality (hazard ratio [HR] = 1.48, 95% confidence interval [CI] 1.21-1.81, P < 0.001) and a 1.51-fold increased risk of cardiovascular mortality (HR = 1.51, 95% CI 1.04-2.18, P = 0.030) compared to a lower SII. Kaplan-Meier analyses corroborated significantly reduced survival rates within the higher SII cohort for both all-cause and cardiovascular mortality (Pall-cause mortality < 0.0001 and Pcardiovascular mortality = 0.0004). RCS analyses confirmed a positive nonlinear relationship between SII and mortality rates. In conclusion, the SII offers a straightforward indicator of the equilibrium between detrimental innate inflammation and beneficial adaptive immunity. Our investigation, utilizing a comprehensive and nationally representative sample, reveals that elevated SII levels independently forecast a greater risk of mortality from all causes, as well as cardiovascular-specific mortality, in individuals suffering from RA. These insights underscore the clinical relevance of the SII as an affordable and readily accessible biomarker. Its incorporation into regular clinical practice could significantly enhance the precision of risk assessment and forecasting for patients with RA, facilitating more tailored and effective management strategies. Specifically, patients with high SII levels could be identified for more stringent cardiovascular risk management, including closer monitoring, lifestyle interventions, and aggressive pharmacological treatments to mitigate their increased risk of mortality.

Exploring the utility of a latent variable as comprehensive inflammatory prognostic index in critically ill patients with cerebral infarction

Objective

We introduce the comprehensive inflammatory prognostic index (CIPI), a novel prognostic tool for critically ill cerebral infarction patients, designed to meet the urgent need for timely and convenient clinical decision-making in this high-risk patient group.

Methods

Using exploratory factor analysis on selected indices-neutrophil to lymphocyte ratio (NLR), systemic inflammation response index (SIRI), and systemic immune inflammation index (SIII)-we derived CIPI, a latent variable capturing their combined predictive power. Data from 1,022 patients in the Medical Information Mart for Intensive Care (MIMIC)-IV database were used to develop CIPI-based survival models, with the robustness and area under the receiver operating characteristic curve (AUC) performance of CIPI validated against an independent dataset of 326 patients from the MIMIC-III CareVue subset. The CIPI's predictive power for in-hospital and intensive care unit (ICU) mortality was assessed through Kaplan-Meier analysis, univariate and multivariate Cox regression models, and time-dependent AUC analysis. Linearity, subgroup sensitivity analyses and interaction effects with CIPI were also evaluated.

Results

CIPI was an independent prognostic factor, demonstrating a statistically significant association with in-hospital and ICU mortality, when assessed as a continuous and a categorical variable. It showed a linear relationship with mortality rates and demonstrated stability across most subgroups, with no significant interactions observed. Its predictive capabilities for in-hospital and ICU mortality among critically ill cerebral infarction patients matched those of established prognostic indices in the MIMIC database.

Conclusion

Our study indicates that CIPI is a reliable and effective prognostic tool for critically ill cerebral infarction patients in predicting in-hospital and ICU mortality. Its straightforward calculation, rooted in routine blood tests, enhances its practicality, promising significant utility in clinical settings.

Preoperative Immunocyte-Derived Ratios Predict Postoperative Recovery of Gastrointestinal Motility after Colorectal Cancer Surgery

The aim of this study was to assess the role of immunocyte-derived ratios (IDRs), such as the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR), as markers for the postoperative recovery of gastrointestinal function following colorectal cancer surgery. A retrospective analysis was conducted on a consecutive cohort of 260 patients who underwent radical colorectal cancer surgery within the timeframe spanning from January 2016 to December 2022. Data concerning the postoperative recovery of gastrointestinal function included the I-FEED score, time to pass flatus, toleration for liquids in the first 48 h, and the need for nasogastric tube reinsertion in the immediate postoperative period. A special emphasis was allocated towards the examination of IDRs and their interrelation with the postoperative gastrointestinal functional parameters. The I-FEED score exhibited a positive correlation with the NLR, SII, and PLR. The univariate analysis indicated that all IDRs, multiorgan resection, hemoglobin and protein levels, regional nodal extent of the tumor (N), and obesity significantly affected nasogastric tube reinsertion. The multivariate analysis showed that the SII and N1 stages were risk factors for nasogastric tube reinsertion after colorectal cancer surgery. The SII and multiorgan resection were the only classifiers that remained significant in the multivariable analysis for the toleration for liquids. In summation, certain preoperative IDRs, such as the SII, PLR, and NLR, may hold potential as predictive determinants for postoperative gastrointestinal functional recovery following colorectal cancer surgery.