Prognosis of Ischemic Stroke Patients Undergoing Endovascular Thrombectomy is Influenced by Systemic Inflammatory Index Through Malignant Brain Edema

Abstract

Purpose The systemic immune inflammatory index (SII), as a new marker, is widely used to predict the disease prognosis. We investigated the predictive value of SII for malignant cerebral edema (MCE) and whether postoperative MCE mediates the relationship between SII and functional prognosis in patients undergoing endovascular thrombectomy (EVT). Patients and Methods A total of 829 patients with anterior circulation large-vessel occlusive stroke (LVOS) were registered, and 675 (81.4%) met the inclusion criteria. We collected baseline data upon admission, including SII. Postoperative computed tomography was performed to assess the presence and grading of cerebral edema (CED), and MCE was defined as a CED score of 3. A good prognosis was defined as a modified Rankin Scale (mRS) score of 0–2 at the 90-day follow-up. Results A total of 132 patients developed MCE after EVT. The patients were divided into MCE and non-MCE groups, and univariate and multifactorial analyses were performed. Among these risk factors, an elevated SII was independently correlated with the occurrence of MCE. In addition, the receiver operating characteristic (ROC) curve was used to assess the predictive capability of SII levels for prognosis. The area under the ROC was 0.69, and the optimal critical value was 2.14. In addition, postoperative MCE may partially account for the poorer functional prognosis of patients with elevated SII (regression coefficient changed by 40.3%). Conclusion The SII is an independent predictor of malignant brain edema after EVT. Postoperative MCE is partly the reason for the poorer prognosis in patients with elevated SII.

Association of the systemic immune-inflammation index (SII) and severity of diabetic ketoacidosis in patients with type 1 diabetes mellitus: a retrospective cohort study

“…Another study found that SII of 444.77 can predict atrial fibrillation recurrence after ablation among diabetic patients 33 . In studies that included diabetic and non-diabetic patients, SII greater than 2140 could predict poor outcomes in stroke patients after endovascular thrombectomy 34 . Also, SII greater than 2120 was an independent risk factor of mortality among patients with ischemic stroke in another study 35 .…”

Association of the systemic immune-inflammation index (SII) and clinical outcomes in patients with stroke: A systematic review and meta-analysis

“…(10) further identified that higher SII meant a greater risk of stroke severity and adverse clinical outcomes after AIS. Ji et al (24) identified elevated SII as related to malignant brain edema after EVT. Wang et al (25) findings further affirmed that SII was closely associated with the short-and long-term prognosis of patients with AIS, and higher SII were more likely to have poor outcomes.…”

Prognostic value of inflammation biomarkers for 30-day mortality in critically ill patients with stroke

“…Inflammation associated biomarkers such as monocyte and plateletcrit were reported to be associated with the development of cerebrovascular events including acute ischemic stroke (10,11). Recently, neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), neutrophil-albumin ratio (NAR), prognostic nutritional index (PNI), systemic immune inflammatory index (SII) and red cell distribution width (RDW) to albumin ratio (RA) have been reported as potential novel biomarkers of baseline inflammatory process and they were identified to be associated with the mortality of stroke (12)(13)(14)(15)(16)(17). These studies mainly explored the associations between these inflammation biomarkers and all stroke patients or ischemic stroke patients.…”