Systemic Immune-Inflammation Index Predicts Delayed Cerebral Vasospasm After Aneurysmal Subarachnoid Hemorrhage

Abstract

BACKGROUND Delayed cerebral vasospasm is a feared complication of aneurysmal subarachnoid hemorrhage (SAH). OBJECTIVE To investigate the relationship of systemic inflammation, measured using the systemic immune-inflammation (SII) index, with delayed angiographic or sonographic vasospasm. We hypothesize that early elevations in SII index serve as an independent predictor of vasospasm. METHODS We retrospectively reviewed the medical records of 289 SAH patients for angiographic or sonographic evidence of delayed cerebral vasospasm. SII index [(neutrophils × platelets/lymphocytes)/1000] was calculated from laboratory data at admission and dichotomized based on whether or not the patient developed vasospasm. Multivariable logistic regression and receiver operating characteristic (ROC) analysis were performed to determine the ability of SII index to predict the development of vasospasm. RESULTS A total of 246 patients were included in our study, of which 166 (67.5%) developed angiographic or sonographic evidence of cerebral vasospasm. Admission SII index was elevated for SAH in patients with vasospasm compared to those without (P < .001). In univariate logistic regression, leukocytes, neutrophils, lymphocytes, neutrophil-lymphocyte ratio (NLR), and SII index were associated with vasospasm. After adjustment for age, aneurysm location, diabetes mellitus, hyperlipidemia, and modified Fisher scale, SII index remained an independent predictor of vasospasm (odds ratio 1.386, P = .003). ROC analysis revealed that SII index accurately distinguished between patients who develop vasospasm vs those who do not (area under the curve = 0.767, P < .001). CONCLUSION Early elevation in SII index can independently predict the development of delayed cerebral vasospasm in aneurysmal SAH.

The lymphocyte-to-monocyte ratio predicts intracranial atherosclerotic stenosis plaque instability

“…A previous study showed that the levels of peripheral blood neutrophils were associated with the presence of ICAS (29). The NLR, LMR and SII are sensitive inflammatory markers in peripheral blood that can predict poor outcomes and prognosis for patients with intracerebral hemorrhage, spontaneous intracerebral hemorrhage, and ischemic stroke (13)(14)(15)(16)(17)(18). Furthermore, this study indicated that the LMR was independently associated with plaque enhancement and showed a linear negative correlation with the CR, which reflecting the degree of plaque enhancement.…”

“…The neutrophil-to-lymphocyte ratio (NLR), lymphocyte-tomonocyte ratio (LMR), and systemic immune inflammation index (SII), known as novel circulating inflammatory biomarkers, have been reported to be effective predictors in patients with carotid artery stenosis and coronary atherosclerosis (10)(11)(12). The NLR, LMR and SII can predict poor outcomes and prognosis in patients with intracerebral hemorrhage, spontaneous intracerebral hemorrhage, and ischemic stroke (13)(14)(15)(16)(17)(18). Moreover, these novel composite inflammatory ratios are more effective and have superior predictive capacities than traditional inflammatory factors (19).…”

Systemic immune-inflammation index predicts postoperative delirium in elderly patients after surgery: a retrospective cohort study

“…Some studies have shown the potential value of the NLR, PLR, and PWR in predicting POD after lower limb, head and neck free-flap reconstruction, total hip arthroplasty, abdominal surgery, oesophagectomy carotid endarterectomy, and cardiac surgery [11][12][13][14][15]. As a white-cell derived inflammatory biomarker, systemic immune inflammation index (SII) has been used to predict ischemic stroke, delayed vasospasm, microvascular dysfunction, and acute kidney injury [16][17][18][19]. However, the SII has not been applied to predict POD in elderly patients after surgery.…”

Inflammation and immune cell abnormalities in intracranial aneurysm subarachnoid hemorrhage (SAH): Relevant signaling pathways and therapeutic strategies

“…These dangerous molecules may further drive the neuroinflammation and brain injury after SAH ( 14 ). Brain injury following intracranial aneurysm SAH is multimodal and serious, as early brain injury (EBI), but is also secondary to the development of immune-inflammation events ( 9 , 10 , 15 , 16 ). Crosstalk between immune cell populations, active substances, and inflammation responses may aggravate the symptoms of SAH and contribute to poor prognosis ( 9 , 17 , 18 ).…”