The Efficacy of the Systemic Immune-Inflammation Index and Prognosis Nutritional Index for the Diagnosis of Venous Thromboembolism in Gastrointestinal Cancers

Abstract

Purpose This study aimed to analyze the association between venous thromboembolism (VTE) and inflammatory markers like systemic immune-inflammation index (SII) and prognosis nutritional index (PNI), and to evaluate their efficacy for the diagnosis of VTE in patients with gastrointestinal malignancies. Patients and Methods A total of 1326 patients with the initial diagnosis of gastrointestinal cancer in the First Affiliated Hospital of Anhui Medical University (AHMU) were enrolled in the training cohort. Univariate and multivariate analysis was used to pinpoint independent predictors of VTE, which were eventually visualized as the nomogram models. The Akaike Information Criterion (AIC) was used to screen the best model. The receiver operating characteristic curve (ROC) and the clinical decision curve analysis (DCA) were utilized to evaluate the models’ predictive performance in the training queue and another external sample of 250 patients at the Second Affiliated Hospital of AHMU. Results A total of 476 patients were complicated with VTE in the training cohort. Multifactorial analysis of clinical characteristics and inflammatory markers showed that PNI, SII, age, tumor location, and therapy were independent risk factors of VTE, visualized as model A. Another model B was constructed by adding coagulation markers to the previous analysis. Model B was the best prediction model with the minimum AIC value, followed by model A with an AUC of 0.806 (95% CI 0.782~0.830) which was similar to model B’s 0.832 (95% CI 0.810~0.855) but significantly higher than the currently widely used Khorana score’s 0.592 (95% CI 0.562~0.621) and the CATS score’s 0.682 (95% CI 0.653~0.712). The external verification yielded similar findings, with the AUC being 0.792 (95% CI 0.734~0.851), 0.834 (95% CI 0.778~0.890), 0.655 (95% CI 0.582~0.729), and 0.774 (95% CI 0.699~0.849) respectively. The DCA curves demonstrated that new models had excellent usefulness in screening patients with a high VTE risk. Conclusion The SII and PNI were simple and viable inflammatory markers associated with VTE, and the nomogram based on them and clinical features had a meaningful clinical utility for VTE in patients with gastrointestinal malignancies.

Preoperative Systemic Immune-Inflammatory Index as a Predictive Biomarker for Lower Extremity Deep Vein Thrombosis after Breast Cancer Surgery: Stratified Nursing Intervention to Reduce Incidence

“…Group sizes were calculated to achieve statistical power of 0.80 and type 1 error rate of 5%. Referring to the previous literature of our institute, the incidence of LEDVT after breast cancer surgery was estimated to be 5.2% [ 18 ]; 28 cases with LEDVT needed to be included, and the total sample size was estimated as at least 539.…”

“…First, SII has been reported to be correlated with D-dimer levels in patients with colorectal cancer and gastric cancer [ 17 ], suggesting a link between SII and coagulation activation. Second, SII has been found to be an independent prognostic factor for venous thromboembolism in patients with gastrointestinal cancer [ 18 ] and lung cancer [ 19 ], indicating its potential value for predicting thrombotic events in cancer patients. Third, SII has been demonstrated to be associated with tumor angiogenesis, lymph node metastasis, tumor-infiltrating lymphocytes, and tumor microenvironment [ 20 ], which are all relevant factors for the development and progression of breast cancer and LEDVT.…”

Novel Insights in Venous Thromboembolism Risk Assessment Methods in Ambulatory Cancer Patients: From the Guidelines to Clinical Practice

“…Table 3 summarizes the relevant studies related to the scores used in VTE risk assessment in ambulatory cancer patients. Zhang et al studied the systemic immune-inflammation index (SII) and the prognosis nutritional index (PNI) in VTE prediction in gastrointestinal cancer patients [72]. The SII was an auxiliary diagnostic test for patients with venous thrombosis in general, with an AUC of 0.861 (95% CI: 0.820-0.902; p < 0.001), a sensitivity of 78.1%, and a specificity of 73.1% for an SII > 755.54 [73].…”

Preoperative systemic immune‐inflammation index as a significant prognostic factor after TURBT in patients with non‐muscle‐invasive bladder cancer: A retrospective study based on propensity score matching analysis

“…The systemic immune‐inflammation index (SII) has been proposed as a potential SIR indicator that may be helpful for prognostic prediction in patients with various malignancies. 14 , 15 , 16 However, studies examining its value in NMIBC are still limited.…”

“…These markers offer a lot of potential for clinical use as they are rapid, precise, practical, and affordable. The systemic immune‐inflammation index (SII) has been proposed as a potential SIR indicator that may be helpful for prognostic prediction in patients with various malignancies 14–16 . However, studies examining its value in NMIBC are still limited.…”