Comparison of Clinical Features, Immune-Inflammatory Markers, and Outcomes Between Patients with Acute In-Hospital and Out-of-Hospital Ischemic Stroke

PY, Chen; GC, Chen; CL, Hsiao; PJ, Hsu; FY, Yang; CY, Liu; Tsou, Adam; WL, Chang; HH, Liu; SK, Lin

doi:10.2147/jir.s342830

Cited by 7 publications

(4 citation statements)

References 34 publications

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“…The present study also revealed elevation of serum RvD1 from admission to discharge in patients with AIS, likely due to the level of inflammation in patients with AIS being correspondingly ameliorated by in-hospital treatment ( 52 , 53 ). In addition, serum RvD1 is a widely endorsed anti-inflammatory factor, the elevation of which represents resolution of acute inflammation ( 54 ).…”

Section: Discussionsupporting

confidence: 61%

Serum resolvin D1 potentially predicts neurofunctional recovery, the risk of recurrence and death in patients with acute ischemic stroke

Chen,

Zhou,

Deng

2023

Biomed Rep

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Resolvin D1 (RvD1) represses inflammation, oxidative damage and neural injury related to acute ischemic stroke (AIS) progression. The present study aimed to explore the association of serum RvD1 with disease features, neurological recovery and prognosis in patients with AIS. A total of 212 patients with newly diagnosed AIS, whose serum RvD1 was quantified at admission and at discharge using an ELISA were enrolled in the current study. The modified Rankin scale (mRS) score was noted at 3 months after patient enrolment (M3), and patients were followed up for a median duration of 11.4 (range, 1.1-21.0) months. The median RvD1 in patients with AIS at admission was 1.07 (range, 0.11-9.29) ng/ml and it was negatively correlated with the neutrophil/lymphocyte ratio (r=-0.160; P=0.009) and C-reactive protein level (r=-0.272; P<0.001), but it was not correlated with comorbidities or other biochemical indexes. RvD1 at admission was lower in patients with mRS >2 at M3 (P=0.001), recurrence (P=0.001) or death (P=0.032) compared with that in patients without the aforementioned characteristics, which had a general ability to estimate mRS >2 at M3 [area under curve (AUC), 0.633], as well as lower risk of recurrence (AUC, 0.745) and death (AUC, 0.757) according to receiver operator characteristic (ROC) curve analyses. The median RvD1 was raised to 1.70 (range, 0.30-16.62) ng/ml at discharge. RvD1 at discharge was able to forecast mRS >2 at M3 (AUC, 0.678) and was able to predict the risk of recurrence (AUC, 0.796) and death (AUC, 0.826) in the ROC curve analyses. Increased serum RvD1 was associated with an attenuated inflammation status, and predicted improved neurological recovery, and lower risk of recurrence and death in patients with AIS. More specifically, its level at discharge exhibits a better prognostic utility than that at admission.

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Section: Discussionsupporting

confidence: 61%

Serum resolvin D1 potentially predicts neurofunctional recovery, the risk of recurrence and death in patients with acute ischemic stroke

Chen,

Zhou,

Deng

2023

Biomed Rep

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“…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 . Different cut-off values that can predict outcomes among patients with ASCVD were described in two meta-analyses 14 , 17 .…”

Section: Discussionmentioning

confidence: 84%

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

Aon,

Aoun,

Alshami

et al. 2024

Annals of Medicine &Amp; Surgery

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Background: Diabetic ketoacidosis (DKA) is the most serious metabolic complication of type 1 diabetes mellitus (T1DM). Insulin deficiency and inflammation play a role in the pathogenesis of DKA. We aimed to assess the systemic immune-inflammation index (SII) as a marker of severity among T1DM patients with DKA and without infection. Methods: We included T1DM patients ≥ 12 years hospitalized because of DKA. We excluded patients with infection or any condition that can change SII parameters or cause metabolic acidosis. We compared SII, neutrophil-lymphocyte ratio (NLR), and platelet-lymphocyte ratio (PLR) between severe and non-severe DKA groups. We also assessed the need for an intensive care unit (ICU), length of stay, and 90-day readmission rate between the groups. Results: The study included 241 patients with a median age of 17 (14,24) years, and 44.8% were males. More patients with severe DKA (45%) required ICU admission (P<0.001). Median SII increased with DKA severity, and the difference was significant (P=0.033). No significant difference was observed as regards median NLR or PLR (P=0.380 and 0.852, respectively). SII, but not NLR or PLR, had a significant negative correlation with PH (r=−0.197, P=0.002) and HCO3 level (r=−0.144, P=0.026). Also, being in the highest SII quartile was an independent risk factor for DKA severity (OR, 2.522; 95% CI, 1.063–6.08; P=0.037). We estimated an SII cutoff value of 2524.24 to predict DKA severity with high specificity. Conclusion: Elevated SII is a risk factor for DKA severity in T1DM. It is better than NLR and PLR in prognosticating DKA patients. These findings highlight the role of inflammation in DKA. SII can help as a valuable and simple tool to assess DKA severity.

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“…A previous study based on the MIMIC-IV database showed that a high SII increased 30-day all-cause mortality ( 36 ). Chen investigated the difference between four inflammatory immune markers in predicting the outcome of patients with ischemic stroke ( 37 ). Moreover, in a meta-analysis, high SII was strongly associated with poor ischemic stroke outcomes and a high mortality rate ( 38 ).…”

Section: Discussionmentioning

confidence: 99%

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

Liang

Hao

et al. 2023

Front. Neurol.

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BackgroundAcute ischemic stroke (AIS) is a primary cause of death and disability worldwide. Four markers that can be readily determined from peripheral blood, namely, the systemic immune-inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and total bilirubin, were measured in this study. We examined the relationship between the SII and in-hospital mortality after AIS and evaluated which of the above four indicators was most accurate for predicting in-hospital mortality after AIS.MethodsWe selected patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database who were aged >18 years and who were diagnosed with AIS on admission. We collected the patients’ baseline characteristics, including various clinical and laboratory data. To investigate the relationship between the SII and in-hospital mortality in patients with AIS, we employed the generalized additive model (GAM). Differences in in-hospital mortality between the groups were summarized by the Kaplan–Meier survival analysis and the log-rank test. The receiver operating characteristic (ROC) curve analysis was used to assess the accuracy of the four indicators (SII, NLR, PLR, and total bilirubin) for predicting in-hospital mortality in patients with AIS.ResultsThe study included 463 patients, and the in-hospital mortality rate was 12.31%. The GAM analysis showed a positive correlation between the SII and in-hospital mortality in patients with AIS, but the correlation was not linear. Unadjusted Cox regression identified a link between a high SII and an increased probability of in-hospital mortality. We also found that patients with an SII of >1,232 (Q2 group) had a considerably higher chance of in-hospital mortality than those with a low SII (Q1 group). The Kaplan–Meier analysis demonstrated that patients with an elevated SII had a significantly lower chance of surviving their hospital stay than those with a low SII. According to the results of the ROC curve analysis, the in-hospital mortality of patients with AIS predicted by the SII had an area under the ROC curve of 0.65, which revealed that the SII had a better discriminative ability than the NLR, PLR, and total bilirubin.ConclusionThe in-hospital mortality of patients with AIS and the SII were positively correlated, but not linearly. A high SII was associated with a worse prognosis in patients with AIS. The SII had a modest level of discrimination for forecasting in-hospital mortality. The SII was slightly better than the NLR and significantly better than the PLR and total bilirubin for predicting in-hospital mortality in patients with AIS.

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Comparison of Clinical Features, Immune-Inflammatory Markers, and Outcomes Between Patients with Acute In-Hospital and Out-of-Hospital Ischemic Stroke

Cited by 7 publications

References 34 publications

Serum resolvin D1 potentially predicts neurofunctional recovery, the risk of recurrence and death in patients with acute ischemic stroke

Serum resolvin D1 potentially predicts neurofunctional recovery, the risk of recurrence and death in patients with acute ischemic stroke

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

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

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