Prognostic Impact of Multiple Lymphocyte-Based Inflammatory Indices in Acute Coronary Syndrome Patients

Abstract

BackgroundThe aim of this study was to evaluate the prognostic values of five lymphocyte-based inflammatory indices (platelet-lymphocyte ratio [PLR], neutrophil-lymphocyte ratio [NLR], monocyte-lymphocyte ratio [MLR], systemic immune inflammation index [SII], and system inflammation response index [SIRI]) in patients with acute coronary syndrome (ACS).MethodsA total of 1,701 ACS patients who underwent percutaneous coronary intervention (PCI) were included in this study and followed up for major adverse cardiovascular events (MACE) including all-cause death, non-fatal ischemic stroke, and non-fatal myocardial infarction. The five indices were stratified by the optimal cutoff value for comparison. The association between each of the lymphocyte-based inflammatory indices and MACE was assessed by the Cox proportional hazards regression analysis.ResultsDuring the median follow-up of 30 months, 107 (6.3%) MACE were identified. The multivariate COX analysis showed that all five indices were independent predictors of MACE, and SIRI seemingly performed best (Hazard ratio [HR]: 3.847; 95% confidence interval [CI]: [2.623–5.641]; p < 0.001; C-statistic: 0.794 [0.731–0.856]). The addition of NLR, MLR, SII, or SIRI to the Global Registry of Acute Coronary Events (GRACE) risk score, especially SIRI (C-statistic: 0.699 [0.646–0.753], p < 0.001; net reclassification improvement [NRI]: 0.311 [0.209–0.407], p < 0.001; integrated discrimination improvement [IDI]: 0.024 [0.010–0.046], p < 0.001), outperformed the GRACE risk score alone in the risk predictive performance.ConclusionLymphocyte-based inflammatory indices were significantly and independently associated with MACE in ACS patients who underwent PCI. SIRI seemed to be better than the other four indices in predicting MACE, and the combination of SIRI with the GRACE risk score could predict MACE more accurately.

Investigation of the Associations of Novel Inflammatory Biomarkers—Systemic Inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI)—With the Severity of Coronary Artery Disease and Acute Coronary Syndrome Occurrence

“…The observation of more than 5000 patients with CAD treated with PCI showed that SII predicts the occurrence of MACE (ACS, stroke not resulting in death or death from heart disease) compared to classic risk factors [ 30 ]. These results were corroborated by Li et al, who not only found the relationship of lymphocyte-based inflammatory markers with MACE, but also reported the advantage of SIRI compared to other inflammatory markers in this setting [ 29 ]. Another 10-year observation of 85 thousand respondents revealed the correlation of elevated SIRI with higher frequency of ACS in patients under 60 years of age.…”

“…Significantly higher SII and SIRI values were observed among patients with ACS (STEMI) compared to those with stable CAD in our cohort. The correlation of inflammatory biomarkers with ACS episodes was suggested previously [ 29 , 30 ]. The observation of more than 5000 patients with CAD treated with PCI showed that SII predicts the occurrence of MACE (ACS, stroke not resulting in death or death from heart disease) compared to classic risk factors [ 30 ].…”

“…SII employs three blood cell subtypes (neutrophils, lymphocytes, and platelets), reflecting the balance between inflammation and the immune response to it [ 22 , 23 ]. In cardiac patients, elevated SII was associated with an increased risk of CAD and its greater severity [ 24 , 25 , 26 ], as well as a worse development of collateral circulation in heart muscle [ 27 ] or a higher risk of major adverse cardiovascular events (MACE) in patients with heart failure [ 28 ] after coronary intervention [ 29 , 30 ] or cardiosurgery [ 31 , 32 , 33 , 34 ]. SII was also described as an independent predictor of massive pulmonary embolism [ 35 ], a contrast-induced nephropathy risk factor in patients undergoing coronary angiography [ 36 , 37 ], a risk factor for postoperative and recurrent atrial fibrillation after cardiac surgery [ 38 ], as well as for developing patent systolic dysfunction in postpartum cardiomyopathy [ 39 ].…”

“…In a 10-year observation, SIRI was found to have an association with CVD occurrence [ 41 ] and an increased risk of supraventricular tachycardia in patients with a history of stroke [ 42 ]. In patients who underwent percutaneous coronary intervention (PCI) due to ACS, SIRI was an independent predictor of MACE [ 29 , 43 ].…”

High Systemic Immune-Inflammation Index and Body Mass Index Are Independent Risk Factors of the Thoracic Ossification of the Ligamentum Flavum

“…Several clinical models consisting of leukocytes from the circulatory system were constructed for the further investigation of the role of systemic inflammatory responses in diseases and have been proven to have satisfactory diagnostic or prognostic value in human diseases [17][18][19][20]. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyteto-lymphocyte ratio (MLR), and systemic immuneinflammation index (SII) are the most commonly used inflammatory biomarkers among existing models and have been verified to play an unfavorable role in the prognosis of several human diseases, especially cancers [21][22][23]. However, the relationship between inflammatory biomarkers and the development of OLF has not been investigated until now.…”