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

Abstract

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.

Exploring the utility of a latent variable as comprehensive inflammatory prognostic index in critically ill patients with cerebral infarction

“…In most research on ischemic stroke patients using the MIMIC database, the selection of cases is overly broad. Many studies indiscriminately include all patients coded under ICD-9: 433, ICD-9: 434, ICD-9: 436, and ICD-10: I63 ( 25–28 ). However, half of these specific sub-codes, such as 433.00: Occlusion and stenosis of the basilar artery without mention of cerebral infarction, 433.10: Occlusion and stenosis of the carotid artery without mention of cerebral infarction, 433.20: Occlusion and stenosis of the vertebral artery without mention of cerebral infarction, and 433.30: Occlusion and stenosis of multiple and bilateral precerebral arteries without mention of cerebral infarction, do not necessarily diagnose an ischemic stroke.…”

Association of the systemic immune-inflammation index with all-cause and cardiovascular mortality in individuals with rheumatoid arthritis

“…Existing literature has highlighted a link between elevated SII levels and an increased risk of mortality both in the general population and among individuals with conditions characterized by significant inflammatory processes 28 – 31 . Regarding the acute ischemic stroke in intensive care units, one study identified a positive, albeit non-linear, relationship between SII and in-hospital mortality 11 , as well as in individuals with stroke-associated pneumonia 32 . Furthermore, research has shown that SII is associated with a heightened risk of mortality in adults with asthma 33 .…”

“…It is derived from a formula incorporating levels of specific immune system markers obtained from complete blood counts, specifically, (platelets × neutrophils) / lymphocytes 7 . Traditionally, SII has been utilized as a mortality predictor for patients with various tumors 6 , 7 , 34 , 36 , cerebrovascular diseases 8 , 9 , 11 , and cardiovascular conditions 9 , 10 , 12 . The scope of SII's application has been broadening, with recent research indicating its potential in forecasting disease severity and monitoring the efficacy of treatments 13 – 17 .…”

Preoperative Immunocyte-Derived Ratios Predict Postoperative Recovery of Gastrointestinal Motility after Colorectal Cancer Surgery

“…Presently, IDRs are extensively utilized across a diverse spectrum of medical disciplines as a dependable and conveniently accessible metric for gauging the immune reaction to a range of both infectious and noninfectious triggers. These ratios are subject to the influences of numerous factors, encompassing variables like diabetes, obesity, psychiatric disorders, solid organ malignancies, sepsis, pharmaceutical interventions, acute and chronic vascular disease, including coronary heart disease and stroke, and viral infections such as the SARS-CoV-2 virus [21,22]. Our analysis suggests that the preoperative values of three of the IDRs-namely, NLR, SII, and PLR, respectively-are elevated in POGD patients and seem to positively correlate with the duration of intestinal paresis, as assessed by the Tf, TL, and NGtR.…”