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Prognosis of Ischemic Stroke Patients Undergoing Endovascular Thrombectomy is Influenced by Systemic Inflammatory Index Through Malignant Brain Edema
Clinical Interventions in Aging ( IF 3.6 ) Pub Date : 2022-07-02 , DOI: 10.2147/cia.s365553 Yachen Ji 1 , Xiangjun Xu 1 , Kangfei Wu 1 , Yi Sun 1 , Hao Wang 1 , Yapeng Guo 1 , Ke Yang 1 , Junfeng Xu 1 , Qian Yang 1 , Xianjun Huang 1 , Zhiming Zhou 1
Clinical Interventions in Aging ( IF 3.6 ) Pub Date : 2022-07-02 , DOI: 10.2147/cia.s365553 Yachen Ji 1 , Xiangjun Xu 1 , Kangfei Wu 1 , Yi Sun 1 , Hao Wang 1 , Yapeng Guo 1 , Ke Yang 1 , Junfeng Xu 1 , Qian Yang 1 , Xianjun Huang 1 , Zhiming Zhou 1
Affiliation
Purpose: The systemic immune inflammatory index (SII), as a new marker, is widely used to predict the disease prognosis. We investigated the predictive value of SII for malignant cerebral edema (MCE) and whether postoperative MCE mediates the relationship between SII and functional prognosis in patients undergoing endovascular thrombectomy (EVT).
Patients and Methods: A total of 829 patients with anterior circulation large-vessel occlusive stroke (LVOS) were registered, and 675 (81.4%) met the inclusion criteria. We collected baseline data upon admission, including SII. Postoperative computed tomography was performed to assess the presence and grading of cerebral edema (CED), and MCE was defined as a CED score of 3. A good prognosis was defined as a modified Rankin Scale (mRS) score of 0– 2 at the 90-day follow-up.
Results: A total of 132 patients developed MCE after EVT. The patients were divided into MCE and non-MCE groups, and univariate and multifactorial analyses were performed. Among these risk factors, an elevated SII was independently correlated with the occurrence of MCE. In addition, the receiver operating characteristic (ROC) curve was used to assess the predictive capability of SII levels for prognosis. The area under the ROC was 0.69, and the optimal critical value was 2.14. In addition, postoperative MCE may partially account for the poorer functional prognosis of patients with elevated SII (regression coefficient changed by 40.3%).
Conclusion: The SII is an independent predictor of malignant brain edema after EVT. Postoperative MCE is partly the reason for the poorer prognosis in patients with elevated SII.
Keywords: acute ischemic stroke, endovascular treatment, systemic immune inflammatory index, malignant cerebral edema
中文翻译：
接受血管内血栓切除术的缺血性中风患者的预后受恶性脑水肿引起的全身炎症指数的影响
目的：全身免疫炎症指数（SII）作为一种新的标志物，广泛用于预测疾病的预后。我们研究了 SII 对恶性脑水肿 (MCE) 的预测价值，以及术后 MCE 是否介导了 SII 与接受血管内血栓切除术 (EVT) 患者功能预后之间的关系。
患者和方法：共登记前循环大血管闭塞性卒中（LVOS）患者829例，675例（81.4%）符合纳入标准。我们在入院时收集了基线数据，包括 SII。进行术后计算机断层扫描以评估脑水肿 (CED) 的存在和分级，并将 MCE 定义为 CED 评分为 3。良好的预后定义为改良 Rankin 量表 (mRS) 在 90 分时评分为 0-2 - 日跟进。
结果：共有 132 名患者在 EVT 后发生 MCE。将患者分为 MCE 组和非 MCE 组，并进行单因素和多因素分析。在这些风险因素中，升高的 SII 与 MCE 的发生独立相关。此外，受试者工作特征（ROC）曲线用于评估 SII 水平对预后的预测能力。ROC下面积为0.69，最佳临界值为2.14。此外，术后 MCE 可能部分解释了 SII 升高患者的功能预后较差（回归系数改变了 40.3%）。
结论： SII 是 EVT 后恶性脑水肿的独立预测因子。术后 MCE 是 SII 升高患者预后较差的部分原因。
【关键词】：急性缺血性脑卒中 血管内治疗 全身免疫炎症指数 恶性脑水肿
更新日期：2022-07-03
Patients and Methods: A total of 829 patients with anterior circulation large-vessel occlusive stroke (LVOS) were registered, and 675 (81.4%) met the inclusion criteria. We collected baseline data upon admission, including SII. Postoperative computed tomography was performed to assess the presence and grading of cerebral edema (CED), and MCE was defined as a CED score of 3. A good prognosis was defined as a modified Rankin Scale (mRS) score of 0– 2 at the 90-day follow-up.
Results: A total of 132 patients developed MCE after EVT. The patients were divided into MCE and non-MCE groups, and univariate and multifactorial analyses were performed. Among these risk factors, an elevated SII was independently correlated with the occurrence of MCE. In addition, the receiver operating characteristic (ROC) curve was used to assess the predictive capability of SII levels for prognosis. The area under the ROC was 0.69, and the optimal critical value was 2.14. In addition, postoperative MCE may partially account for the poorer functional prognosis of patients with elevated SII (regression coefficient changed by 40.3%).
Conclusion: The SII is an independent predictor of malignant brain edema after EVT. Postoperative MCE is partly the reason for the poorer prognosis in patients with elevated SII.
Keywords: acute ischemic stroke, endovascular treatment, systemic immune inflammatory index, malignant cerebral edema
中文翻译：
接受血管内血栓切除术的缺血性中风患者的预后受恶性脑水肿引起的全身炎症指数的影响
目的：全身免疫炎症指数（SII）作为一种新的标志物，广泛用于预测疾病的预后。我们研究了 SII 对恶性脑水肿 (MCE) 的预测价值，以及术后 MCE 是否介导了 SII 与接受血管内血栓切除术 (EVT) 患者功能预后之间的关系。
患者和方法：共登记前循环大血管闭塞性卒中（LVOS）患者829例，675例（81.4%）符合纳入标准。我们在入院时收集了基线数据，包括 SII。进行术后计算机断层扫描以评估脑水肿 (CED) 的存在和分级，并将 MCE 定义为 CED 评分为 3。良好的预后定义为改良 Rankin 量表 (mRS) 在 90 分时评分为 0-2 - 日跟进。
结果：共有 132 名患者在 EVT 后发生 MCE。将患者分为 MCE 组和非 MCE 组，并进行单因素和多因素分析。在这些风险因素中，升高的 SII 与 MCE 的发生独立相关。此外，受试者工作特征（ROC）曲线用于评估 SII 水平对预后的预测能力。ROC下面积为0.69，最佳临界值为2.14。此外，术后 MCE 可能部分解释了 SII 升高患者的功能预后较差（回归系数改变了 40.3%）。
结论： SII 是 EVT 后恶性脑水肿的独立预测因子。术后 MCE 是 SII 升高患者预后较差的部分原因。
【关键词】：急性缺血性脑卒中 血管内治疗 全身免疫炎症指数 恶性脑水肿
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