Systemic-Immune-Inflammation Index as a Promising Biomarker for Predicting Perioperative Ischemic Stroke in Older Patients Who Underwent Non-cardiac Surgery

Faqiang Zhang; Mu Niu; Long Wang; Yanhong Liu; Likai Shi; Jiangbei Cao; Weidong Mi; Yulong Ma; Jing Liu

doi:10.3389/fnagi.2022.865244

Systemic-Immune-Inflammation Index as a Promising Biomarker for Predicting Perioperative Ischemic Stroke in Older Patients Who Underwent Non-cardiac Surgery

Front Aging Neurosci. 2022 Apr 1:14:865244. doi: 10.3389/fnagi.2022.865244. eCollection 2022.

Authors

Faqiang Zhang¹, Mu Niu², Long Wang³, Yanhong Liu¹, Likai Shi¹, Jiangbei Cao¹, Weidong Mi¹, Yulong Ma¹, Jing Liu¹

Affiliations

¹ Anesthesia and Operation Center, The First Medical Center, Chinese PLA General Hospital, Beijing, China.
² Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, China.
³ Department of Pain Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China.

Abstract

Objective: This study aimed to investigate the clinical prognostic values of the preoperative systemic-immune-inflammation index (SII) in older patients undergoing non-cardiac surgery, using perioperative ischemic stroke as the primary outcome.

Methods: This retrospective cohort study included older patients who underwent non-cardiac surgery between January 2008 and August 2019. The patients were divided into SII < 583 and SII ≥ 583 group according to the optimal SII cut-off value. The outcome of interest was ischemic stroke within 30 days after surgery. Primary, sensitivity, and subgroup analyses were performed to confirm that preoperative SII qualifies as a promising, independent prognostic indicator. Propensity score matching (PSM) analysis was further applied to address the potential residual confounding effect of covariates to examine the robustness of our results.

Results: Among the 40,670 included patients with a median age of 70 years (interquartile range: 67, 74), 237 (0.58%) experienced an ischemic stroke within 30 days after surgery. SII ≥ 583 was associated with an increased risk of perioperative ischemic stroke in multivariate regression analysis [odds ratio (OR), 1.843; 95% confidence interval (CI), 1.369-2.480; P < 0.001]. After PSM adjustment, all covariates were well balanced between the two groups. The correlation between the SII and perioperative ischemic stroke remained significantly robust (OR: 2.195; 95% CI: 1.574-3.106; P < 0.001) in the PSM analysis.

Conclusion: Preoperative SII, which includes neutrophil, platelet, and lymphocyte counts obtained from routine blood analysis, was a potential prognostic biomarker for predicting perioperative ischemic stroke after non-cardiac surgery in elderly older patients. An elevated SII, based on an optimal cut-off value of 583, was an independent risk factor for perioperative ischemic stroke.

Keywords: biomarker; inflammation; older patients; perioperative stroke; postoperative complication; systemic-immune-inflammation index (SII).