Systemic immune-inflammation index,neutrophilto-lymphocyte ratio,and platelet-to-lymphocyte ratio in patients with type 2 diabetes at different stages of diabetic retinopathy

AIM:To investigate systemic immune-inflammation index(SII),neutrophil-to-lymphocyte ratio(NLR),and plateletto-lymphocyte ratio(PLR)levels in patients with type 2 diabetes at different stages of diabetic retinopathy(DR).METHODS:This retrospective study included 141 patients with type 2 diabetes mellitus(DM):45 without diabetic retinopathy(NDR),47 with non-proliferative diabetic retinopathy(NPDR),and 49 with proliferative diabetic retinopathy(PDR).Complete blood counts were obtained,and NLR,PLR,and SII were calculated.The study analysed the ability of inflammatory markers to predict DR using receiver operating characteristic(ROC)curves.The relationships between DR stages and SII,PLR,and NLP were assessed using multivariate logistic regression.RESULTS:The average NLR,PLR,and SII were higher in the PDR group than in the NPDR group(P=0.011,0.043,0.009,respectively);higher in the NPDR group than in the NDR group(P<0.001 for all);and higher in the PDR group than in the NDR group(P<0.001 for all).In the ROC curve analysis,the NLR,PLR,and SII were significant predictors of DR(P<0.001 for all).The highest area under the curve(AUC)was for the PLR(0.929 for PLR,0.925 for SII,and 0.821 for NLR).Multivariate regression analysis indicated that NLR,PLR,and SII were statistically significantly positive and independent predictors for the DR stages in patients with DM[odds ratio(OR)=1.122,95%confidence interval(CI):0.200–2.043,P<0.05;OR=0.038,95%CI:0.018–0.058,P<0.05;OR=0.007,95%CI:0.001–0.01,P<0.05,respectively).CONCLUSION:The NLR,PLR,and SII may be used as predictors of DR.

Systemic immune-inflammation index combined with pediatric appendicitis score in assessing the severity and prognosis for paediatric appendicitis

BACKGROUND Pediatric appendicitis is a common cause of abdominal pain in children and is recognized as a significant surgical emergency.A prompt and accurate diagnosis is essential to prevent complications such as perforation and peritonitis.AIM To investigate the predictive value of the systemic immune-inflammation index(SII)combined with the pediatric appendicitis score(PAS)for the assessment of disease severity and surgical outcomes in children aged 5 years and older with appendicitis.METHODS Clinical data of 104 children diagnosed with acute appendicitis were analyzed.The participants were categorized into the acute appendicitis group and chronic appendicitis group based on disease presentation and further stratified into the good prognosis group and poor prognosis group based on prognosis.The SII and PAS were measured,and a joint model using the combined SII and PAS was constructed to predict disease severity and surgical outcomes.RESULTS Significant differences were observed in the SII and PAS parameters between the acute appendicitis group and chronic appendicitis group.Correlation analysis showed associations among the SII,PAS,and disease severity,with the combined SII and PAS model demonstrating significant predictive value for assessing disease severity[aera under the curve(AUC)=0.914]and predicting surgical outcomes(AUC=0.857)in children aged 5 years and older with appendicitis.CONCLUSION The study findings support the potential of integrating the SII with the PAS for assessing disease severity and predicting surgical outcomes in pediatric appendicitis,indicating the clinical utility of the combined SII and PAS model in guiding clinical decision-making and optimizing surgical management strategies for pediatric patients with appendicitis.

Systemic immune-inflammation index for predicting prognosis of colorectal cancer

AIM To investigate the clinical significance of preoperative systemic immune-inflammation index(SII) in patients with colorectal cancer(CRC). METHODS A retrospective analysis of 1383 cases with CRC was performed following radical surgery. SII was calculated with the formula SII =(P × N)/L, where P, N, and L refer to peripheral platelet, neutrophil, and lymphocyte counts, respectively. The clinicopathological features and follow-up data were evaluated to compare SII with other systemic inflammation-based prognostic indices such as the neutrophil-lymphocyte ratio(NLR) and platelet-lymphocyte ratio(PLR) in patients with CRC.RESULTS The optimal cut-off point for SII was defined as 340. The overall survival(OS) and disease-free survival(DFS) were better in patients with low NLR, PLR, and SII(P < 0.05). The SII was an independent predictor of OS and DFS in multivariate analysis. The area under the receiver-operating characteristics(ROC) curve for SII(0.707) was larger than those for NLR(0.602) and PLR(0.566). In contrast to NLR and PLR, SII could effectively discriminate between the TNM subgroups. CONCLUSION SII is a more powerful tool for predicting survival outcome in patients with CRC. It might assist the identification of high-risk patients among patients with the same TNM stage.

Prognostic significance of systemic immune-inflammation index in patients with intrahepatic cholangiocarcinoma undergoing hepatic resection

BACKGROUND The prognosis of intrahepatic cholangiocarcinoma(ICC)patients following surgical resection remains poor.It is necessary to investigate effective biomarkers or prognostic models for ICC patients.AIM To investigate the prognostic effect of systemic immune-inflammation index(SII)to predict long-term outcomes in ICC patients with undergoing hepatic resection.METHODS Consecutive ICC patients who underwent initial hepatectomy with curative intent from January 2009 to September 2017 were retrospectively reviewed.Receiver-operating characteristic(ROC)curves were used to determine the optimal cut-off values of SII.Kaplan-Meier curves and Cox proportional hazards regression were performed to evaluate the discriminative ability of preoperative SII in predicting overall survival(OS)and recurrence-free survival(RFS).RESULTS A total of 530 patients were included and randomly divided into derivation(n=265)and validation cohort(n=265).The optimal cut-off value for SII was 450.Ata median follow-up of 18 mo(range,1-115.4 mo),317(59.8%)patients died and381(71.9%)patients experienced tumor relapse.Low SII level was associated with better OS and RFS(both P<0.05).Multivariate analyses identified multiple tumors,node invasion and high SII level as independent risk factors for OS,while multiple tumors,node invasion and high SII level were identified as independent risk factors for RFS.Validation cohort confirmed the findings of derivation cohort.CONCLUSION The present study demonstrated the feasibility of preoperative SII as a prognostic indicator for ICC.Patients with increased SII level were associated with worse OS and earlier tumor recurrence.Elevated SII level was an independent risk factor for OS and RFS in patients with ICC after hepatectomy.In the future,the SII could help stratifying patients with ICC,thus guiding therapeutic choices,especially in immunotherapy.

Systemic immune-inflammation index:A predictor of major adverse cardiovascular events for patients with acute coronary syndrome

Background Systemic immune-inflammation index(SII)has emerged as a potential marker for assessing inflammation and predicting outcomes in patients with acute coronary syndrome(ACS).However,its role in forecasting clinical prognosis in ACS patients undergoing primary coronary angiography remains unclear.Methods This retrospective study included 657 ACS patients who underwent primary coronary angiography between January 2016 and January 2023.Patients were divided into low and high SII groups based on the Youden index cut-off value.The primary endpoint was the occurrence of major adverse cardiovascular events(MACEs),including nonfatal myocardial infarction(MI),nonfatal stroke,heart failure,target lesion revascularization(TLR),and cardiovascular death.Kaplan-Meier survival analysis and Cox regression were performed to assess the association between SII and outcomes.Results Patients with high SII had significantly higher rates of MACEs(25.7%vs.10.3%,P<0.001),including nonfatal MI,heart failure,and TLR.After adjusting for conventional risk factors,SII remained an independent predictor of MACEs(HR:2.102,95%CI:1.616-3.011,P=0.002).Kaplan-Meier analysis confirmed poorer event-free survival in the high SII group(P=0.00093).Conclusions Elevated SII was associated with a higher risk of adverse outcomes in ACS patients,suggesting its potential utility as a comprehensive tool for risk stratification and prognosis in ACS patients.[S Chin J Cardiol 2024;25(3):142-148]

Pretreatment systemic immune-inflammation index predicts survival for non-metastatic nasopharyngeal carcinoma:two independent institutional studies

Objective:This study aimed to evaluate the prognostic value of the pretreatment systemic immune-inflammation index(SII)in non-metastatic nasopharyngeal carcinoma(NPC).Methods:We retrospectively analyzed the data of 839 patients with non-metastatic NPC recruited from two independent institutions.The training-set cohort and the external validation-set cohort was comprised of 459 and 380 patients from each institution,respectively.The optimal cut-offvalue of SII was determined,and a prognostic risk stratification model was developed based on the training cohort and further assessed in the validation cohort.The propensity score matching(PSM)method was applied to minimize the confounding effects of unbalanced covariables.Results:The optimal cut-offvalue of the SII in the training cohort was 686,which was confirmed using the vali-dation cohort.Multivariate analysis showed that both before and after PSM,SII values>686 were independently associated with worse progression-free survival(PFS)ratio in both cohorts(before PSM,P=0.008 and P=0.008;after PSM,P=0.008 and P=0.007,respectively).Based on the analysis of independent prognostic factors of SII and N stage,we developed a categorical risk stratification model,which achieved significant discrimination among risk indexes associated with PFS and distant metastasis-free survival(DMFS)in the training cohort.There was no significant difference in PFS between RT alone and combined therapies within the low-and intermediate-risk groups(5-year PFS,77.5%vs.75.3%,P=0.275).Patients in the high-risk group who received concurrent chemoradiotherapy experienced superior PFS compared with those who received other therapies(5-year PFS,64.9%vs.40.3%,P=0.003).Conclusion:Pretreatment SII predicts PFS of patients with non-metastatic NPC.Prognostic risk stratification incorporating SII is instructive for selecting individualized treatment.

Assessment of systemic immune-inflammatory index and other inflammatory parameters in predicting mortality in patients with acute cholecystitis:A retrospective observational study

Objective:To investigate the effectiveness of the systemic immune-inflammatory(SII)index and other inflammatory parameters in predicting mortality among patients with acute cholecystitis(AC).Methods:279 Patients presented to the emergency department with abdominal pain and diagnosis of AC between September 2021 and September 2023 were included in the study.Demographic data,laboratory parameters,clinical follow-ups,and outcomes of the patients were recorded.Results:The mean age of the patients was(55.0±16.3)years and 36.6%were male.63.8%Had gallbladder/choledochal stones and 49.5%underwent surgery.The mortality rate was 6.1%.Advanced age(P=0.170)and prolonged hospitalization(P=0.011)were statistically significant risk factors for mortality.Decreased lymphocyte count(P=0.020)and increased C-reactive protein(CRP)levels(P=0.033)were found to be risk factors for mortality.According to the mortality predictor ROC analysis results,the cut-off for SII index was 3138(AUC=0.817,sensitivity=70.5%,specificity=84.7%),the cut-off for neutrophil count was 15.28×10^(3)/mm^(3)(AUC=0.761,sensitivity=52.9%,specificity=95.0%),the cut-off for leukocyte count was 19.0×10^(3)/mm^(3)(AUC=0.714,sensitivity=52.9%,specificity=98.0%),cut-off for CRP was 74.55(AUC=0.758,sensitivity=70.5%,specificity=79.0%),cut-off for aspartate transaminase(AST)was 33.0 IU/L(AUC=0.658,sensitivity=82.3%,specificity=50.3%).Conclusions:The SII index may be a good predictor of mortality with high sensitivity and specificity.Elevated levels of neutrophils,leukocytes,CRP,and AST are other inflammatory parameters that can be used to predict mortality associated with AC.

Actuality and underlying mechanisms of systemic immuneinflammation index and geriatric nutritional risk index prognostic value in hepatocellular carcinoma

This editorial contains comments on the article“Correlation between preoperative systemic immune inflammation index,nutritional risk index,and prognosis of radical resection of liver cancer”in a recent issue of the World Journal of Gastrointestinal Surgery.It pointed out the actuality and importance of the article and focused primarily on the underlying mechanisms making the systemic immuneinflammation index(SII)and geriatric nutritional risk index(GNRI)prediction features valuable.There are few publications on both SII and GNRI together in hepatocellular carcinoma(HCC)and patient prognosis after radical surgery.Neutrophils release cytokines,chemokines,and enzymes,degrade extracellular matrix,reduce cell adhesion,and create conditions for tumor cell invasion.Neutrophils promote the adhesion of tumor cells to endothelial cells,through physical anchoring.That results in the migration of tumor cells.Pro-angiogenic factors from platelets enhance tumor angiogenesis to meet tumor cell supply needs.Platelets can form a protective film on the surface of tumor cells.This allows avoiding blood flow damage as well as immune system attack.It also induces the epithelial-mesenchymal transformation of tumor cells that is critical for invasiveness.High SII is also associated with macro-and microvascular invasion and increased numbers of circulating tumor cells.A high GNRI was associated with significantly better progression-free and overall survival.HCC patients are a very special population that requires increased attention.SII and GNRI have significant survival prediction value in both palliative treatment and radical surgery settings.The underlying mechanisms of their possible predictive properties lie in the field of essential cancer features.Those features provide tumor nutrition,growth,and distribution throughout the body,such as vascular invasion.On the other hand,they are tied to the possibility of patients to resist tumor progression and development of complications in both postoperative and cancer-related settings.The article is of considerable interest.It would be helpful to continue the study follow-up to 2 years and longer.External validation of the data is needed.

Systemic Inflammation Response Index and weight loss as prognostic factors in metastatic pancreatic cancer: A concept study from the PANTHEIA-SEOM trial

BACKGROUND The prognostic value of the Systemic Inflammation Response Index(SIRI)in advanced pancreatic cancer is recognized,but its correlation with patients´nutritional status and outcomes remains unexplored.AIM To study the prognostic significance of SIRI and weight loss in metastatic pancreatic cancer.METHODS The PANTHEIA-Spanish Society of Medical Oncology(SEOM)study is a multicentric(16 Spanish hospitals),observational,longitudinal,non-interventional initiative,promoted by the SEOM Real World-Evidence work group.This pilot study sought to analyze the association between weight loss and inflammatory status as defined by SIRI.The cohort stems from a proof-of-concept pilot study conducted at one of the coordinating centers.Patients with pathologically confirmed metastatic pancreatic adenocarcinoma,treated from January 2020 to January 2023,were included.The index was calculated using the product of neutrophil and monocyte counts,divided by lymphocyte counts,obtained within 15 days before initiation chemotherapy.This study evaluated associations between overall survival(OS),SIRI and weight loss.RESULTS A total of 50 patients were included.66%of these patients were male and the median age was 66 years.Metastasis sites:36%liver,12%peritoneal carcinomatosis,10%lung,and 42%multiple locations.Regarding the first line palliative chemotherapy treatments:50%received gemcitabine plus nab-paclitaxel;28%,modified fluorouracil,leucovorin,irinotecan and oxaliplatin,and 16%were administered gemcitabine.42%had a weight loss>5%in the three months(mo)preceding diagnosis.21 patients with a SIRI≥2.3×10^(3)/L exhibited a trend towards a lower median OS compared to those with a SIRI<2.3×10^(3)/L(4 vs 18 mo;P<0.000).Among 21 patients with>5%weight loss before diagnosis,the median OS was 6 mo,in contrast to 19 mo for those who did not experience such weight loss(P=0.003).Patients with a weight loss>5%showed higher SIRI levels.This difference was statistically significant(P<0.000).For patients with a SIRI<2.3×10^(3)/L,those who did not lose>5%of their weight had an OS of 20 mo,compared to 11 mo for those who did(P<0.001).No association was found between carbohydrate antigen 19-9 levels≥1000 U/mL and weight loss.CONCLUSION A higher SIRI was correlated with decreased survival rates in patients with metastatic pancreatic cancer and associated with weight loss.An elevated SIRI is suggested as a predictor of survival,emphasizing the need for prospective validation in the upcoming PANTHEIA-SEOM study.

Preoperative systemic inflammatory response index as a prognostic marker for distal cholangiocarcinoma after pancreatoduodenectomy

BACKGROUND The relationship between preoperative inflammation status and tumorigenesis as well as tumor progression is widely acknowledged.AIM To assess the prognostic significance of preoperative inflammatory biomarkers in patients with distal cholangiocarcinoma(dCCA)who underwent pancreat-oduodenectomy(PD).METHODS This single-center study included 216 patients with dCCA after PD between January 1,2011,and December 31,2022.The individuals were categorized into two sets based on their systemic inflammatory response index(SIRI)levels:A low SIRI group(SIRI<1.5,n=123)and a high SIRI group(SIRI≥1.5,n=93).Inflam-matory biomarkers were evaluated for predictive accuracy using receiver operating characteristic curves.Both univariate and multivariate Cox proportional hazards analyses were performed to estimate SIRI for overall survival(OS)and recurrence-free survival(RFS).RESULTS The study included a total of 216 patients,with 58.3%being male and a mean age of 65.6±9.6 years.123 patients were in the low SIRI group and 93 were in the high SIRI group after PD for dCCA.SIRI had an area under the curve value of 0.674 for diagnosing dCCA,showing better performance than other inflammatory biomarkers.Multivariate analysis indicated that having a SIRI greater than 1.5 independently increased the risk of dCCA following PD,leading to lower OS[hazard ratios(HR)=1.868,P=0.006]and RFS(HR=0.949,P<0.001).Additionally,survival analysis indicated a significantly better prognosis for patients in the low SIRI group(P<0.001).CONCLUSION It is determined that a high SIRI before surgery is a significant risk factor for dCCA after PD.

Systemic inflammatory response index is a predictor of prognosis in gastric cancer patients: Retrospective cohort and meta-analysis

BACKGROUND The systemic inflammatory response index(SIRI)has been demonstrated to make a significant difference in assessing the prognosis of patients with different solid neoplasms.However,research is needed to ascertain the accuracy and reliability of applying the SIRI to patients who undergo robotic radical gastric cancer sur-gery.AIM To validate the applicability of the SIRI in assessing the survival of gastric cancer patients and evaluate the clinical contribution of preoperative SIRI levels to predicting long-term tumor outcomes in patients,who received robotic radical gastric cancer surgery.METHODS Initially,an exhaustive retrieval was performed in the PubMed,the Cochrane Library,EMBASE,Web of Science,and Scopus databases to identify relevant studies.Subsequently,a meta-analysis was executed on 6 cohort studies iden-tifying the value of the SIRI in assessing the survival of gastric cancer patients.Additionally,the clinical data of 161 patients undergoing robotic radical gastric cancer surgery were retrospectively analyzed to evaluate their clinicopathological characteristics and relevant laboratory indicators.The association between preoperative SIRI levels and 5-year overall survival(OS)and disease-free survival(DFS)was assessed.RESULTS The findings demonstrated an extensive connection between SIRI values and the outcome of patients with gastric cancer.Preoperative SIRI levels were identified as an independent hazard feature for both OS and DFS among those who received robotic surgery for gastric cancer.SIRI levels in gastric cancer patients were observed to be associated with the presence of comorbidities,T-stage,carcinoembryonic antigen levels,the development of early serious postoperative complications,and the rate of lymph node metastasis.CONCLUSION SIRI values are correlated with adverse in the gastric cancer population and have the potential to be utilized in predicting long-term oncological survival in patients who undergo robotic radical gastric cancer surgery.

Predictive value of systemic immunity index for sepsis in low-medium risk community-acquired pneumonia

Objective:To assess the predictive value of systemic immune inflammation index(SII)for sepsis in low-and medium-risk community-acquired pneumonia.Methods:A total of 589 elderly patients with low-and medium-risk community-acquired pneumonia admitted to the Emergency Department of the Second Affiliated Hospital of Hainan Medical University from January 2020 to January 2023 were included as the research subjects,and the general information and laboratory test results of the patients were collected,and the optimal cut-off value of continuous variables for predicting sepsis in elderly patients with low-and medium-risk community-acquired pneumonia was determined by plotting the receiver work characteristic(ROC)curve,which was converted into dichotomous variables and univariate and multivariate logistic Regression analysis of the influencing factors of sepsis in elderly patients with low-and medium-risk community-acquired pneumonia.Based on this,a nomogram model is constructed to predict the risk of sepsis.The differentiation,consistency and accuracy of the model were verified by calibration curve and subject operating characteristic(ROC)curve,and the clinical utility of the model was determined by decision curve analysis.Results:A total of 589 elderly patients with low-and intermediate-risk community-acquired pneumonia were included in this study,of which 96(16.30%)developed sepsis.There were significant differences in age,diabetes mellitus and chronic obstructive pulmonary disease,Lac,PCT,SII and other indexes between sepsis and non-sepsis groups(P<0.05).Logistics regression analysis showed that age,diabetes mellitus and chronic obstructive pulmonary disease,Lac,and SII were independent risk factors for sepsis in elderly patients with low-and medium-risk community-acquired pneumonia.The nomogram prediction model was used to verify the results,and the AUC was 0.826(95%CI:0.780-0.872),and the calibration curve tended to the ideal curve with good accuracy.The decision curve shows that when the threshold of the model is between 0.10~0.78,the model has the advantage of clinical benefit.Conclusion:The nomogram prediction model constructed based on SII to predict sepsis in elderly patients with low-and medium-risk community-acquired pneumonia has good accuracy,which can predict the occurrence of sepsis early,help early identification of high-risk groups and timely intervention,and thus improve the prognosis of patients.

Research Progress of Systemic Immune Inflammatory Index in Prostate Cancer

Prostate cancer has gradually risen to become the second most common cancer threatening men’s health, and prostate-specific antigen (PSA), as the main screening indicator for prostate cancer, has the defects of low specificity and insufficient diagnostic efficacy. As a novel inflammatory index based on neutrophil, lymphocyte and platelet counts, the systemic immune-inflammation index (SII) has recently become a more powerful biomarker for predicting the occurrence and progression of various malignancies. SII reflects the systemic inflammatory response of prostate cancer patients in a more balanced manner, and has higher predictive value than neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). High SII values are often associated with cancer progression and poor prognosis. This article reviews the research progress of SII in prostate cancer, in order to provide guidance for clinical practice.

The Systemic Immune Inflammatory Index Predicts No-Reflow Phenomenon after Primary Percutaneous Coronary Intervention in Older Patients with STEMI

Purpose:Coronary no-reflow phenomenon(NRP),a common adverse complication in patients with ST-segment eleva-tion myocardial infarction(STEMI)treated by percutaneous coronary intervention(PCI),is associated with poor patient prognosis.In this study,the correlation between the systemic immune-inflammation index(SII)and NRP in older patients with STEMI was studied,to provide a basis for early identification of high-risk patients and improve their prognosis.Materials and methods:Between January 2017 and June 2020,578 older patients with acute STEMI admitted to the Department of Cardiology of Hebei General Hospital for direct PCI treatment were selected for this retrospective study.Patients were divided into an NRP group and normal-flow group according to whether NRP occurred during the operation.Clinical data and the examination indexes of the two groups were collected.Logistic regression was used to analyze the independent predictors of NRP,and the receiver operating characteristic curve was used to further analyze the ability of SII to predict NRP in older patients with STEMI.Results:Multivariate logistic analysis indicated that hypertension(OR=2.048,95%CI:1.252–3.352,P=0.004),lymphocyte count(OR=0.571,95%CI:0.368–0.885,P=0.012),platelet count(OR=1.009,95%CI:1.005–1.013,P<0.001),hemoglobin(OR=1.015,95%CI:1.003–1.028,P=0.018),multivessel disease(OR=2.237,95%CI:1.407–3.558,P=0.001),and SII≥1814(OR=3.799,95%CI:2.190–6.593,P<0.001)were independent predictors of NRP after primary PCI in older patients with STEMI.Receiver operating characteristic curve analysis demonstrated that SII had a high predictive value for NRP(AUC=0.738;95%CI:0.686–0.790),with the best cut-off value of 1814,a sensitivity of 52.85%and a specificity of 85.71%.Conclusion:For older patients with STEMI undergoing primary PCI,SII is a valid predictor of NRP.

Correlation between preoperative systemic immune inflammation index, nutritional risk index, and prognosis of radical resection of liver cancer

BACKGROUND Radical surgery is the most commonly used treatment for hepatocellular carcinoma(HCC).However,the surgical effect remains not ideal,and prognostic evaluation is insufficient.Furthermore,clinical intervention is rife with uncertainty and not conducive to prolonging patient survival.AIM To explore correlations between the systemic immune inflammatory index(SII)and geriatric nutritional risk index(GNRI)and HCC operation prognosis.METHODS This retrospective study included and collected follow up data from 100 HCC.Kaplan–Meier survival curves were used to analyze the correlation between SII and GNRI scores and survival.SII and GNRI were calculated as follows:SII=neutrophil count×platelet count/lymphocyte count;GNRI=[1.489×albumin(g/L)+41.7×actual weight/ideal weight].We analyzed the predictive efficacy of the SII and GNRI in HCC patients using receiver operating characteristic(ROC)curves,and the relationships between the SII,GNRI,and survival rate using Kaplan–Meier survival curves.Cox regression analysis was utilized to analyze independent risk factors influencing prognosis.RESULTS After 1 year of follow-up,24 patients died and 76 survived.The area under the curve(AUC),sensitivity,specificity,and the optimal cutoff value of SII were 0.728(95%confidence interval:0.600-0.856),79.2%,63.2%,and 309.14,respectively.According to ROC curve analysis results for predicting postoperative death in HCC patients,the AUC of SII and GNRI combination was higher than that of SII or GNRI alone,and SII was higher than that of GNRI(P<0.05).The proportion of advanced differentiated tumors,tumor maximum diameter(5–10 cm,>10 cm),lymph node metastasis,and TNM stage III-IV in patients with SII>309.14 was higher than that in patients with SII≤309.14(P<0.05).The proportion of patients aged>70 years was higher in patients with GNRI≤98 than that in patients with GNRI>98(P<0.05).The 1-year survival rate of the SII>309.14 group(compared with the SII≤309.14 group)and GNRI≤98 group(compared with the GNRI>98 group)was lower(P<0.05).CONCLUSION The prognosis after radical resection of HCC is related to the SII and GNRI and poor in high SII or low GNRI patients.

Hemodynamic Profiling Using a Cardiac Index–Systemic Vascular Resistance Plot in Patients with Fontan Circulation

Background: Elevated Fontan pressure (FP) alone cannot fully predict clinical outcomes. We hypothesized thathemodynamic profiling using a cardiac index (CI)-systemic vascular resistance (SVR) plot could characterize clinicalfeatures and predict the prognosis of post-Fontan patients. Methods: We included post-Fontan patients whounderwent cardiac catheterization at age < 10 years. Patients were classified into four categories: A, CI ≥ 3, SVRindex (SVRI) ≥ 20;B, CI < 3, SVRI ≥ 20;C, CI ≥ 3, SVRI < 20;and D, CI < 3, SVRI < 20. The primary outcome wasfreedom from the combined endpoint: new onset of protein-losing enteropathy or plastic bronchitis, heart transplant,and death. Clinical and hemodynamic variables and freedom from the endpoint were compared betweenthe hemodynamic categories and outcome predictors were evaluated. Results: Eighty-three patients wereincluded. Median follow-up was 5.3 years. Category A/B/C/D consisted of 4/15/53/11 patients, respectively. Allthe patients in category A were New York Heart Association I/II and had a significantly lower pulmonary vascularresistance index (PVRI). Patients in category C had lower pulmonary/systemic blood flow. Patients in category Dhad a higher PVRI and had the poorest freedom from the endpoint (44% at 5 years). Elevated FP and category Dwere outcome predictors. Conclusions: CI-SVR plots was a novel adjunctive method for Fontan hemodynamicprofiling.

Effective immune-inflammation index for ulcerative colitis and activity assessments

BACKGROUND The inverse association between systemic immune-inammation index(SII)and overall survival in tumors has been studied.AIM To evaluate the hematological indexes for assessing the activity of ulcerative colitis(UC).METHODS In this case-control study,172 UC patients and healthy participants were included.Comparisons were made among groups of white blood cells,hemoglobin,platelets,neutrophils,lymphocytes,monocytes,SII,neutrophil-tolymphocyte ratio(NLR),and platelet-to-lymphocyte ratio(PLR).The relationship with hematological inflammation was verified by Spearman correlation analyses.The efficiency of SII,NLR,and PLR for distinguishing between UC and severe disease status was assessed by the receiver operator curve and logistic regression analyses.RESULTS The values of SII,NLR,and PLR were higher in UC patients than in controls(P<0.001)and were positively correlated with the Mayo endoscopic score,extent,Degree of Ulcerative Colitis Burden of Luminal Inflammation(DUBLIN)score,and Ulcerative Colitis Endoscopic Index of Severity(UCEIS).The cut-off NLR value of 562.22 predicted UC with a sensitivity of 79.65%and a specificity of 76.16%.Logistic regression analysis revealed that patients with SII and NLR levels above the median had a significantly higher risk of UC(P<0.05).Risk factors independently associated with DUBLIN≥3 included SII≥1776.80[odds ratio(OR)=11.53,P=0.027]and NLR value of 2.67-4.23(OR=2.96,P=0.047)on multivariate analysis.Compared with the first quartile,SII≥1776.80 was an independent predictor of UCEIS≥5(OR=18.46,P=0.012).CONCLUSION SII has a certain value in confirming UC and identifying its activity.

Prognostic value of systemic immune.inflammation index in patients with gastric cancer

Background:Inflammation-based indexes have been used to predict survival and recurrence in cancer patients.Systemic immune-inflammation index(Sll) was reported to be associated with prognosis in some malignant tumors.In the present study,we aimed to explore the association between Sll and the prognosis of patients with gastric cancer.Methods:We retrospectively analyzed data from 444 gastric cancer patients who underwent gastrectomy at the First Affiliated Hospital of Sun Yat-sen University between January 1994 and December 2005.Preoperative Sll was calculated.The Chi square test or Fisher's exact test was used to determine the relationship between preoperative Sll and clinicopathologic characteristics.Overall survival(OS) rates were estimated using the Kaplan-Meier method,and the effect of Sll on OS was analyzed using the Cox proportional hazards model.Receiver operating characteristic(ROC)curves were used to compare the predictive ability of Sll,NLR,and PLR.Results:Sll equal to or higher than 660 was significantly associated with old age,large tumor size,unfavorable Borrmann classification,advanced tumor invasion,lymph node metastasis,distant metastasis,advanced TNM stage,and high carcino-embryonic antigen level,high neutrophil-lymphocyte ratio,and high platelet-lymphocyte ratio(all P<0.05).High Sll was significantly associated with unfavorable prognosis(P<0.001) and Sll was an independent predictor for OS(P=0.015).Subgroups analysis further showed significant associations between high Sll and short OS in stage Ⅰ,Ⅱ,Ⅲ subgroups(all P<0.05).Sll was superior to NLR and PLR for predicting OS in patients with gastric cancer.Conclusion:Preoperative Sll level is an independent prognostic factor for OS in patients with gastric cancer.

Prognostic value of preoperative prognostic nutritional index and its associations with systemic inflammatory response markers in patients with stage Ⅲ colon cancer

Background: The prognostic nutritional index(PNI) has been widely applied for predicting survival outcomes of patients with various malignant tumors. Although a low PNI predicts poor prognosis in patients with colorectal cancer after tumor resection, the prognostic value remains unknown in patients with stage Ⅲ colon cancer undergoing curative tumor resection followed by adjuvant chemotherapy. This study aimed to investigate the prognostic value of PNI in patients with stage III colon cancer.Methods: Medical records of 274 consecutive patients with stage Ⅲ colon cancer undergoing curative tumor resection followed by adjuvant chemotherapy with oxaliplatin and capecitabine between December 2007 and December2013 were reviewed. The optimal PNI cutoff value was determined using receiver operating characteristic(ROC) curve analysis. The associations of PNI with systemic inflammatory response markers, including lymphocyte-to-monocyte ratio(LMR), neutrophil-to-lymphocyte ratio(NLR), platelet-to-lymphocyte ratio(PLR), and C-reactive protein(CRP)level, and clinicopathologic characteristics were assessed using the Chi square or Fisher's exact test. Correlation analysis was performed using Spearman's correlation coefficient. Disease-free survival(DFS) and overall survival(OS)stratified by PNI were analyzed using Kaplan-Meier method and log-rank test, and prognostic factors were identified by Cox regression analyses.Results: The preoperative PNI was positively correlated with LMR(r= 0.483, P < 0.001) and negatively correlated with NLR(r =-0.441, P < 0.001), PLR(r =-0.607, P < 0.001), and CRP level(r =-0.333, P < 0.001). A low PNI(≤49.22)was significantly associated with short OS and DFS in patients with stage ⅢC colon cancer but not in patients with stage ⅢA/ⅢB colon cancer.In addition, patients with a low PNI achieved a longer OS and DFS after being treated with6-8 cycles of adjuvant chemotherapy than did those with < 6 cycles. Multivariate analyses revealed that PNI was independently associated with DFS(hazard ratios 2.001; 95% confidence interval 1.157-3.462; P = 0.013).Conclusion: The present study identified preoperative PNI as a valuable predictor for survival outcomes in patients with stage Ⅲ colon cancer receiving curative tumor resection followed by adjuvant chemotherapy.

Association of systemic inflammation and body mass index with survival in patients with resectable gastric or gastroesophageal junction adenocarcinomas

Objective:The systemic inflammation index and body mass index(BMI)are easily accessible markers that can predict mortality.However,the prognostic value of the combined use of these two markers remains unclear.The goal of this study was therefore to evaluate the association of these markers with outcomes based on a large cohort of patients with gastric cancer.Methods:A total of 2,542 consecutive patients undergoing radical surgery for gastric or gastroesophageal junction adenocarcinoma between 2009 and 2014 were included.Systemic inflammation was quantified by the preoperative neutrophil-to-lymphocyte ratio(NLR).High systemic inflammation was defined as NLR≥3,and underweight was defined as BMI<18.5 kg/m2.Results:Among 2,542 patients,NLR≥3 and underweight were common[627(25%)and 349(14%),respectively].In the entire cohort,NLR≥3 or underweight independently predicted overall survival(OS)[hazard ratio(HR):1.236,95%confidence interval(95%CI):1.069–1.430;and HR:1.600,95%CI:1.350–1.897,respectively]and recurrence-free survival(RFS)(HR:1.230,95%CI:1.054–1.434;and HR:1.658,95%CI:1.389–1.979,respectively).Patients with both NLR≥3 and underweight(vs.neither)had much worse OS(HR:2.445,95%CI:1.853–3.225)and RFS(HR:2.405,95%CI:1.802–3.209).Furthermore,we observed similar results in subgroup analyses according to pathological stage,age,and postoperative chemotherapy.Conclusions:Our results showed that preoperative elevated NLR and decreased BMI had a significant negative effect on survival.Underweight combined with severe inflammation could enhance prognostication.Taking active therapeutic measures to reduce inflammation and increase nutrition may help improve outcomes.