Systemic Immune-Inflammation Index Predicts Restenosis after Interventions for Lower Extremity Arteriosclerosis Obliterans
DOI:
https://doi.org/10.1532/hsf.5303Keywords:
arteriosclerosis obliterans, systemic immune-inflammation index, restenosis, quality of lifeAbstract
Background: To investigate the association between the pretreatment systemic immune-inflammation index (SII) and restenosis after interventions for lower extremity arteriosclerosis obliterans (ASO). Methods: We retrospectively evaluated 309 patients with ASO who underwent endovascular interventions between January 2018 and December 2021. Pretreatment inflammatory markers, including the SII, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic inflammation response index (SIRI), aggregate index of systemic inflammation (AISI), and C-reactive protein (CRP) were collected. The logistic regression model was used to determine the associations between these inflammatory markers and restenosis. Clinical manifestations, ankle-brachial index (ABI), and quality of life after intervention also were compared. Results: The pretreatment SII (p < 0.001), NLR (p < 0.001), PLR (p < 0.001), SIRI (p = 0.002), AISI (p < 0.001), and CRP (p = 0.036) were significantly higher in patients with restenosis than in those without restenosis. Among the four markers, SII had the highest area under the curve (AUC) in predicting restenosis (SII vs. NLR vs. PLR vs. SIRI vs. AISI vs. CRP: 0.715 vs. 0.689 vs. 0.695 vs. 0.643 vs. 0.691 vs. 0.596). Multivariate analysis revealed that the pretreatment SII was the only independent factor for restenosis (hazard ratio [HR]: 4.102; 95% confidence interval [CI]: 1.155–14.567; p = 0.029). Moreover, a lower SII was associated with significantly better improvements in clinical manifestations (Rutherford classification 1–2: 67.5% vs. 52.9%, p = 0.038) and ABI (median: 0.29 vs. 0.22; p = 0.029), together with better quality of life (p < 0.05 for physical functioning, social functioning, pain, and mental health). Conclusions: The pretreatment SII is an independent predictor of restenosis after interventions in patients with lower extremity ASO, providing more accurate prognosis prediction than other inflammatory markers.
References
Song P, Rudan D, Zhu Y, Fowkes FJI, Rahimi K, Fowkes FGR, et al. Global, regional, and national prevalence and risk factors for peripheral artery disease in 2015: an updated systematic review and analysis. The Lancet Global Health. 2019; 7: e1020–e1030.
Goodall R, Salciccioli JD, Davies AH, Marshall D, Shalhoub J. Trends in peripheral arterial disease incidence and mortality in EU15+ countries 1990-2017. European Journal of Preventive Cardiology. 2021; 28: 1201–1213.
Layden J, Michaels J, Bermingham S, Higgins B, Guideline Development Group. Diagnosis and management of lower limb peripheral arterial disease: summary of NICE guidance. British Medical Journal. 2012; 345: e4947.
Gerhard-Herman MD, Gornik HL, Barrett C, Barshes NR, Corriere MA, Drachman DE, et al. 2016 AHA/ACC Guideline on the Management of Patients With Lower Extremity Peripheral Artery Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology. 2017; 69: e71–e126.
Aboyans V, Ricco JB, Bartelink MLEL, Björck M, Brodmann M, Cohnert T, et al. Editor's Choice - 2017 ESC Guidelines on the Diagnosis and Treatment of Peripheral Arterial Diseases, in collaboration with the European Society for Vascular Surgery (ESVS). European Journal of Vascular and Endovascular Surgery. 2018; 55: 305–368.
Schillinger M, Sabeti S, Loewe C, Dick P, Amighi J, Mlekusch W, et al. Balloon angioplasty versus implantation of nitinol stents in the superficial femoral artery. The New England Journal of Medicine. 2006; 354: 1879–1888.
Laird JR, Katzen BT, Scheinert D, Lammer J, Carpenter J, Buchbinder M, et al. Nitinol stent implantation versus balloon angioplasty for lesions in the superficial femoral artery and proximal popliteal artery: twelve-month results from the RESILIENT randomized trial. Circulation. Cardiovascular Interventions. 2010; 3: 267–276.
Tepe G, Laird J, Schneider P, Brodmann M, Krishnan P, Micari A, et al. Drug-coated balloon versus standard percutaneous transluminal angioplasty for the treatment of superficial femoral and popliteal peripheral artery disease: 12-month results from the IN.PACT SFA randomized trial. Circulation. 2015; 131: 495–502.
Ouriel K, Adelman MA, Rosenfield K, Scheinert D, Brodmann M, Peña C, et al. Safety of Paclitaxel-Coated Balloon Angioplasty for Femoropopliteal Peripheral Artery Disease. JACC: Cardiovascular Interventions. 2019; 12: 2515–2524.
Brevetti G, Giugliano G, Brevetti L, Hiatt WR. Inflammation in peripheral artery disease. Circulation. 2010; 122: 1862–1875.
Serrano CV, Jr, de Mattos FR, Pitta FG, Nomura CH, de Lemos J, Ramires JAF, et al. Association between Neutrophil-Lymphocyte and Platelet-Lymphocyte Ratios and Coronary Artery Calcification Score among Asymptomatic Patients: Data from a Cross-Sectional Study. Mediators of Inflammation. 2019; 2019: 6513847.
Angkananard T, Inthanoo T, Sricholwattana S, Rattanajaruskul N, Wongsoasu A, Roongsangmanoon W. The Predictive role of Neutrophil-to-Lymphocyte Ratio (NLR) and Mean Platelet Volume-to-Lymphocyte Ratio (MPVLR) for Cardiovascular Events in Adult Patients with Acute Heart Failure. Mediators of Inflammation. 2021; 2021: 6889733.
Ye Z, Hu T, Wang J, Xiao R, Liao X, Liu M, et al. Systemic immune-inflammation index as a potential biomarker of cardiovascular diseases: A systematic review and meta-analysis. Frontiers in Cardiovascular Medicine. 2022; 9: 933913.
He L, Xie X, Xue J, Xie H, Zhang Y. Association of the systemic immune-inflammation index with all-cause mortality in patients with arteriosclerotic cardiovascular disease. Frontiers in Cardiovascular Medicine. 2022; 9: 952953.
Ye M, Qian X, Guo X, Wang H, Ni Q, Zhao Y, et al. Neutrophil-Lymphocyte Ratio and Platelet-Lymphocyte Ratio Predict Severity and Prognosis of Lower Limb Arteriosclerosis Obliterans. Annals of Vascular Surgery. 2020; 64: 221–227.
Cai Z, Guo L, Qi L, Cui S, Tong Z, Guo J, et al. Midterm Outcome of Directional Atherectomy Combined with Drug-Coated Balloon Angioplasty Versus Drug-Coated Balloon Angioplasty Alone for Femoropopliteal Arteriosclerosis Obliterans. Annals of Vascular Surgery. 2020; 64: 181–187.
Petersohn S, Ramaekers BLT, Olie RH, Ten Cate-Hoek AJ, Daemen JWHC, Ten Cate H, et al. Comparison of three generic quality-of-life metrics in peripheral arterial disease patients undergoing conservative and invasive treatments. Quality of Life Research. 2019; 28: 2257–2279.
Campesi I, Montella A, Sotgiu G, Dore S, Carru C, Zinellu A, et al. Combined oral contraceptives modify the effect of smoking on inflammatory cellular indexes and endothelial function in healthy subjects. European Journal of Pharmacology. 2021; 891: 173762.
Libby P, Loscalzo J, Ridker PM, Farkouh ME, Hsue PY, Fuster V, et al. Inflammation, Immunity, and Infection in Atherothrombosis: JACC Review Topic of the Week. Journal of the American College of Cardiology. 2018; 72: 2071–2081.
Drechsler M, Megens RTA, van Zandvoort M, Weber C, Soehnlein O. Hyperlipidemia-triggered neutrophilia promotes early atherosclerosis. Circulation. 2010; 122: 1837–1845.
Drechsler M, Döring Y, Megens RTA, Soehnlein O. Neutrophilic granulocytes - promiscuous accelerators of atherosclerosis. Thrombosis and Haemostasis. 2011; 106: 839–848.
Kyaw T, Peter K, Li Y, Tipping P, Toh BH, Bobik A. Cytotoxic lymphocytes and atherosclerosis: significance, mechanisms and therapeutic challenges. British Journal of Pharmacology. 2017; 174: 3956–3972.
Núñez J, Miñana G, Bodí V, Núñez E, Sanchis J, Husser O, et al. Low lymphocyte count and cardiovascular diseases. Current Medicinal Chemistry. 2011; 18: 3226–3233.
Tsiantoulas D, Sage AP, Mallat Z, Binder CJ. Targeting B cells in atherosclerosis: closing the gap from bench to bedside. Arteriosclerosis, Thrombosis, and Vascular Biology. 2015; 35: 296–302.
Liu Y, Ye T, Chen L, Jin T, Sheng Y, Wu G, et al. Systemic immune-inflammation index predicts the severity of coronary stenosis in patients with coronary heart disease. Coronary Artery Disease. 2021; 32: 715–720.
Arbel Y, Finkelstein A, Halkin A, Birati EY, Revivo M, Zuzut M, et al. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis. 2012; 225: 456–460.
Gary T, Pichler M, Belaj K, Hafner F, Gerger A, Froehlich H, et al. Platelet-to-lymphocyte ratio: a novel marker for critical limb ischemia in peripheral arterial occlusive disease patients. PLoS ONE. 2013; 8: e67688.
Larmann J, Handke J, Scholz AS, Dehne S, Arens C, Gillmann HJ, et al. Preoperative neutrophil to lymphocyte ratio and platelet to lymphocyte ratio are associated with major adverse cardiovascular and cerebrovascular events in coronary heart disease patients undergoing non-cardiac surgery. BMC Cardiovascular Disorders. 2020; 20: 230.
Li H, Zhou Y, Ma Y, Han S, Zhou L. The prognostic value of the platelet-to-lymphocyte ratio in acute coronary syndrome: a systematic review and meta-analysis. Kardiologia Polska. 2017; 75: 666–673.
Zhao WM, Tao SM, Liu GL. Neutrophil-to-lymphocyte ratio in relation to the risk of all-cause mortality and cardiovascular events in patients with chronic kidney disease: a systematic review and meta-analysis. Renal Failure. 2020; 42: 1059–1066.
Chen IC, Yu CC, Wu YH, Chao TH. Elevated Neutrophil-to-Lymphocyte Ratio Predicts Intermediate-Term Outcomes in Patients Who Have Advanced Chronic Kidney Disease with Peripheral Artery Disease Receiving Percutaneous Transluminal Angioplasty. Acta Cardiologica Sinica. 2016; 32: 532–541.
Gallo G, Pierelli G, Forte M, Coluccia R, Volpe M, Rubattu S. Role of oxidative stress in the process of vascular remodeling following coronary revascularization. International Journal of Cardiology. 2018; 268: 27–33.
Jiang Y, Fan J, Li Y, Wu G, Wang Y, Yang J, et al. Rapid reduction in plaque inflammation by sonodynamic therapy inpatients with symptomatic femoropopliteal peripheral artery disease: A randomized controlled trial. International Journal of Cardiology. 2021; 325: 132–139.
Yuan S, Bruzelius M, Damrauer SM, Håkansson N, Wolk A, Åkesson A, et al. Anti-inflammatory diet and incident peripheral artery disease: Two prospective cohort studies. Clinical Nutrition. 2022; 41: 1191–1196.
