PDF(Pubmed)
Abstract：
UNASSIGNED: Early systemic inflammatory changes are increasingly recognized as factors influencing outcomes after aneurysmal subarachnoid hemorrhage (aSAH). Systemic inflammation response index (SIRI), an inflammation biomarker, was thought to be associated with adverse outcomes in many other diseases. However, in aSAH, research on SIRI remains limited. Thus, our objective was to investigate the association between SIRI and poor long-term functional outcomes while evaluating the mediating role of in-hospital complications in this association.
UNASSIGNED: SIRI was defined as neutrophil count × monocyte count/lymphocyte count. Patients were categorized according to SIRI quartiles. Stabilized inverse probability of treatment weighting (sIPTW) was utilized to minimize group differences. The association between SIRI and in-hospital complications as well as poor 90-day functional outcomes (mRS 3-6) was estimated by multivariable logistic regression analyses. Mediation analysis was performed to investigate the relationship between SIRI and poor functional outcomes mediated by in-hospital complications.
UNASSIGNED: A total of 650 patients were prospectively included. After sIPTW, compared to the lowest quartile, an elevated SIRI was associated with delayed cerebral ischemia (DCI) (OR 2.12, 95% CI 1.20-3.74), post-operative pneumonia (POP) (OR 2.16, 95% CI 1.29-3.62) and poor 90-day functional outcomes (OR 3.03, 95% CI 1.55-5.91). In-hospital complications including DCI (mediation proportion, 18.18% before sIPTW and 20.0% after sIPTW) and POP (mediation proportion, 18.18% before sIPTW and 26.7% after sIPTW) partially mediated the association between SIRI and poor 90-day functional outcomes. Mediation analysis yielded comparable results in subgroups stratified by age and sex.
UNASSIGNED: In this study, SIRI was associated with poor long-term functional outcomes in aSAH, which was partially mediated by DCI and POP with a mediation proportion exceeding 18%. Our findings might underscore the potential utility of SIRI in prompting physicians to address systemic inflammatory status timely to prevent in-hospital complications, including DCI and POP, and ultimately improve long-term functional outcomes.
UNASSIGNED: SIRI was defined as neutrophil count × monocyte count/lymphocyte count. Patients were categorized according to SIRI quartiles. Stabilized inverse probability of treatment weighting (sIPTW) was utilized to minimize group differences. The association between SIRI and in-hospital complications as well as poor 90-day functional outcomes (mRS 3-6) was estimated by multivariable logistic regression analyses. Mediation analysis was performed to investigate the relationship between SIRI and poor functional outcomes mediated by in-hospital complications.
UNASSIGNED: A total of 650 patients were prospectively included. After sIPTW, compared to the lowest quartile, an elevated SIRI was associated with delayed cerebral ischemia (DCI) (OR 2.12, 95% CI 1.20-3.74), post-operative pneumonia (POP) (OR 2.16, 95% CI 1.29-3.62) and poor 90-day functional outcomes (OR 3.03, 95% CI 1.55-5.91). In-hospital complications including DCI (mediation proportion, 18.18% before sIPTW and 20.0% after sIPTW) and POP (mediation proportion, 18.18% before sIPTW and 26.7% after sIPTW) partially mediated the association between SIRI and poor 90-day functional outcomes. Mediation analysis yielded comparable results in subgroups stratified by age and sex.
UNASSIGNED: In this study, SIRI was associated with poor long-term functional outcomes in aSAH, which was partially mediated by DCI and POP with a mediation proportion exceeding 18%. Our findings might underscore the potential utility of SIRI in prompting physicians to address systemic inflammatory status timely to prevent in-hospital complications, including DCI and POP, and ultimately improve long-term functional outcomes.
摘要：
■早期全身性炎症改变越来越被认为是动脉瘤性蛛网膜下腔出血（aSAH）后预后的影响因素。全身炎症反应指数（SIRI），炎症生物标志物，被认为与许多其他疾病的不良后果有关。然而,在ASAH中，对SIRI的研究仍然有限。因此，我们的目的是调查SIRI与不良长期功能结局之间的关联,同时评估院内并发症在该关联中的中介作用.
■SIRI定义为中性粒细胞计数×单核细胞计数/淋巴细胞计数。根据SIRI四分位数对患者进行分类。使用稳定的治疗加权的逆概率(sIPTW)来最小化组差异。通过多变量逻辑回归分析估计SIRI与住院并发症以及不良90天功能结局（mRS3-6）之间的关联。进行中介分析以研究SIRI与院内并发症介导的不良功能结局之间的关系。
■共纳入650例患者。在SIPTW之后，与最低四分位数相比，SIRI升高与迟发性脑缺血(DCI)相关(OR2.12,95%CI1.20-3.74),术后肺炎（POP）（OR2.16，95％CI1.29-3.62）和90天功能结局差（OR3.03，95％CI1.55-5.91）。住院并发症，包括DCI(调解比例，sIPTW前18.18%和sIPTW后20.0%)和POP(调解比例，sIPTW之前的18.18％和sIPTW之后的26.7％）部分介导了SIRI与90天不良功能结局之间的关联。中介分析在按年龄和性别分层的亚组中产生了可比的结果。
■在这项研究中，SIRI与aSAH不良的长期功能结局相关，部分由DCI和POP介导，介导比例超过18%。我们的发现可能强调了SIRI在促使医生及时解决全身炎症状态以预防院内并发症方面的潜在效用。包括DCI和POP，并最终改善长期功能结果。
■SIRI定义为中性粒细胞计数×单核细胞计数/淋巴细胞计数。根据SIRI四分位数对患者进行分类。使用稳定的治疗加权的逆概率(sIPTW)来最小化组差异。通过多变量逻辑回归分析估计SIRI与住院并发症以及不良90天功能结局（mRS3-6）之间的关联。进行中介分析以研究SIRI与院内并发症介导的不良功能结局之间的关系。
■共纳入650例患者。在SIPTW之后，与最低四分位数相比，SIRI升高与迟发性脑缺血(DCI)相关(OR2.12,95%CI1.20-3.74),术后肺炎（POP）（OR2.16，95％CI1.29-3.62）和90天功能结局差（OR3.03，95％CI1.55-5.91）。住院并发症，包括DCI(调解比例，sIPTW前18.18%和sIPTW后20.0%)和POP(调解比例，sIPTW之前的18.18％和sIPTW之后的26.7％）部分介导了SIRI与90天不良功能结局之间的关联。中介分析在按年龄和性别分层的亚组中产生了可比的结果。
■在这项研究中，SIRI与aSAH不良的长期功能结局相关，部分由DCI和POP介导，介导比例超过18%。我们的发现可能强调了SIRI在促使医生及时解决全身炎症状态以预防院内并发症方面的潜在效用。包括DCI和POP，并最终改善长期功能结果。
