AUTHOR=Li Wen-Cai , Zhou Yun-Xiang , Zhu Gang , Zeng Kai-Liang , Zeng Hai-Yong , Chen Jian-Sheng , Deng Yi-Fan , Qin Zhong-Zong , Luo Hong-Hai 

TITLE=Systemic immune inflammatory index is an independent predictor for the requirement of decompressive craniectomy in large artery occlusion acute ischemic stroke patients after mechanical thrombectomy

JOURNAL=Frontiers in Neurology

VOLUME=Volume 13 - 2022

YEAR=2022

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2022.945437

DOI=10.3389/fneur.2022.945437

ISSN=1664-2295

ABSTRACT=Background and purpose:Following mechanical thrombectomy (MT), patients with large artery occlusive acute ischemic stroke (LAO-AIS) often have cerebral herniation due to its complications, resulting in poor prognosis. Decompressive craniectomy (DC) can markedly improve patient prognosis. This study aimed to verify the predictive value of clinical parameters such as the systemic immune inflammatory index (SII) for DC in LAO-AIS patients after MT.
Methods:Clinical data of a total of 173 LAO-AIS patients treated with MT between January 2020 and January 2022 were retrospectively analyzed. Patients receiving DC were grouped into anexperimental group or acontrol group (no DC). The patients were randomly divided into the training set (n=126, 75%) and validation set (n=43, 25%). Multivariate logistic regression was used to construct a nomogram predictive model.
Results:The SII value in the experimental group (median: 2851.1×109/L) was significantly higher than that in the control group (median: 1898.6×109/L) (P=0.019). ROC (receiver operating characteristic) analyses showed that the best cutoff value of the SII was 2505.7×109/L with a sensitivity of 55%, a specificity of 75.8%, and an AUC (area under the curve) of 0.649. Multivariate logistic regression indicated that the SII was an independent predictor for performing DC in LAO-AIS patients after MT (OR=3.579, 95%CI=1.360-9.422, P=0.010). The AUC was 0.728 in the training set and 0.583 in the validation set. The average error of the calibration curve was 0.032 in the training set and 0.023 in the validation set. The average error was relatively small and consistent in the training set and validation set. The C-index of the nomogram was 0.804 suggesting good accuracy.
Conclusions:The SII at admission is an independent predictor for the requirement of DC in LAO-AIS patients after MT. The SII-based nomogram helps doctors make decisions on whether DC is needed timely and rationally, and thereby may improve the prognosis of these patients.