王震, 白佳玉, 李澎, 焦光宇. SIRI、AISI和SII对急性肺栓塞的诊断和危险分层的预测价值[J]. 解放军医学院学报, 2024, 45(1): 53-58, 66. DOI: 10.12435/j.issn.2095-5227.2023.145
引用本文: 王震, 白佳玉, 李澎, 焦光宇. SIRI、AISI和SII对急性肺栓塞的诊断和危险分层的预测价值[J]. 解放军医学院学报, 2024, 45(1): 53-58, 66. DOI: 10.12435/j.issn.2095-5227.2023.145
WANG Zhen, BAI Jiayu, LI Peng, JIAO Guangyu. Predictive value of SIRI, AISI and SII in diagnosis and risk stratification of acute pulmonary embolism[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2024, 45(1): 53-58, 66. DOI: 10.12435/j.issn.2095-5227.2023.145
Citation: WANG Zhen, BAI Jiayu, LI Peng, JIAO Guangyu. Predictive value of SIRI, AISI and SII in diagnosis and risk stratification of acute pulmonary embolism[J]. ACADEMIC JOURNAL OF CHINESE PLA MEDICAL SCHOOL, 2024, 45(1): 53-58, 66. DOI: 10.12435/j.issn.2095-5227.2023.145

SIRI、AISI和SII对急性肺栓塞的诊断和危险分层的预测价值

Predictive value of SIRI, AISI and SII in diagnosis and risk stratification of acute pulmonary embolism

  • 摘要:
    背景 急性肺栓塞(acute pulmonary embolism,APE)是一种常见且可能致命的疾病,处理这种疾病的挑战主要在于快速诊断和准确预后评估分层。
    目的 分析系统炎症反应指数(system inflammation response index,SIRI)、全身炎症综合指数(aggregate index of systemic inflammation,AISI)和系统免疫炎症指数(systemic immune-inflammation index, SII)对急性肺栓塞的诊断和危险分层的预测价值。
    方法 回顾性收集2020年6月—2023年3月中国医科大学附属盛京医院呼吸与危重症医学科收治及确诊的急性肺栓塞患者(急性肺栓塞组)和同时期收治的严重呼吸困难但未发生急性肺栓塞患者(对照组)的资料,比较分析两组的SIRI、AISI和SII及其在急性肺栓塞的诊断/预测和危险分层中的鉴别/预测价值。
    结果 APE组127例,男性58例,女性69例,平均年龄(64.50 ± 13.46)岁;对照组124例,男性63例,女性61例,平均年龄(62.49 ± 10.74)岁。两组性别构成比和年龄的差异无统计学意义(P>0.05)。急性肺栓塞按分层标准分为低危组43例,中低危组31例,中高危组28例,高危组25例。急性肺栓塞组的SII、SIRI和AISI值均高于对照组(P均<0.05),多因素Logistic回归分析发现,高水平SIRI(OR:1.458;95% CI:1.119~1.900)、AISI(OR:1.796;95% CI:1.298~2.488)、SII(OR:1.303;95% CI:1.093~1.555)的患者发病风险更高。受试者工作特征曲线显示出SIRI、AISI、SII三种指标联合应用对急性肺栓塞的预测价值最高,曲线下面积(AUC)为0.804。在急性肺栓塞的危险分层中,SII、SIRI、AISI和D-二聚体水平在非低危组均大于低危组,其中SII、SIRI和AISI值越高,急性肺栓塞的危险分层越高,且SII在肺栓塞亚组中的预测价值最高,AUC为0.865,敏感度为82.1%,特异度为88.4%。
    结论 SIRI、AISI和SII对预测急性肺栓塞及其危险分层具有一定应用价值。

     

    Abstract:
    Background Acute pulmonary embolism (APE) is a common and potentially fatal disease. The main challenges in managing this disease lie first in rapid diagnosis and accurate assessment of prognostic stratification.
    Objective To analyze the predictive value of system inflammation response index (SIRI), aggregate index of systemic inflammation (AISI) and systemic immune-inflammation index (SII) in the diagnosis and risk stratification of acute pulmonary embolism (APE).
    Methods Patients diagnosed with acute pulmonary embolism and admitted to the Department of Respiratory and Critical Care Medicine at Shengjing Hospital Affiliated to China Medical University from June 2020 to March 2023 (APE group) were retrospectively collected, while patients admitted during the same period with severe dyspnea but without acute pulmonary embolism served as the control group. The differences of SIRI, AISI and SII between the two groups and their predictive values for APE in diagnosis and risk stratification were compared.
    Results A total of 127 patients were enrolled in the APE group, including 58 males and 69 females, with an average age of (64.50 ± 13.46) years. The control group consisted of 124 patients without acute pulmonary embolism (63 males, 61 females, mean age: 62.49 ± 10.74 years). There were no significant differences in these demographic indicators between the two groups. Based on the stratification criteria for acute pulmonary embolism, they were divided into low-risk group (43 cases), medium-low risk group (31 cases), medium-high risk group (28 cases), and high-risk group (25 cases). The levels of SII, SIRI, and AISI were significantly higher in the pulmonary embolism group compared to the control group (all P<0.05). Multivariate logistic regression analysis revealed that elevated levels of SIRI (OR: 1.458; 95% CI: 1.119-1.900), AISI (OR: 1.796; 95% CI: 1.298-2.488) and SII (OR: 1.303; 95% CI: 1.093-1.555) were all independent risk factors for developing acute pulmonary embolism among patients. Receiver operating characteristic curve analysis demonstrated that combining SIRI, AISI, and SII had the highest predictive value for acute pulmonary embolism with an area under the curve (AUC) of 0.804. In terms of risk stratification for acute pulmonary embolism, non-low-risk groups exhibited higher values of SII, SIRI, and AISI compared to low-risk groups. The higher the values of SII, SIRI, and AISI, the greater their association with increased risk stratification for acute pulmonary embolism. Specifically, SII showed superior predictive value within the subgroup affected by pulmonary embolism with an AUC of 0.865 and a sensitivity of 82.1%. The specificity was 88.4%.
    Conclusion SIRI, AISI and SII are useful in predicting acute pulmonary embolism and risk stratification.

     

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