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. 2020 Nov-Dec;34(6):3349-3360.
doi: 10.21873/invivo.12173.

The Systemic Immune-Inflammation Index Predicts Clinical Outcomes in Kidney Transplant Recipients

Samantha E Halpern  1 , Dimitrios Moris  2 , Brian I Shaw  3 , Madison K Krischak  1 , Danae G Olaso  1 , Samuel J Kesseli  3 , Kadiyala Ravindra  3 , Lisa M McElroy  3 , Andrew S Barbas  3
Affiliations

The Systemic Immune-Inflammation Index Predicts Clinical Outcomes in Kidney Transplant Recipients

Samantha E Halpern et al. In Vivo. 2020 Nov-Dec.

Abstract

Background: Outcomes after kidney transplantation (KTx) remain limited by delayed graft function (DGF) and acute rejection. Non-invasive biomarkers may help identify patients at increased risk for these events. We examined the association between the systemic immune-inflammation index (SII), a novel inflammatory biomarker, and outcomes after KTx and evaluated its ability to predict post-transplant prognosis.

Patients and methods: Adult patients who underwent primary KTx at our institution between 2016-2019 were included. SII was calculated from pre-transplant complete blood counts as the ratio of the neutrophil count to the lymphocyte count multiplied by the platelet count. The cutoff between high and low SII was determined by maximizing the area under the curve. Multivariable logistic and Cox regression were used to identify factors associated with DGF and patient, rejection-free, and graft survival respectively.

Results: Overall, 378 KTx recipients were included; 224 (59.3%) had high SII. On unadjusted analysis, high SII was associated with reduced odds of DGF, and improved patient and rejection-free survival. After adjustment, high SII was independently associated with improved patient survival alone. Multivariable models incorporating SII performed well for the prediction of DGF (c-statistic=0.755) and patient survival (c-statistic=0.786), though rejection-free survival was more difficult to predict (c-statistic=0.635).

Conclusion: SII demonstrated limited utility as an independent predictor of outcomes after KTx. However, in combination with other clinically relevant parameters, SII is a useful predictor of post-KTx prognosis. Validation of this novel inflammatory biomarker in a multi-institutional study is needed to further elucidate its practical applications in transplantation.

Keywords: Systemic immune-inflammation index; acute rejection; biomarkers; delayed graft function; kidney transplantation.

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Conflict of interest statement

The Authors report no conflicts of interest. SEH is supported by a Pfizer Foundation grant and the Duke Clinical Translational Science Institute. The content is solely the responsibility of the Authors and does not necessarily represent the official views of the Pfizer Foundation or Duke Clinical Translational Science Institute.

Figures

Figure 1
Figure 1. Circulating levels of neutrophils, lymphocytes, and platelets in peripheral blood samples of patients with low versus high systemic immune-inflammation index (SII). High SII was defined as >475.5. ****Significantly different at p<0.01
Figure 2
Figure 2. Kaplan-Meier survival analysis of the whole cohort stratified by high versus low systemic immune-inflammation index (SII). A: Patient survival. B: Rejection-free survival. C: Graft survival
Figure 3
Figure 3. Kaplan-Meier survival analysis of the whole cohort stratified by high versus low platelet-to-lymphocyte ratio (PLR). A: Patient survival. B: Rejection-free survival. C: Graft survival
Figure 4
Figure 4. Kaplan-Meier survival analysis of the whole cohort stratified by high versus low neutrophil-to-lymphocyte ratio (NLR). A: Patient survival. B: Rejection-free survival. C: Graft survival.
See this image and copyright information in PMC

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References

    1. Tonelli M, Wiebe N, Knoll G, Bello A, Browne S, Jadhav D, Klarenbach S, Gill J. Systematic review: kidney transplantation compared with dialysis in clinically relevant outcomes. Am J Transplant. 2011;11:2093–2109. doi: 10.1111/j.1600-6143.2011.03686.x. - DOI - PubMed
    1. Hart A, Smith JM, Skeans MA, Gustafson SK, Wilk AR, Castro S, Foutz J, Wainright JL, Snyder JJ, Kasiske BL, Israni AK. OPTN/SRTR 2018 Annual Data Report: kidney. Am J Transplant. 2020;20:20–130. doi: 10.1111/ajt.15672. - DOI - PubMed
    1. Perico N, Cattaneo D, Sayegh MH, Remuzzi G. Delayed graft function in kidney transplantation. Lancet. 2004;364:1814–1827. doi: 10.1016/S0140-6736(04)17406-0. - DOI - PubMed
    1. Singh N, Samant H, Hawxby A, Samaniego MD. Biomarkers of rejection in kidney transplantation. Curr Opin Organ Transplant. 2019;24:103–110. doi: 10.1097/MOT.0000000000000606. - DOI - PubMed
    1. Menon MC, Murphy B, Heeger PS. Moving biomarkers toward clinical implementation in kidney transplantation. J Am Soc Nephrol. 2017;28:735–747. doi: 10.1681/ASN.2016080858. - DOI - PMC - PubMed