Predictive value of immune inflammation index and systemic inflammation response index for contrast-induced acute kidney injury in endovascular treatment for acute ischemic stroke

Abstract

Endovascular treatment (EVT) is the treatment method for acute ischemic stroke (AIS) caused by large vessel occlusion. Contrast-induced acute kidney injury (CI-AKI) is a relatively common complication. In this study, we aimed to investigate the incidence and possible risk factors of CI-AKI including systemic inflammation response index (SIRI) and systemic immune inflammation index (SII) in patients undergoing mechanical thrombectomy. We retrospectively analyzed patients who underwent EVT for acute cerebral large vessel occlusion between January 1, 2021, and March 31, 2024. Before the intervention, blood was drawn from the antecubital vein and collected in the appropriate tubes. Serum levels of neutrophils, lymphocytes, platelets, hemoglobin, CRP, and albumin were measured, alongside lipid profiles and liver and kidney function parameters. An increase in serum creatinine of 0.5 mg/dL or more than 25% in the measurements 48 to 72 hours after EVT compared to before was defined as CI-AKI. SII was calculated with the formula of: peripheral (platelet count × neutrophil count)/ lymphocyte count; SIRI was calculated with the formula of: (neutrophil count × monocyte count)/ lymphocyte count. Their predictive value for CI-AKI occurrence was compared. CI-AKI was detected in 54 (19%) of the 281 patients included in the study. In terms of clinical parameters, baseline NIHSS, postthrombectomy, cerebral edema, hemorrhagic transformation, recanalization time, discharge mRS and contrast amount were significantly higher in patients with CI-AKI. SII exhibited the highest discriminative performance in predicting CI-AKI in patients undergoing mechanical thrombectomy, with a threshold of > 1784 (AUC = 0.710, 95% CI: 0.631-0.788, P < .001, sensitivity 42.6%, specificity 89.0%) followed by SIRI (AUC = 0.652, 95% CI: 0.576-0.728, P < .001, sensitivity 88.9%, specificity 37.9%). SII and SIRI were found to be significantly higher in patients with CI-AKI. These scores may be new promising low-grade inflammatory indicators for predicting CI-AKI development.

Keywords: contrast-induced acute kidney injury; endovascular treatment; systemic immune inflammation index; systemic inflammation response index.

Figure 1.

Box plots represent the distribution of systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (P/L) in CI-AKI positive (CI-AKI+) and CI-AKI negative (CI-AKI−) patients.

Figure 2.

ROC curves show the diagnostic performance of 4 inflammatory indices – P/L, SIRI, SII, and N/L – for predicting contrast-induced acute kidney injury. area under the curve (bars) values and 95% CI (whiskers) are displayed for each index. NLR = neutrophil-to-lymphocyte ratio, PLR = platelet-to-lymphocyte ratio, SII = systemic immune inflammation index, SIRI = systemic inflammation response index.