Objective: to evaluate the validity of the systemic inflammatory response index (SIRI) in predicting the three months outcome in patients with ischemic stroke undergoing fibrinolytic treatment. Methods: patients hospitalized for ischemic stroke at the stroke unit of the university Politecnica delle Marche were selected from 2018 to 2020. For the calculation of the SIRI, it has been considered the neutrophil count, monocyte count and lymphocyte count obtained within 24 hours of the onset of stroke according to the formula: neutrophil x monocyte/ lymphocyte. The outcome measure of the study is functional status at 3 months: the outcome was considered unfavorable if mRS> 2. The association between the SIRI and functional outcome was evaluated with logistic regression. The predictive capacity of the SIRI was assessed through the discrimination test: the discriminatory power was verified through the estimation of the area under the ROC curve (receiver operating characteristic). The statistical analysis was conducted through the software STATA/IC 13.1 (StataCorp LP, Texas, USA). Results: in the study court (81), the median value of the SIRI was 3.45 [1.53-4.55] x 10 ^ 9 / L and 22 (27.2%) patients had an unfavorable outcome 3 months after stroke. The median value of the SIRI in patients with favorable and unfavorable functional outcome was 2.27 [1.15-2.84] x 10 ^ 9 / L and 6.62 [3.90-8.42] x 10 ^ 9 / L respectively (p <0.001). On logistic regression analysis, the SIRI analyzed as a continuous variable showed an independent connection with the unfavorable clinical outcome at 3 months with an Odds Ratio of 2.676 (95% confidence interval: 1.700-4.212; p <0.001) for unitary increase of the value. In the ROC analysis, the area under the curve calculated to evaluate the discriminatory power of the SIRI in predicting the functional outcome at 3 months was 0.926 with a 95% confidence range between 0.867 and 0.985; standard error: 0.030. Conclusions: The results achieved in this study enable to assert that the SIRI could prove to be a reliable predictor of functional outcome at three months in patients with ischemic stroke treated with systemic fibrinolytic therapy.
Obiettivo: valutare il possibile utilizzo del SIRI come indice predittivo di outcome a tre mesi in pazienti con ictus ischemico a seguito di terapia fibrinolitica. Materiali e metodi: sono stati selezionati pazienti ricoverati per ictus ischemico presso la stroke unit dell’università Politecnica delle Marche tra il 2018 e il 2020. Per il calcolo del SIRI sono stati utilizzati i valori di conta dei neutrofili, conta dei monociti e conta dei linfociti ottenuti entro 24 ore dall’esordio dell’ictus secondo la formula: SIRI=neutrofili x monociti/linfociti. La misura di outcome dello studio è lo stato funzionale a 3 mesi: l’outcome è stato considerato come sfavorevole se mRS > 2. L’associazione tra il SIRI e l’outcome dello studio (stato funzionale a 3 mesi) è stata valutata mediante regressione logistica. La capacità predittiva del SIRI è stata valutata attraverso il test di discriminazione: il potere discriminativo è stato verificato attraverso la stima dell’area sotto la curva ROC (receiver operating characteristic). L’analisi statistica è stata condotta tramite il software STATA/IC 13.1 (StataCorp LP, Texas, USA). Risultati: nella corte di studio (81), il valore mediano del SIRI è risultato 3.45 [1.53-4.55] x 10^9/L e 22 (27.2%) pazienti hanno avuto un esito sfavorevole a 3 mesi dall’ictus. Il valore mediano del SIRI nei pazienti con esito funzionale favorevole e sfavorevole è risultato 2.27 [1.15-2.84] x 10^9/L e 6.62 [3.90-8.42] x 10^9/L rispettivamente (p<0.001). All’ analisi di regressione logistica, il SIRI analizzato come una variabile continua ha mostrato un’associazione indipendente con l’esito clinico sfavorevole a 3 mesi di distanza con un Odds Ratio pari a 2.676 (intervallo di confidenza al 95%: 1.700-4.212; p<0.001) per incremento unitario del valore. All’analisi ROC, l’area sotto la curva calcolata per valutare il potere discriminativo del SIRI nel predire l’esito funzionale a 3 mesi è stata 0.926 con un intervallo di confidenza al 95% compreso tra 0.867 e 0.985; standard error: 0.030. Conclusione: I risultati conseguiti in questo studio permettono di asserire che il SIRI potrebbe rivelarsi un indice predittivo affidabile dell’esito funzionale a tre mesi, nei pazienti con ictus ischemico trattati con terapia fibrinolitica sistemica.
Biomarcatori di infiammazione nell'ictus ischemico
TARTARI, TOMMASO
2020/2021
Abstract
Objective: to evaluate the validity of the systemic inflammatory response index (SIRI) in predicting the three months outcome in patients with ischemic stroke undergoing fibrinolytic treatment. Methods: patients hospitalized for ischemic stroke at the stroke unit of the university Politecnica delle Marche were selected from 2018 to 2020. For the calculation of the SIRI, it has been considered the neutrophil count, monocyte count and lymphocyte count obtained within 24 hours of the onset of stroke according to the formula: neutrophil x monocyte/ lymphocyte. The outcome measure of the study is functional status at 3 months: the outcome was considered unfavorable if mRS> 2. The association between the SIRI and functional outcome was evaluated with logistic regression. The predictive capacity of the SIRI was assessed through the discrimination test: the discriminatory power was verified through the estimation of the area under the ROC curve (receiver operating characteristic). The statistical analysis was conducted through the software STATA/IC 13.1 (StataCorp LP, Texas, USA). Results: in the study court (81), the median value of the SIRI was 3.45 [1.53-4.55] x 10 ^ 9 / L and 22 (27.2%) patients had an unfavorable outcome 3 months after stroke. The median value of the SIRI in patients with favorable and unfavorable functional outcome was 2.27 [1.15-2.84] x 10 ^ 9 / L and 6.62 [3.90-8.42] x 10 ^ 9 / L respectively (p <0.001). On logistic regression analysis, the SIRI analyzed as a continuous variable showed an independent connection with the unfavorable clinical outcome at 3 months with an Odds Ratio of 2.676 (95% confidence interval: 1.700-4.212; p <0.001) for unitary increase of the value. In the ROC analysis, the area under the curve calculated to evaluate the discriminatory power of the SIRI in predicting the functional outcome at 3 months was 0.926 with a 95% confidence range between 0.867 and 0.985; standard error: 0.030. Conclusions: The results achieved in this study enable to assert that the SIRI could prove to be a reliable predictor of functional outcome at three months in patients with ischemic stroke treated with systemic fibrinolytic therapy.| File | Dimensione | Formato | |
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Tesi_TommasoTartari (1).pdf
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https://hdl.handle.net/20.500.12075/1397