Association of preoperative systemic immune-inflammation index and atherogenic index of plasma with early postoperative clinical outcomes in patients undergoing isolated elective coronary artery bypass grafting with cardiopulmonary bypass.

چکیده اصلی

BACKGROUND: Coronary artery disease (CAD) is a complex cardiovascular condition associated with multifaceted pathophysiological mechanisms such as inflammation, thrombotic activation, endothelial dysfunction, and an atherogenic lipid profile. The cardiopulmonary bypass (CPB) process, in turn, may influence early postoperative clinical outcomes by inducing a systemic inflammatory response, oxidative stress, and alterations in organ perfusion. Consequently, the assessment of practical indices reflecting the inflammatory and atherogenic burden during the preoperative period is of clinical importance. This preliminary retrospective study aimed to evaluate how preoperative systemic immune-inflammation index (SII) and atherogenic index of plasma (AIP) values associate with early postoperative clinical outcomes in patients with CAD undergoing isolated elective coronary artery bypass grafting with CPB. METHODS: This retrospective, single-centre, observational study included 50 adult patients who underwent elective cardiac surgery with CPB due to CAD. Preoperative blood count results for neutrophil, lymphocyte and platelet counts, and lipid profile results for triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) levels were recorded. SII was calculated using the platelet × neutrophil/lymphocyte formula; AIP was calculated using the log10 (TG/HDL-C) formula. The relationships between preoperative SII and AIP values and postoperative lactate, postoperative creatinine, the development of acute kidney injury (AKI), duration of mechanical ventilation, and length of stay (LOS) in the intensive care unit (ICU) were evaluated. Postoperative lactate and creatinine values were obtained from routine early postoperative laboratory records. AKI was defined according to creatinine-based criteria within the first 48 postoperative hours. TG and HDL-C values used for AIP calculation were recorded in mg/dL. RESULTS: The mean age of the patients included in the study was 61.8 ± 9.7 years, and 32 (64.0%) were male. The median SII score was 762.4 (485.2-1189.6), and the mean AIP score was 0.58 ± 0.21. AKI developed in 11 patients (22.0%). SII scores were significantly correlated with postoperative lactate levels (r = 0.421, p = 0.002), ICU LOS (r = 0.368, p = 0.009), duration of mechanical ventilation (r = 0.331, p = 0.019), and postoperative creatinine levels (r = 0.394, p = 0.005). AIP values showed a significant positive correlation with postoperative lactate levels (r = 0.287, p = 0.043) and postoperative creatinine levels (r = 0.302, p = 0.033) but did not show a significant association with ICU LOS or duration of mechanical ventilation. CONCLUSION: Higher preoperative SII values were associated with less favourable early postoperative parameters, including postoperative lactate and creatinine levels, mechanical ventilation duration, and ICU LOS, in this small retrospective cohort. AIP was associated mainly with postoperative lactate and creatinine levels. These findings suggest that SII and AIP may serve as practical adjunctive markers reflecting preoperative inflammatory and atherogenic burden; however, independent predictive value cannot be inferred from these data and should be validated in larger, multicentre studies with adjusted models.

ترجمه فارسی چکیده

بیماری شریان کرونر (CAD) یک وضعیت قلبی عروقی پیچیده است که با مکانیسم‌های فیزیولوژیک متعددی مانند التهاب، فعالیت ترومبوتیک، اختلال عملکرد اندوتلیال و پروفایل لیپیدی آتروژنیک مرتبط است. فرآیند بای‌پس قلب و ریه (CPB) ممکن است با ایجاد پاسخ التهابی سیستمیک، استرس اکسیداتیو و تغییرات در عملکرد اعضا، نتایج بالینی زودهنگام پس از عمل را تحت تأثیر قرار دهد. این مطالعه پیش‌دستی بازتابی، هدف آن ارزیابی نحوه ارتباط مقادیر شاخص سیستمیک ایمنی-التهابی (SII) و شاخص آتروژنیک پلاسما (AIP) با نتایج بالینی زودهنگام پس از عمل در بیماران مبتلا به CAD undergoing جراحی بای‌پس شریان کرونر با CPB بود. این مطالعه مشاهده‌ای، بازتابی و تک‌مرکزی شامل ۵۰ بیمار بالغ undergoing جراحی قلبی اضطراری با CPB به دلیل CAD بود. نتایج شمارش خون پیش‌عملی و پروفایل لیپیدی ثبت شد. SII با فرمول پلاکت × نوتروفیل/لنفوسیت و AIP با فرمول log10 (TG/HDL-C) محاسبه شد. روابط بین مقادیر SII و AIP پیش‌عملی و لاکتات پس از عمل، کراتینین پس از عمل، بروز آسیب کلیوی حاد (AKI)، مدت زمان تنفس مصنوعی و مدت اقامت در واحد مراقبت‌های ویژه (ICU) ارزیابی شد.

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