Systemic immune inflammation index: a novel predictor for coronary collateral circulation

AIM

Recently, a new inflammatory and prognostic marker has emerged called as Systemic Immune Inflammation Index (SII). In the current study, we searched the relation between SII and Coronary Collateral Circulation (CCC) formation in stable Coronary Artery Disease (CAD).

MATERIALS & METHODS

449 patients with stable CAD who underwent coronary angiography and documented coronary stenosis of 95% or more in at least one major coronary vessel were included in the study. The study patients were divided into two groups according to the Rentrop score as well CCC (Rentrop 2-3) and bad CCC (Rentrop 0-1). Blood samples for SII and other laboratory parameters were gathered from all the patients on admission. The SII score was formulized as platelet × neutrophil/lymphocyte counts.

RESULTS

Patients, who had developed bad CCC had a higher C-reactive protein (CRP), neutrophil/lymphocyte ratio (NLR), platelets/lymphocyte ratio (PLR) and SII levels compared to those who had developed well CCC (p < 0.001, for all). Multivariate logistic regression analysis showed that high levels of SII was an independent predictor of bad CCC (OR: 1.005, 95% confidence interval (CI): 1.003-1.006, p < 0.001) together with dyslipidemia, high levels of CRP and NLR. In Receiver Operator Characteristic curve (ROC) analysis, the optimal cutoff value of SII to predict poor CCC was found to be 729.8, with 78.4% sensitivity and 74.6% specificity (area under ROC curve = 0.833 (95% CI: 0.777-0.889, p < 0.001).

CONCLUSION

We have demonstrated that SII, a novel cardiovascular risk marker, might be used as one of the independent predictors of CCC development.

Relationship Between C-Reactive Protein to Albumin Ratio and Coronary Collateral Circulation in Patients With Stable Coronary Artery Disease

We investigated the relationship between the C-reactive protein (CRP) to albumin ratio (CAR) and coronary collateral circulation (CCC) in stable coronary artery disease (CAD). Patients with stable CAD (n = 354) who underwent coronary angiography for suspected CAD and had a total occlusion ≥1 major coronary artery were included in the study. The participants were divided into 2 groups according to the Rentrop score as satisfactory CCC (Rentrop 2-3) and poor CCC (Rentrop 0-1). Patients who had poor CCC had a higher CRP, neutrophil/lymphocyte ratio (NLR), and CAR levels compared with those who had satisfactory CCC (P < .001, P = .046, P < .001, respectively). The CAR (odds ratio: 3.522, 95% CI: 2.515-4.932, P < .001), CRP, NLR, and diabetes mellitus were independent predictors of poor CCC. In receiver operator characteristic curve (ROC) analysis, the optimal cutoff value of CAR to predict poor CCC was 1.27 (area under ROC curve = 0.735 [95% CI: 0.667-0.803], P < .001). A raised CAR may be an independent predictor of poor CCC.

The correlation between lymphocyte/monocyte ratio and coronary collateral circulation in stable coronary artery disease patients

AIM

Coronary collateral circulation (CCC) has an important impact on cardiovascular prognosis and well-developed CCC is associated with better clinical outcomes. We investigated whether lymphocyte/monocyte ratio (LMR) has an association with CCC in patients with stable coronary artery disease (SCAD).

METHODS

The study population consisted of 245 patients with SCAD. Patients were classified into a poor CCC group (Rentrop grades 0/1, n = 87), or good CCC group (Rentrop grades 2/3, n = 158).

RESULTS

LMR values were significantly higher in patients with good CCC than in those with poor CCC (4.41 ± 1.58 vs 2.76 ± 1.10; p < 0.001). In receiver operating characteristic analysis, optimal cutoff of LMR for predicting well-developed CCC was 3.38. In multivariate analysis, LMR >3.38 (OR 4.637; p = 0.004), high sensitivity C-reactive protein (OR 0.810, p < 0.001), dyslipidemia (OR 2.485; p = 0.039), and presence of chronic total occlusion (OR 16.836; p < 0.001) were independent predictors of well-developed CCC.

CONCLUSION

Increased LMR predicts well-developed CCC in SCAD patients.

Neutrophil/lymphocyte ratio in obese adolescents

OBJECTIVE

Obesity is a growing health problem in most of the developed countries. It is associated with many chronic diseases, affecting particularly endocrine and cardiovascular systems. Inflammation plays a key role in pathophysiology of obesity. In this study, we aimed to investigate the inflammation status in obese children using neutrophil/lymphocyte ratio.

METHODS

In this study 130 obese and 57 healthy children were assessed retrospectively. According to Centers for Disease Control 2000 (CDC) BMI percentiles for childhood and adulthood, 85-95 percentile was considered as overweight and >95 percentile as obese.

RESULTS

Lymphocyte/neutrophil ratios in the obese group were significantly higher compared to those in healthy controls (p=0.03 and p=0.045, respectively). Neutrophil/lymphocyte ratio and CRP level in the obese group were significantly higher compared to those in healthy controls (p=0.02 and p=0.00, respectively). Thrombocyte/lymphocyte ratios were not significantly different between two groups (p=0.156).

CONCLUSION

It is possible that childhood obesity which has been increasingly prevalent recently triggers the pathogenesis of atherosclerosis during the early years of life. Increased neutrophil/lymphocyte ratio might be associated with the severity of inflammation which plays a role in the early stages of atherosclerosis. Therefore, taking childhood obesity under control using diet and other treatment methods will prevent mortality and morbidity in the elderly.