Lower extremity peripheral arterial disease (LEAD) is characterized by the narrowing and occlusion of arteries in the lower extremities. The most severe form of LEAD is chronic limb-threatening ischemia (CLTI), which carries a poorer prognosis for major amputation. The systemic immune-inflammation index (SII) is an index developed to simultaneously reflect the inflammatory and immunothrombosis status of patients, based on platelet counts and the neutrophil-to-lymphocyte ratio.
Objective
Our study aimed to investigate the relationship between elevated SII and major limb amputation.
Method
The study included 140 patients with foot wounds (Rutherford 5 or 6) due to LEAD who were scheduled for endovascular intervention between 2018 and 2023. Major amputation was required in 27 patients (19.2%). The neutrophil-to-lymphocyte ratio (2.1/2.8/3.8 vs 3.8/6.6/9.3, p < .001), platelet-to-lymphocyte ratio (103.8/128.8/162.9 vs 132.8/212.3/314.6, p < .001), and SII (527/720/1055.5 vs 1108/1951/3807, p < .001) were higher in the major amputation group. ROC curve analysis determined that the optimal cut-off value for SII to predict major amputation in LEAD patients was 1018, with a sensitivity and specificity of 81% and 73%, respectively (AUC: 0.84, 95% CI: 0.74–0.92, p < .001). Logistic regression analysis showed that high SII (OR = 1.001, 95% CI = 1–1.001, p = .009) was identified as an independent predictor of major amputation in LEAD patients.
Conclusion
This study establishes that a high SII value is associated with major amputation in LEAD patients with foot wounds.
Result
SII is a valuable and straightforward parameter for predicting major amputation risk and guiding treatment decisions in LEAD patients.
CriquiMHMatsushitaKAboyansV, et al.Lower extremity peripheral artery disease: contemporary epidemiology, management gaps, and future directions: a scientific statement from the American Heart Association. Circulation2021; 144: e171–e191.
2.
SimonFOberhuberAFlorosN, et al.Pathophysiology of chronic limb ischemia. Gefässchirurgie2018; 23(Suppl. S1): 13–18.
3.
ConteMSBradburyAWKolhP; et al.Global vascular guidelines on the management of chronic limb-threatening ischemia. J Vasc Surg2019; 69: 3S–125S.e40, Erratum in J. Vasc. Surg. 2019, 70, 662.
4.
MustaphaJAKatzenBTNevilleRF, et al.Critical limb ischemia: a threat to life and limb. Endovasc. Today Off2019; 18: 80–82.
5.
JalkanenJMaksimowMHollménM, et al.Compared to intermittant claudication critical limb ischemia is associated with elevated levels of cytokines. PLoS One2016; 11: e0162353.
6.
WoodburnKRRumleyALoweGD, et al.Fibrinogen and mark ers of fibrinolysis and endothelial damage following resolution of criti cal limb ischaemia. Eur J Vasc Endovasc Surg1995; 10: 272–278.
7.
Skorkowska-TelichowskaKKropielnickaKBulinskaK, et al.Insufficient modification of atherosclerosis risk factors in PAD patients. Adv Clin Exp Med2018; 27: 819e26.
8.
Jakovljevi´cBStojanovVLovi´cD, et al.Obesity and fat distribution as predictors of aortoiliac peripheral arterial disease in middle-aged men. Eur J Intern Med2011; 22: 84–88.
9.
DahlTBYndestadASkjellandM, et al.Increased expression of visfatin in macrophages of human unstable carotid and coronary atherosclerosis: possible role in inflammation and plaque destabilization. Circulation2007; 115: 972–980.
10.
LibbyP. Inflammation in atherosclerosis. Nature2002; 420: 868–874.
11.
HuBYangXRXuY, et al.Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res2014; 20: 6212–6222.
12.
HuangYGaoYWuY, et al.Prognostic value of systemic immune-inflammation index in patients with urologic cancers: a meta-analysis. Cancer Cell Int2020; 20: 499.
13.
CandemirMKiziltunçENurkoçS, et al.Relationship between systemic immune-inflammation index (SII) and the severity of stable coronary artery disease. Angiology2021; 72: 575–581.
14.
TangYZengXFengY, et al.Association of systemic immuneinflammation index with short-term mortality of congestive heart failure: a retrospective cohort study. Front Cardiovasc Med2021; 8: 753133.
15.
VatanMBÇakmakACAgaçS, et al.The systemic immune-inflammation index predicts impaired myocardial perfusion and short-term mortality in ST-segment elevation myocardial infarction patients. Angiology2023; 74: 365–373.
16.
CakmakACKocayigitİVarımP, et al.The effect of the systemic immune–inflammatory index on the no-reflow phenomenon in patients undergoing saphenous vein intervention. Adv Interv Cardiol2024; 20(2): 148–156.
17.
TosuARKalyoncuogluMBiterHI, et al.Prognostic value of systemic immune-inflammation index for major adverse cardiac events and mortality in severe aortic stenosis patients after TAVI. Medicina2021; 57: 588.
18.
MillsJLSConteMSArmstrongDG, et al.The society for vascular Surgery lower extremity threatened limb classification system: risk stratification based on wound, ischemia, and foot infection (WIfI). J Vasc Surg2014; 59(1): 220–234.e1-2.
19.
RutherfordRBBakerJDErnstC, et al.Recommended standards for reports dealing with lower extremity ischemia: revised version. J Vasc Surg1997; 26(3): 517–538.
20.
IidaOSogaYHiranoK, et al.Long-term results of direct and indirect endovascular revascularization based on the angiosome concept in patients with critical limb ischemia presenting with isolated below-the-knee lesions. J Vasc Surg2012; 55(2): 363–370.e5.
21.
TarriconeAGeeAde la MataK, et al.Outcomes for patients with chronic limb-threatening ischemia after direct and indirect endovascular and surgical revascularization: a meta-analysis and systematic review. J Endovasc Ther2024; 30: 15266028241248524.
22.
LiBShaikhFZamzamA, et al.The identification and evaluation of interleukin-7 as a myokine biomarker for peripheral artery disease prognosis. J Clin Med2024; 13(12): 3583.
23.
CullDLManosGHartleyMC, et al.An early validation of the Society for Vascular Surgery lower extremity threatened limb classification system. J Vasc Surg2014; 60: 1535e42.
24.
de Athayde SoaresRMatieloMFBrochado NetoFC, et al.WIfI classification versus angiosome concept: a change in the infrapopliteal angioplasties paradigm. Ann Vasc Surg2021; 71: 338–345.
25.
Tunstall-PedoeHPetersSAEWoodwardM, et al.Twenty-year predictors of peripheral arterial disease compared with coronary heart disease in the Scottish heart health extended cohort (SHHEC). JAHA2017; 6: e005967.
26.
CauleyJAKassemAMLaneNE, et al.Prevalent peripheral arterial disease and inflammatory burden. BMC Geriatr2016; 16(1): 213.
27.
PeerschkeEIYinWGhebrehiwetB. Complement activation on platelets: implications for vascular inflammation and thrombosis. Mol Immunol2010; 47: 2170–2175.
28.
OnofreiVCrișanAAdamCA, et al.The role played by novel inflammatory markers in assessment of peripheral artery disease. Medicina (Kaunas)2023; 59(9): 1557.
29.
CosarcaMCHălmaciuIMuresanAV, et al.Neutrophil-to-lymphocyte, platelet-to-lymphocyte and lymphocyte-to-monocyte ratios are associated with amputation rates in patients with peripheral arterial disease and diabetes mellitus who underwent revascularization: a Romanian regional center study. Exp Ther Med2022; 24: 703.
30.
ToorISJaumdallyRJMossMS, et al.Preprocedural neutrophil count predicts outcome in patients with advanced peripheral vascular disease undergoing percutaneous transluminal angioplasty. J Vasc Surg2008; 48: 1504–1508.
31.
LiangR-FLiMLiJ-H, et al.The significance of preoperative hematological inflammatory markers in patients with meningiomas. Clin Neurol Neurosurg2019; 182: 1–4.
32.
TaşoğluİSertDColakN, et al.Neutrophil-lymphocyte ratio and the platelet-lymphocyte ratio predict the limb survival in critical limb ischemia. Clin Appl Thromb Hemost2014; 20: 645–650.
33.
SelcukMCinarTSaylikF, et al.Predictive value of systemic immune inflammation index for postoperative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting. Medeni Med J2021; 36: 318–324.
34.
ZhangZCZ. Higher systemic immune-inflammation index is associated with higher likelihood of peripheral ar terial disease. Ann Vasc Surg2022; 84: 322–326.
35.
OflarEAkdenizEYıldızC, et al.Evaluation of systemic immune-inflammation index for predicting severity of lower extremity arterial disease. Vascular2024; 32: 17085381241251772.
