High Preoperative Systemic Immune-Inflammation Index Values Significantly Predicted Poor Outcomes After on-Pump Coronary Artery Bypass Surgery
I Made Adi Parmana, Cindy Elfira Boom, Herdono Poernomo, Chairil Gani, Budi Nugroho, Riza Cintyandy, Lisa Sanjaya, Yudi Hadinata, Dian Raseka Parna, Mefri Yulia, Dudy Arman Hanafy
Abstract
Purpose: On-pump coronary artery bypass grafting (CABG) is one of the most common revascularization surgical therapies for coronary artery disease (CAD). However, owing to the use of cardiopulmonary bypass (“on-pump”), the body develops systemic inflammatory response syndrome, which leads to the risk of morbidity and mortality. This study aimed to determine the perioperative outcomes of patients who underwent on-pump CABG surgery using the systemic immune-inflammation index (SII). Patients and methods: This single-center retrospective study used secondary data from patients’ electronic medical records and medical records archives at the National Cardiovascular Center Harapan Kita, who underwent on-pump CABG from January 2019 to December 2022. A total of 1056 on-pump CABG procedures were performed after exclusion. Lymphocyte, segmental neutrophil, and platelet counts from the preoperative data were used to calculate the SII values. An SII cutoff value of 528.715 × 10 3 /mm 3 divided the patients into two groups. Results: The SII value of 1056 patients were calculated, among which 490 (46%) patients had a preoperative SII value of ≥ 528.715 × 10 3 /mm 3. Multivariate analysis showed that a high SII significantly prolonged the duration of surgery (OR 1.005, 95% CI 1.003– 1.006) and cardiopulmonary bypass (CPB) time (OR 1.007, 95% CI 1.005– 1.009). High SII values significantly predicted prolonged mechanical ventilation (OR 6.154, 95% CL 3.938– 9.617), intensive care unit (ICU) stay (OR 6.332, 95% CL 4.232– 9.474), and hospital stay (OR 3.517, 95% CL 2.711– 4.562). Regarding other perioperative outcomes, a high SII significantly predicted the risk of postoperative atrial AF, cardiac arrest, acute myocardial infarction, and mortality. Conclusion: A high preoperative SII value can predict morbidity and mortality in patients undergoing on-pump CABG surgery. Keywords: systemic immune-inflammation index, on-pump coronary artery bypass graft, systemic inflammation, morbidity, mortality