Inflammatory Burden Index: Association Between Novel Systemic Inflammatory Biomarkers and Prognosis as Well as in-Hospital Complications of Patients with Aneurysmal Subarachnoid Hemorrhage

Zhenshan Song; Fa Lin; Yu Chen; Tu Li; Runting Li; Junlin Lu; Heze Han; Ruinan Li; Jun Yang; Zhipeng Li; Haibin Zhang; Kexin Yuan; Ke Wang; Yunfan Zhou; Yitong Jia; Xiaolin Chen

doi:10.2147/JIR.S416295

Inflammatory Burden Index: Association Between Novel Systemic Inflammatory Biomarkers and Prognosis as Well as in-Hospital Complications of Patients with Aneurysmal Subarachnoid Hemorrhage

J Inflamm Res. 2023 Sep 4:16:3911-3921. doi: 10.2147/JIR.S416295. eCollection 2023.

Authors

Zhenshan Song^#¹, Fa Lin^#¹, Yu Chen¹, Tu Li¹, Runting Li¹, Junlin Lu¹, Heze Han¹, Ruinan Li¹, Jun Yang¹, Zhipeng Li¹, Haibin Zhang¹, Kexin Yuan¹, Ke Wang¹, Yunfan Zhou¹, Yitong Jia¹, Xiaolin Chen^{1

2

3}

Affiliations

¹ Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
² Stroke Center, Beijing Institute for Brain Disorders, Beijing, People's Republic of China.
³ Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, People's Republic of China.

^# Contributed equally.

Abstract

Purpose: Systemic inflammation plays an important role in the pathophysiology and progression of aneurysmal subarachnoid hemorrhage (aSAH). In this study, we aimed to investigate the association between a new biomarker, the inflammatory burden index (IBI) and the prognosis as well as in-hospital complications of aSAH patients.

Patients and methods: We analyzed data from patients with aSAH between January 2019 and September 2022 who were included in the LongTEAM (Long-term Prognosis of Emergency Aneurysmal Subarachnoid Hemorrhage) registry study. The IBI was formulated as C-reactive protein × neutrophils/lymphocytes. The unfavorable functional prognosis was assessed by the modified Rankin Scale (mRS). Receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal cut-off values for IBI to distinguish the unfavorable functional prognosis. Multivariate logistic regression was applied to investigate the association between IBI and in-hospital complications. Propensity score matching was adjusted for imbalances in baseline characteristics to assess the effect of IBI on prognosis.

Results: A total of 408 consecutive patients with aSAH enrolled in the study, of which 235 (57.6%) were female patients and the mean age was 55.28 years old. An IBI equal to 138.03 was identified as the best cut-off threshold to distinguish the unfavorable prognosis at 3 months (area under the curve [AUC] [95% CI] 0.637 [0.568-0.706]). ln IBI was independently associated with 3-month functional prognosis (OR [95% CI] 1.362 [1.148-1.615]; P<0.001), pneumonia (OR [95% CI] 1.427 [1.227-1.659]; P<0.001) and deep venous thrombosis (DVT). (OR [95% CI] 1.326 [1.124-1.564]; P=0.001). After propensity score matching (57:57), an increased proportion of patients with IBI ≥138.03 had a poor functional prognosis at 3 months and in-hospital complications including developed pneumonia and DVT.

Conclusion: In patients with aSAH, high IBI level at admission was associated with unfavorable functional prognosis as well as pneumonia and deep vein thrombosis.

Keywords: aneurysmal subarachnoid hemorrhage; complications; functional prognosis; inflammatory burden index.

Grants and funding

This study was supported by the National Key Research and Development Program of China (Grant Nos. 2021YFC2501101 and 2020YFC2004701), Beijing Municipal Administration of Hospitals Incubating Program, Beijing, China (Grant No. pX2020023), and the Natural Science Foundation of Beijing, China (Grant No. 7204253).