The Association Between Systemic Immune-Inflammation Index and Postoperative Cognitive Decline in Elderly Patients

Abstract

Purpose

Postoperative cognitive decline (POCD) is highly prevalent in elderly patients who received surgery. The systemic immune-inflammation index (SII) has been shown to be an independent predictor of many diseases associated with inflammation, but the relationship between the SII and POCD is unknown. We aimed to investigate the association between POCD and SII levels to examine the potential of SII in predicting POCD in elderly patients.

Patients and Methods

The present study was carried out among elderly patients who underwent elective orthopedics operation in our hospital, and SII, neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR) were calculated from the admission blood sample. POCD was measured by Mini-mental State Examination (MMSE) in elderly patients. The association between SII levels and POCD was analyzed by binary logistic regression analysis.

Results

Finally, 19 (25%) of 76 patients were diagnosed with POCD. Compared with Non-POCD patients, POCD patients showed significantly higher levels of NLR, MLR, SII, especially SII at admission. SII was independently associated with the occurrence of POCD through the logistic regression analysis. Receiver operating characteristic curve analysis indicated that preoperative SII was a significant predictor for POCD, and the area under the curve was 0.909.

Conclusion

Our data suggest that preoperative NLR, MLR, SII levels in the blood are related to the occurrence of POCD. Preoperative SII level is a prognostic biomarker of POCD in elderly patients after orthopedics operation. More clinical studies are needed to further verify the value of SII in POCD.

Keywords:

• systemic immune-inflammation index
• postoperative cognitive decline
• geriatric
• neutrophil to lymphocyte ratio
• monocyte to lymphocyte ratio

Data Sharing Statement

The data supporting the findings of this study can be obtained from the corresponding author according to reasonable request, and the corresponding author/s can be directly contacted for further inquiry.

Ethics Statement

The studies concerning human participants were reviewed and approved by the ethics committee of Shanghai Changhai Hospital. The patients/participants participated in the study by providing written informed consent. The study project conforms to the ethical guidelines of the Declaration of Helsinki. In order to publish any potentially identifiable images or data contained in this article, written informed consent was obtained from the individual(s).

Acknowledgments

We thank all those who support and participate in the study, including our staff, patients and their family members.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors state that the study was conducted without any commercial or financial relationships and potential conflicts of interest.

Additional information

Funding

This study was funded by the National Natural Science Foundation of China (81871579 to Jinjun Bian, and 81701062 to Xiya Yu) and Innovative Program of First Affiliated Hospital of Naval Medical University (2020YXK013 to Xiya Yu).