Prognostic Value of Systemic Immune-Inflammation Index and NT-proBNP in Patients with Acute ST-Elevation Myocardial Infarction

Figures & data

Figure 1 The flow chart of participants inclusion.

Table 1 Clinical and Laboratory Characteristics of Enrolled Patients According to SII and NT-proBNP

Variable	Low SII/Low NT-proBNP (GroupQ1 n=263)	High SII+ High NT-proBNP (GroupQ2 n=92)	P
Age (years, )	62.24 ± 12.97	66.49 ± 11.51	0.005
Gender
Male, n (%)	196 (74.5)	66 (71.7)	0.178
Laboratory parameters
WBC, (10^9/L)	9.833 ± 3.084	11.076 ± 2.813	0.001
Neut, (10^9/L)	7.69 (5.67–9.81)	9.86 (8.41–11.83)	<0.001
Lymph, (10^9/L)	1.70 (1.20–2.40)	0.90 (0.80–1.20)	<0.001
RBC, (10^9/L)	4.719 ± 0.544	4.592 ± 0.463	0.069
HB, (g/L)	143.99 ± 16.979	138.75 ± 15.449	0.008
PLT, (10^9/L)	199.00 (166.75–239.25)	228.00 (194.00–262.00)	<0.001
Total cholesterol (mmol/L)	4.501 ± 1.161	4.181 ± 0.998	0.044
Triglycerides (mmol/L)	1.697 ± 1.962	1.278 ± 0.738	0.084
HDL-C (mmol/L)	1.001 ± 0.262	1.005 ± 0.226	0.904
LDL-C (mmol/L)	2.60 (2.05–3.14)	2.85 (2.24–3.16)	0.497
CKMB (ng/mL)	5.94 (2.44–31.03)	12.86 (5.41–55.68)	<0.001
Creatinine (µmol/L)	62 (55–74)	55.50 (46.00–71.00)	0.006
Fibrinogen (g/L)	2.902 ± 1.06	3.135 ± 1.161	0.107
LVEF (%)	51 (50–55)	51 (49.75–56.25)	0.363
Daily smokers, n (%)	82 (31.2)	56 (60.9)	<0.001
Use of therapeutic agents
Aspirin, n (%)	263 (100)	92 (100)	1
Clopidogrel/Ticagrelor, n (%)	263 (100)	92 (100)	1
Beta-blocker, n (%)	198 (75.3)	76 (80.9)	0.894
ACEI/ARB, n (%)	156 (59.3)	52 (56.5)	0.196
CCB, n (%)	58 (22.1)	16 (17.4)	0.202
Diuretics, n (%)	78 (29.7)	59 (64.1)	<0.001
Statins, n (%)	231 (87.8)	89 (96.7)	0.508
Nitrates, n (%)	175 (66.5)	68 (73.9)	0.728
Hypertension, n (%)	82 (31.2)	40 (43.5)	0.098
Diabetes mellitus, n (%)	66 (25.1)	18 (19.6)	0.152
Heart rate (bmp)	83.08 ± 15.513	87.13 ± 13.380	0.074
Systolic pressure (mmHg, )	125.59 ± 20.531	123.73 ± 22.362	0.470
Diastolic pressure (mmHg, )	78.92 ± 13.202	76.24 ± 15.517	0.116
SII	798.07 (458.41–1134.34)	2091.68 (1775.56–2642.77)	<0.001
NT-proBNP (pg/mL)	935.581 ± 2432.152	2657.958 ± 4665.864	<0.001

Abbreviations: WBC, white blood cell; Neut, neutrophils; Lymph, lymphocyte; RBC, red blood cell; HB, hemoglobin; PLT, platelet; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; LVEF, left ventricular ejection fractions; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor inhibitor; CCB, calcium channel blockers; SII, systemic immune-inflammation index.

Table 2 Comparison of Clinical and Laboratory Characteristics of Enrolled Patients According to the Occurrence of MACEs

Variable	MACE Group (n=100)	MACE-Free Group (n=255)	P
Age (years, )	65.80 ± 11.92	62.46 ± 12.92	0.026
Gender
Male, n (%)	69 (69.0)	193 (75.7)	<0.001
Laboratory parameters
WBC, (10^9/L)	10.618 ± 3.066	9.998 ± 3.045	0.086
Neut, (10^9/L)	8.53 (6.85–10.81)	7.47 (5.51–9.60)	0.002
Lymph, (10^9/L)	1.15 (0.80–1.50)	1.40 (1.00–2.20)	0.004
RBC, (10^9/L)	4.574 ± 0.513	4.731 ± 0.528	0.019
HB, (g/L)	138.61 ± 17.284	144.11 ± 16.264	0.005
PLT, (10^9/L)	216.50 (180.50–259.75)	207.00 (173.00–245.00)	0.035
Total cholesterol (mmol/L)	4.379 ± 1.156	4.424 ± 1.115	0.775
Triglycerides (mmol/L)	1.445 ± 0.910	1.634 ± 1.957	0.43
HDL-C (mmol/L)	1.006 ± 0.227	1.001 ± 0.262	0.86
LDL-C (mmol/L)	2.58 (2.20–3.06)	2.62 (2.09–3.14)	0.801
CKMB (ng/mL)	22.27 (6.00–82.99)	8.09 (2.65–38.15)	0.001
Creatinine (µmol/L)	64.50 (52.00–76.75)	61.00 (52.00–72.00)	0.17
Fibrinogen (g/L)	3.318 ± 1.233	2.825 ± 0.999	<0.001
LVEF (%)	50 (47–53)	51 (50.00–56.00)	0.105
Daily smokers, n (%)	40 (40.0)	122 (47.8)	0.182
Use of therapeutic agents
Aspirin, n (%)	100 (100)	255 (100)	1
Clopidogrel/Ticagrelor, n (%)	100 (100)	255 (100)	1
Beta-blocker, n (%)	84 (84.0)	190 (74.5)	0.055
ACEI/ARB, n (%)	67 (67.0)	141 (55.3)	0.044
CCB, n (%)	21 (21.0)	53 (20.8)	0.964
Diuretics, n (%)	52 (52.0)	85 (33.3)	0.001
Statins, n (%)	74 (74.0)	246 (96.5)	<0.001
Nitrates, n (%)	72 (72.0)	171 (67.1)	0.368
Hypertension, n (%)	42 (42.0)	80 (31.4)	0.058
Diabetes mellitus, n (%)	38 (38.0)	46 (18.0)	<0.001
Heart rate (bmp)	86.05 ± 14.507	83.49 ± 15.224	0.264
Systolic pressure (mmHg, )	123.19 ± 19.729	125.83 ± 21.520	0.301
Diastolic pressure (mmHg, )	77.21 ± 14.771	78.57 ± 13.558	0.422
SII	1649.08 (912.04–2447.79)	1122.94 (562.24–1830.82)	<0.001
NT-proBNP (pg/mL)	3544.303 ± 5420.347	566.283 ± 1029.638	<0.001

Abbreviations: WBC, white blood cell; Neut, neutrophils; Lymph, lymphocyte; RBC, red blood cell; HB, hemoglobin; PLT, platelet; HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; LVEF, left ventricular ejection fractions; ACEI, angiotensin converting enzyme inhibitor; ARB, angiotensin receptor inhibitor; CCB, calcium channel blockers; SII, systemic immune-inflammation index.

Table 3 Univariate and Multivariate Cox Regression Analysis Results for MACEs

Variables	HR	Univariate 95% CI	P value	HR	Multivariate 95% CI	P value
Lymph	0.604	0.426–0.857	0.005	1.149	0.698–1.891	0.586
Hemoglobin	0.982	0.970–0.994	0.004	0.973	0.903–1.048	0.472
HCT	0.943	0.903–0.985	0.009	1.114	0.866–1.433	0.400
Fibrinogen	1.276	1.067–1.525	0.007	1.208	0.924–1.578	0.166
RDW	2.21	1.569–3.114	<0.001	0.975	0.869–1.095	0.673
hs-CRP	1.018	1.004–1.012	<0.001	0.994	0.984–1.005	0.285
Ln(SII)	2.262	1.591–3.217	<0.001	2.952	1.565–5.566	<0.001
Ln(NT-proBNP)	2.277	1.828–2.836	<0.001	2.112	1.662–2.683	<0.001

Abbreviations: Ln(SII), natural -logarithm of systemic immune-inflammation index; Ln(NT-proBNP); natural-logarithm of NT-proBNP.

Figure 2 Kaplan-Meier survival curves of MACEs in STEMI patients according to the level of SII and NT-proBNP. Based on the median SII and NT-proBNP (Group Q1, SII ≤1240.61 or NT-proBNP ≤280.53; Group Q2, SII>1240.61 and NT-proBNP >280.53).

Figure 3 Receiver operating characteristic curves of SII, NT-proBNP, SII combined with NT-proBNP for 1-year MACEs prediction.