Systemic immun inflammatoir index: As a new predictor of mortality in precapillary pulmonary hypertension patients before administiration of spesific treatment

Objective: Even today, Pulmonary Hypertension is still highly mortal, can be challenging to diagnose. It is stated that there is a relationship between PH and inflammation. On this basis, we want to check if there is a relationship between PH mortality and inflammation using new inflamation markers like PLR, SLR and SII. Method: In this study, a total of consecutive 130 patients diagnosed with precapillary PH based on right-left heart catheterization or echocardiography since 2012 were retrospectively analyzed, and 50 patients (36 females-%72) who met the criteria were included in the study. 32 (%64) of these patients were Group 1 PH (PAH) patients, 18 of them were Group 4 PH patients. The patients with rheumatologic diseases, hepatic cirrhosis, active infection, malignities were excluded since these pathologies can increase inflammation or reduce blood cells like thrombocytes and alter results. The demographic characteristics, biochemical parameters, hematological parameters, echocardiographic parameters, catheterization parameters, 6-minute walk test, SII, NLR, PLR values, first treatments at the time of initial diagnosis were evaluated. The data of 23 patients who died during the follow-up period and 27 patients who survived were compared. Results: The SII value at the time of initial diagnosis was significantly higher in the group of patients who died compared to the group of patients who survived. The SII value was analyzed using Receiver Operating Characteristics (ROC) curve in terms of mortality, and the probable cut-off value was determined to be 769.53 with a sensitivity of 78.3% and specificity of 70.4% (AUC: 0.749, %95 CI:0.605 – 0.892, p = 0.003) (Figure 1). After detecting cut-off value Kaplan-Meier analysis was performed. While mean follow up time was 36 months, 3 year survival rate was %75.5, whose SII index value was above 769.53. However 3 year survival rate was %52.3 whose SII index value was under 769.53.(p=0.01) According to univariate analysis, low hematocrit, hemoglobin, lymphocyte, albumin, GFR levels were independent predictors of mortality in precapillary PH. Age, preexistent CAD, preexistent AF, high uric acid, high BNP, high potassium, thrombocytosis, higher SII, NLR,PLR levels, higher LA diameters in echocardiography, usage of furosemide, CCB's, iloprost are linked with higher mortality. After elimination using a multivariate logistic regression model, age, preexistent CAD, higher SII levels, usage of CCB's and furosemide were independent predictors of mortality in precapillary PH. 0.008) (Figure 2). Conclusion: According to literature first used for this purpose, an easily calculated, statistically significant, predictor marker SII can be used as a predictor of mortality in newly diagnosed precapillary PH patients undergoing specific treatment. We demonstrated that SII levels above 769.53 is associated with higher mortality in precapillary PH patients. Key Words: Biomarkers, İnflammation, KTEPH, Prekapillary Pulmonary Hypertension, Pulmonary Arterial Hypertension, Pulmonary Hypertension, SII.