The perioperative trajectory of the systemic immune-inflammatory index and it's effect on prognosis in patients undergoing coronary artery bypass grafting

The Perioperative Trajectory of the Systemic Immune-Inflammatory Index and its Effect on Prognosis in Patients Undergoing Coronary Artery Bypass Grafting Objectıve: Coronary artery disease (CAD) is a chronic condition that can result in high mortality and morbidity due to the underlying atherosclerosis. Coronary artery bypass grafting (CABG), performed using cardiopulmonary bypass (CPB), is one of the principal surgical treatment methods for CAD. The use of CPB can trigger systemic inflammation, thereby increasing the risk of morbidity and mortality. This study aims to evaluate the perioperative trajectory of the systemic immune-inflammatory index and its effect on prognosis in patients undergoing CABG with CPB. Methods: This study retrospectively examined 219 patients who underwent coronary artery bypass grafting (CABG) due to coronary artery disease (CAD) between January 1, 2021, and December 31, 2022. Demographic data, preoperative medication use, laboratory findings, intraoperative data, and postoperative complications were recorded. The systemic immune-inflammatory index (SII) was calculated using the formula (Neutrophil × Platelet) / Lymphocyte a total of seven times, from the preoperative period until the outpatient followup. The effect of the SII index trajectory on the presence of complications was analyzed using logistic regression. Receiver operating characteristic (ROC) analysis was employed to determine the cut-off points for SII values in relation to the presence of complications. Results: Considering the development of general complications, a statistically significant difference was observed between the preoperative (p=0,008) and postoperative day 3 (p=0,015) values of the systemic immune inflammatory index (SII). The cut-off point for the preoperative SII value was determined to be ≥699,04 x 103 /mm3 (p=0,008). For the postoperative day 3 SII value, the cut-off point was identified as ≥936,76 103 /mm3 . The impact of SII progression on the presence of complications was assessed using both univariate and multivariate regression models. Univariate analysis indicated that the preoperative and postoperative day 3 SII values had statictically significant effects when evaluated independently. Variables that were deemed significant in the univariate analysis were incorporated into the multivariate model; however, the collective effects in this model were not statistically significant (p>0,05). When complications were analyzed individually, xvii no significant relationship was found between the preoperative SII value and the occurence of complications. Conversely, a significant association was identified solely between the postoperative day 3 SII value and Infection/Non-prophylactic antibiotics use complication (p=0,039). Conclusıon: Elevated preoperative and postoperative day 3 of SII is associated with prognosis in patients undergoing coronary artery bypass grafting (CABG). Both preoperative measurements and postoperative index monitoring are effective in predicting the risk of complications following CABG. Key Words: Coronary artery bypass grafting, Prognosis, Systemic immune inflammatuar indeks.