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Systemic inflammatory response index as an independent risk factor for ischemic stroke in patients with rheumatoid arthritis: a retrospective study based on propensity score matching

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Abstract

Objective

To investigate the relationship between systemic inflammatory response index (SIRI) and ischemic stroke (IS) in rheumatoid arthritis (RA) patients.

Methods

Fifty-two RA patients with IS, who were admitted to Wujin Hospital Affiliated with Jiangsu University between 2015 and 2019, were selected as the study group, and 236 RA patients without IS were selected as the control group. Propensity score matching (PSM) function of SPSS 26.0 was used to carry out 1:1 propensity score matching for gender, age, blood pressure, blood glucose, blood lipid, and smoking history of patients in the two groups, and the caliper value was set as 0.02 to obtain covariate balanced samples between groups. When performing blood tests, the following are determined: rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), mean platelet volume (MPV), calculated SIRI = (neutrophil × monocyte)/lymphocyte, and completed 28-joint disease activity score (DAS28-CRP). The differences in inflammatory markers between the two groups were compared, the independent risk factors were analyzed by logistic regression, and the auxiliary diagnostic value was evaluated by the receiver operating characteristic (ROC) curve.

Results

A total of 48 pairs of patients were successfully matched. SIRI in the study group was higher than that in the control group (p < 0.05), and the mean platelet volume (MPV) was lower in the study group than in the control group (p < 0.05). SIRI, DAS28-CRP (r = 0.508, p < 0.01), ESR (r = 0.359, p < 0.05), and CRP (r = 0.473, p < 0.01) were positively correlated. Logistic regression analysis showed that SIRI was an independent IS risk factor in RA patients (odds ratio, 1.30; 95% confidence interval, approximately 1.008–1.678). The optimal threshold for SIRI-assisted diagnosis of patients with RA and IS was 1.62, the area under the ROC curve was 0.721 (p < 0.01), sensitivity was 54.17%, and specificity was 83.33%.

Conclusion

SIRI was independently associated with the occurrence of ischemic stroke in patients with RA. Thus, RA patients with elevated SIRI should be closely monitored.

Key points

• RA patients with IS had fewer traditional risk factors such as hypertension and diabetes, while inflammatory indicators were significantly increased.

• The SIRI have drawn attention in recent years as novel non-specific inflammatory markers. However, only a few studies have been conducted to investigate their value in RA.

• This study completes the gaps in the research on the relationship between SIRI and the risk of IS occurrence in RA patients.

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Abbreviations

IS:

Ischemic stroke

RA:

Rheumatoid arthritis

SIRI:

Systemic inflammatory response index

PSM:

Propensity score matching

ESR:

Erythrocyte sedimentation rate

CRP:

C-reactive protein

MPV:

Mean platelet volume

NPC:

Nasopharyngeal cancer

OR:

Odds ratio

CI:

Confidence interval

ROC:

Receiver operating characteristic

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Funding

This study was funded by the Young Talent Development Plan of Changzhou Health Commission (CZQM2020120) and Jiangsu Key Laboratory of Immunology and Metabolism (XZSYSKF2020018).

Author information

Author notes

  1. Zihan Jin, Dongli Hao, and Yuanjian Song contributed equally to this work and should be considered co-first authors

Authors and Affiliations

  1. Department of Clinical Laboratory, The Affiliated Changzhou No. 2 People’s Hospital of Nanjing Medical University, Changzhou City, Jiangsu Province, China

    Zihan Jin

  2. Department of Neurology, Wujin Hospital Affiliated with Jiangsu University, Changzhou City, Jiangsu Province, China

    Dongli Hao

  3. School of Basic Medicine, Xuzhou Medical University, Xuzhou City, Jiangsu Province, China

    Yuanjian Song

  4. Department of Surgery, Wujin Hospital Affiliated with Jiangsu University, Changzhou City, Jiangsu Province, China

    Lin Zhuang & Qiang Wang

  5. Science and Education Section, Wujin Hospital Affiliated with Jiangsu University, Changzhou City, Jiangsu Province, China

    Xiaolong Yu

  6. Department of Ultrasonics, The Wujin Clinical College of Xuzhou Medical University, Changzhou City, Jiangsu Province, China

    Xiaolong Yu

  7. Jiangsu Key Laboratory of Immunology and Metabolism (Xuzhou Medical University), Xuzhou City, Jiangsu Province, China

    Xiaolong Yu

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  1. Zihan Jin
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  2. Dongli Hao
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Contributions

Zihan Jin, Lin Zhuang, and Dongli Hao performed the experiments, analyzed the data, and wrote the manuscript. Yuanjian Song and Qiang Wang were involved in performing the experiments. Xiaolong Yu conceived the study and assumed overall responsibility for this work. All authors were involved in drafting the article or revising it critically for important intellectual content, and all authors approved the final version to be submitted for publication.

Corresponding author

Correspondence to Xiaolong Yu.

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The study has been conducted in compliance with the principles of the Declaration of Helsinki and with the local China laws and regulations.

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Jin, Z., Hao, D., Song, Y. et al. Systemic inflammatory response index as an independent risk factor for ischemic stroke in patients with rheumatoid arthritis: a retrospective study based on propensity score matching. Clin Rheumatol 40, 3919–3927 (2021). https://doi.org/10.1007/s10067-021-05762-z

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  • DOI: https://doi.org/10.1007/s10067-021-05762-z

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