Article 2025 · 1 citations

Inflammation-Based Cell Ratios Beyond White Blood Cell Count for Predicting Postimplantation Syndrome After EVAR and TEVAR

Sonmez, Ebubekir, Jalalzai, Izatullah, Arslan, Umit

Abstract

Postimplantation syndrome (PIS) is an early inflammatory response following endovascular stent-graft implantation (EVAR and TEVAR), defined by culture-negative fever and leukocytosis. The patient's preoperative inflammatory status is thought to play a central role in its development. This study aimed to evaluate whether the systemic inflammatory response index (SIRI) and the eosinophil-to-lymphocyte ratio (ELR) can serve as preoperative predictors of PIS. Clinical data from 300 patients who underwent aortic endograft implantation and laboratory results obtained 24 h before the procedure, and at 24 h, 72 h, and 1 week postoperatively, were prospectively recorded. PIS was defined as culture-negative fever >= 37.8 degrees C accompanied by leukocytosis >= 12,000/mu L. Inflammation-based indices derived from complete blood count (SIRI and ELR), along with serum C-reactive protein (CRP) and albumin levels, were compared between patients with and without PIS. Logistic regression and receiver operating characteristic (ROC) analyses were performed to identify independent predictors. PIS developed in 55 patients (18.3%). Patients with PIS were younger (70.1 +/- 8.6 vs. 72.7 +/- 7.3 years; p = 0.042) and had larger aneurysm diameters and greater mural thrombus thickness. Preoperatively, leukocyte count, SIRI, and CRP levels were significantly higher in patients who developed PIS, whereas ELR and albumin levels were lower. Multivariable analysis showed that a larger aneurysm diameter (OR: 1.2; 95% CI: 1.0-1.3; p = 0.003), greater mural thrombus thickness (OR: 1.3; 95% CI: 1.0-1.6; p = 0.012), EVAR procedure (OR: 3.7; 95% CI: 1.2-6.3; p = 0.033), elevated SIRI (OR: 1.9; 95% CI: 1.2-3.1; p = 0.005), and higher CRP (OR: 1.4; 95% CI: 1.1-3.2; p = 0.003) were significantly associated with PIS. In contrast, increasing age, higher ELR, and higher albumin levels were associated with a reduced risk of PIS. Simple biomarkers routinely obtained from standard laboratory tests can contribute meaningfully to the preoperative prediction and postoperative identification of PIS. Their integration into risk stratification models and confirmation against definitive diagnostic criteria will require validation in larger, multicenter studies.

Keywords

postimplantation syndrome endovascular aneurysm repair EVAR thoracic endovascular aortic repair TEVAR neutrophil-to-lymphocyte ratio systemic inflammatory response index eosinophil-to-lymphocyte ratio C-reactive protein albumin ABDOMINAL AORTIC-ANEURYSM ENDOVASCULAR REPAIR STENT-GRAFTS PATIENT COAGULOPATHY RESPONSES OUTCOMES RELEASE SURGERY

WoS Categories

Biochemistry & Molecular Biology Chemistry, Multidisciplinary

Sustainable Development Goals

Good Health and Well-being

Citation

Journal: INTERNATIONAL JOURNAL OF MOLECULAR SCIENCES
Year: 2025
Volume: 26
Issue: 19
ISSN: 1661-6596
eISSN: 1422-0067
DOI: 10.3390/ijms26199753
WoS UID: WOS:001593637800001

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