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24-05-2021 | Rheumatology | News | Article

Systemic inflammatory response index may predict ischemic stroke risk in RA

Author: Hannah Kitt

medwireNews: An elevated systemic inflammatory response index (SIRI) could signal an increased risk for ischemic stroke in patients with rheumatoid arthritis (RA), report Chinese researchers.

“Thus, RA patients with elevated SIRI should be closely monitored,” Xiaolong Yu (Wujin Hospital Affiliated with Jiangsu University, Changzhou City, China) and colleagues recommend in Clinical Rheumatology.

The researchers reference a previous report of a 2.66-fold elevated risk for cerebrovascular events in patients with RA compared with the general population, and therefore emphasize that “studying the inflammatory indicators of RA patients with [ischemic stroke] and evaluating the risk of such indicators in RA patients with [ischemic stroke] are significant and critical.”

Accordingly, they compared 48 patients with RA who had an ischemic stroke and were treated at Wujin Hospital Affiliated with Jiangsu University with an equal number of patients with RA who had not had an ischemic stroke. The patients were matched using propensity scores for covariables including sex, age, blood pressure, glucose, and lipid levels.

Patients in the ischemic stroke group had a significantly higher SIRI than those in the control group, at an average 1.67 versus 0.94 ×109/L. Multivariate analysis showed that SIRI independently predicted the risk for ischemic stroke, whereby patients with an elevated SIRI were a significant 30% more likely to have an ischemic stroke than those with a lower SIRI.

Area under the receiver operating characteristic curve analysis showed that a SIRI cutoff of 1.62 ×109/L aided ischemic stroke prediction with an accuracy of 72.10%, a sensitivity of 54.17%, and a specificity of 83.33%. Therefore, at this cutoff, “RA patients may be considered to have a high inflammatory state and be at risk for concurrent [ischemic stroke],” say the researchers.

Indeed, SIRI was positively associated with C-reactive protein and erythrocyte sedimentation rate, with significant correlation coefficients of 0.471 and 0.358, and moderately associated with DAS28-CRP, with a correlation coefficient of 0.508. There was, however, no significant association between SIRI and rheumatoid factor.

These associations indicate that “SIRI may provide a reference for preliminary determination and inflammatory activity differential diagnosis in this group of patients,” suggests the team.

The researchers add that mean platelet volume was significantly lower in patients with than without an ischemic stroke (10.20 vs 10.50 µm3), but unlike SIRI, this did not translate to a “relevant risk factor.”

They acknowledge the limitations of the study, including the use of electronic medical records from a single center, the fact that SIRI was not dynamically monitored and may therefore be influenced by the time change rule, and the need for a larger sample size to confirm the findings.

Nevertheless, they conclude that their study “completes the gaps in research on the relationship between SIRI and the risk of ischemic stroke occurrence in RA patients.”

medwireNews is an independent medical news service provided by Springer Healthcare Ltd. © 2021 Springer Healthcare Ltd, part of the Springer Nature Group

Clin Rheumatol 2021; doi:10.1007/s10067-021-05762-z