Central line-associated bloodstream infections (CLABSI) are a common and serious problem in critically ill patients; their early detecting is challenging. This study evaluated the predictive ability of the aggregate index of systemic inflammation (AISI) and its modified form for early identification of CLABSI within two calendar days following central line insertion, using a machine learning approach. We conducted an analysis of patients who received central line insertion. Inflammatory indices were calculated using laboratory parameters obtained on second day post-insertion. Four machine learning algorithms were applied to evaluate their predictive performance for early CLABSI detection. Among 234 patients who met the inclusion criteria, 39 were confirmed CLABSI cases. We found both indices significantly elevated in the CLABSI group. Modified AISI demonstrated the strongest performance using XGBoost, with the highest area under the ROC curve (0.99), 97% sensitivity and 98% specificity, indicating its potential as the better early screening marker for CLABSI than AISI. Both AISI and modified AISI demonstrated strong predictive value for early CLABSI detection, being both accessible and cost-effective. Modified AISI outperformed AISI in predictive performance. These findings support the need for the prospective validation of the modified AISI before clinical implementation. Zentralvenenkatheter (ZVK)-assoziierte Blutstrominfektionen (CLABSI) stellen bei kritisch kranken Patienten ein häufiges und schwerwiegendes Problem dar; ihre frühzeitige Erkennung ist eine Herausforderung. In dieser Studie wurde die Vorhersagekraft des Aggregate Index of Systemic Inflammation (AISI) und seiner modifizierten Form für die frühzeitige Erkennung von CLABSI innerhalb von zwei Kalendertagen nach Katheterlegung unter Verwendung eines maschinellen Lernansatzes untersucht. Wir führten eine Analyse bei Patienten durch, bei denen ein ZVK gelegt wurde. Die Entzündungsindizes wurden anhand von Laborwerten berechnet, die am zweiten Tag nach Katheteranlage erhoben wurden. Vier Algorithmen des maschinellen Lernens wurden eingesetzt, um die Vorhersageleistung zur frühzeitigen Erkennung von CLABSI zu bewerten. Von 234 Patienten, die die Einschlusskriterien erfüllten, waren 39 bestätigte CLABSI-Fälle. Wir stellten fest, dass beide Indizes in der CLABSI-Gruppe signifikant erhöht waren. Der modifizierte AISI zeigte unter Verwendung von XGBoost die beste Leistungsfähigkeit mit der höchsten Fläche unter der ROC-Kurve (0,99), einer Sensitivität von 97% und einer Spezifität von 98%, was auf sein Potenzial als besserer Marker für das Früherkennen von CLABSI im Vergleich zum AISI hinweist. Sowohl der AISI als auch der modifizierte AISI zeigten einen hohen prädiktiven Wert für die Früherkennung von CLABSI, erwiesen sich als leicht zugänglich und kosteneffizient. Das modifizierte AISI übertraf AISI hinsichtlich der prädiktiven Leistungsfähigkeit. Die Ergebnisse untermauern die Notwendigkeit einer prospektiven Validierung vor der klinischen Einführung des modifizierte AISI.
Drilling is often used to create holes in CFRP/AISI 316L hybrid stacks to facilitate the assembly process. Due to the non-uniform properties and difficult machinability of Cr-Ni-Mo AISI 316L steel, drilling CFRP/AISI 316L stacks poses significant challenges in manufacturing processes. This paper aims to evaluate the tool-workpiece interaction and the effect of the drilling strategy on the technological aspects of drilling CFRP/AISI 316L stacks. The experimental results show that cutting parameters have a significant impact on the drilling performance of CFRP/AISI 316L stacks. The AISI 316L → CFRP drilling strategy provides lower hole surface roughness with less burr formation in the AISI 316L layer, while the CFRP → AISI 316L drilling strategy is preferred in terms of minimizing delamination damage. The high temperature generated during drilling of the AISI 316L layer directly affects the hole surface quality in the CFRP layer and the phenomena occurring in the interlayer of the stack materials. The experimental results presented in this work allowed us to formulate several recommendations regarding the selection of cutting strategy and cutting parameters when drilling CFRP/AISI 316L hybrid stacks.
Growing evidence supports the prognostic utility of AISI in adults, but its association with mortality in the critically ill pediatric population remains poorly characterized. To investigate the association between AISI and 28-day all-cause mortality in critically ill pediatric patients. A total of 8,797 patients admitted to the pediatric intensive care unit were included from the PIC Database. The AISI was log₂-transformed and categorized into four groups based on quartiles. The outcomes included 28-day all-cause mortality, both in-hospital and in-ICU. Cox proportional hazards regression, restricted cubic spline, two-piecewise threshold model, and subgroup analyses were used to evaluate the association between AISI and 28-day all-cause mortality. Males accounted for 4,930 (56.0%) of the patients. The overall 28-day in-hospital and ICU all-cause mortality rates were 4.3% and 4.2%, respectively. The RCS analysis revealed a significant nonlinear association between the log2-transformed AISI and both mortality outcomes. Threshold effect analysis identified that the threshold points of log₂-AISI were 5.410 and 5.407 for 28-day in-hospital and ICU mortality, respectively. Subgroup analyses revealed no notable differences between specific patient subgroups. This study suggests a nonlinear association between AISI and 28-day mortality in critically ill pediatric patients. AISI levels above the threshold were independently associated with an increased mortality risk.
Ileostomy closure following rectal cancer surgery is generally considered a low-risk procedure; however, postoperative complications remain clinically relevant. Reliable and easily accessible biomarkers for predicting these complications are lacking. This study aimed to evaluate the predictive value of dynamic changes in the aggregate index of systemic inflammation (ΔAISI) for postoperative complications following ileostomy closure. This retrospective cohort study included 137 patients who underwent curative rectal cancer surgery with diverting ileostomy followed by ileostomy closure between January 2015 and March 2026. Inflammatory and nutritional markers were recorded prior to primary surgery and before ileostomy closure. ΔAISI was calculated as the difference between these two time points. Comparisons were performed using the Mann-Whitney U test and chi-square test. Receiver operating characteristic (ROC) curve analysis and multivariate logistic regression were conducted to evaluate predictive performance. Postoperative complications occurred in 23 patients (16.8%). No significant differences were observed in inflammatory markers measured before primary surgery. In contrast, several inflammatory markers measured prior to ileostomy closure were significantly associated with postoperative complications. Among the evaluated indices, ΔAISI demonstrated good discriminative ability (AUC: 0.755, 95% CI: 0.628-0.882, p < 0.001). In multivariate analysis, high ΔAISI remained an independent predictor of postoperative complications (OR: 4.13, 95% CI: 1.41-12.03, p = 0.009). ΔAISI is a promising and independent predictor of postoperative complications following ileostomy closure in rectal cancer patients. Both pre-closure AISI and ΔAISI demonstrated good predictive performance, whereas AISI measured before primary surgery showed poor discrimination. These findings suggest that inflammatory status immediately before ileostomy closure may serve as a clinically useful biomarker for perioperative risk stratification.
Inflammation plays a key role in complications and organ damage in type 2 diabetes mellitus (T2DM). The Aggregate Index of Systemic Inflammation (AISI) and Systemic Inflammation Response Index (SIRI) have emerged as potential markers for inflammation and prognosis. This study aimed to assess the association between AISI, SIRI levels, and mortality in T2DM patients. This study combined a population-level time-trend analysis using Global Burden of Disease data from 1990 to 2021 with a retrospective cohort study using National Health and Nutrition Examination Survey data from 1999 to 2018 linked to the National Death Index mortality files. The Global Burden of Disease data revealed an upward trend in T2DM incidence, with a slight decline in mortality rates from 2003 onward. In the National Health and Nutrition Examination Survey cohort, higher AISI and SIRI levels correlated with increased risks of cardiovascular disease (CVD) and all-cause mortality. After adjusting for confounders, the highest quartile of both indices (Q4) showed significantly higher mortality risks: for AISI quartile 4 (Q4) vs Q1, hazard ratio (HR) = 1.46 for CVD and HR = 1.71 for all-cause mortality; for SIRI Q4 vs Q1, HR = 1.98 for CVD and HR = 2.13 for all-cause mortality. These findings suggest AISI and SIRI may serve as simple markers for risk stratification in T2DM.
This study presents an integrated investigation of the machinability of heat treated AISI 1040 steel under annealed, normalized, and oil quenched conditions. The effects of heat treatment parameters, namely austenitizing temperature and soaking time, together with machining parameters including cutting speed, feed rate, and depth of cut, were evaluated in terms of tool life and surface roughness. Experiments were designed using a Taguchi L27 orthogonal array, and the responses were analyzed through analysis of variance (ANOVA), regression modeling, and optimization techniques. The results showed that temperature, cutting speed, and feed rate significantly influenced tool life, whereas feed rate was the most dominant factor affecting surface roughness in all heat treatment conditions. Annealed AISI 1040 steel exhibited the highest tool life and the best overall machinability because of its relatively softer ferrite-pearlite microstructure, while oil quenched specimens showed the lowest tool life due to the formation of hard martensitic phases. Normalized specimens displayed intermediate behavior, indicating a balanced combination of strength and machinability. The developed regression models showed good predictive capability for both tool life and surface roughness within the investigated parameter range. SEM analysis further confirmed that the observed variations in machinability were closely associated with microstructural evolution caused by different heat treatment routes. The study provides useful guidance for selecting suitable heat treatment and machining parameters to improve productivity, tool performance, and surface quality during machining of AISI 1040 steel.
Dry turning of AISI D2 steel requires a balance between productivity, surface integrity, thermal loading, and energy demand. This study compares the machinability of a chamfered Xcel insert and a conventional carbide insert during dry turning of AISI D2 steel using a 24 full-factorial design with cutting speed (VCS: 100-150 m/min), feed rate (FR: 0.2-0.3 mm/rev), and depth of cut (DOC: 0.5-1.0 mm). Volumetric material removal rate (VMR), microhardness (MH), turning-zone temperature (TTZ), and power consumption (PC) were measured and analysed using ANOVA, ANN modelling, and NSGA-II optimization. The results showed that the Xcel insert consistently outperformed the conventional carbide insert within the investigated range. The highest measured VMR and MH were 1341.57 cm3 and 177.78 HV, respectively, whereas the lowest TTZ and PC were 272 °C and 420.28 W under conservative cutting conditions. ANOVA showed that FR was the dominant factor for VMR (27.69%), while VCS dominated MH (74.51%) and TTZ (49.36%); DOC was the strongest contributor to PC (29.55%). Artificial neural network (ANN) models were used as local-response surrogates, and Non-dominated sorting genetic algorithm (NSGA-II) identified an optimum at 149.84 m/min, 0.3 mm/rev, 0.997 mm, and Xcel insert. The study shows that the Xcel geometry is beneficial for increasing productivity in dry turning of AISI D2 without a disproportionate increase in thermal and energy penalties.
In this study, electrical discharge machining (EDM) of AISI D2 die steel was performed by varying three different process parameters: peak current (Ip), pulse-on time (Ton), and duty cycle (c). Enhancing both surface quality and machining performance is very important for die steel applications; therefore, a hybrid approach for multi-objective optimization was employed. A Box-Behnken design of response surface methodology (RSM) was utilized to conduct the experiments, while analysis of variance (ANOVA) was used to examine the influence of process parameters on the responses. Mathematical models were developed using RSM, which were finally utilized as fitness functions for the Non-Dominated Sorting Genetic Algorithm II (NSGA-II) to get solutions of multi-objective optimization. The algorithm generated a set of non-dominated solutions forming the Pareto frontier. To identify the most desirable solution, the Technique for Order Preference by Similarity to Ideal Solution (TOPSIS) was used. The optimal results obtained through TOPSIS analysis were a surface roughness of 5.22 µm and a material removal rate (MRR) of 0.250 g/min, corresponding to the process parameters: peak current (Ip) = 10.03 A, pulse-on time (Ton) = 30.70 µs, and duty cycle (c) = 14.94%.
This work investigates crack evolution in AISI 316L steel borided by powder-pack process at 1223 K for 2 and 6 h. Microscopy, X-ray diffraction (XRD), and nanoindentation confirmed the formation of FeB/Fe2B composite layers whose hardness and Young's modulus increased with treatment time. Spherical indentation tests using a 3 mm indenter produced circular cracks in both systems, with more pronounced damage in the 6 h layer due to higher elastic energy storage and stress concentration within the coating. Finite element modeling in ANSYS, using the SMART Crack technique, accurately reproduced the indentation imprint geometry and the stress fields governing the mechanical response under spherical indentation, showing good agreement with the experimentally observed surface imprint. The findings demonstrate that the thicker and stiffer layer formed after 6 h promotes deeper crack propagation toward the Fe2B/substrate interface, whereas the thinner 2 h layer confines damage mainly within the FeB phase with no evidence of interfacial failure. These results provide relevant insights for the design and performance prediction of brittle composite layers subjected to concentrated loading.
This study aimed to investigate the association between the Aggregate Index of Systemic Inflammation (AISI) and non-dipper blood pressure (BP) pattern in hypertensive (HT) patients with type 2 diabetes mellitus (DM). Given the well-established role of systemic inflammation in circadian BP regulation, we hypothesized that elevated AISI levels would be associated with impaired nocturnal BP decline. A total of 356 newly diagnosed HT patients with type 2 DM and 170 normotensive control subjects were included in this observational study. HT patients were further classified as dipper (n=186) or non-dipper (n=170) based on 24-hour ambulatory blood pressure monitoring (ABPM). AISI was calculated using neutrophil, lymphocyte, platelet, and monocyte counts. Correlation analyses were performed to evaluate the relationship between AISI and ambulatory BP parameters. Multivariate logistic regression analysis with a backward stepwise method was conducted to determine independent predictors of non-dipper status. Receiver operating characteristic (ROC) curve analysis was used to assess the discriminative performance of AISI and other inflammatory indices. AISI and ln(AISI) levels were significantly higher in non-dipper HT patients than in dipper HT patients and normotensive controls (p<0.001 for all). Ln(AISI) was positively correlated with nighttime systolic and diastolic BP (p<0.05). In multivariate logistic regression analysis, ln(AISI) emerged as the strongest independent predictor of non-dipper blood pressure pattern (OR: 14.13, 95% CI: 3.68-54.32, p<0.001). In ROC analysis, ln(AISI) showed the highest discriminative performance for identifying non-dipper status, with a sensitivity of 71.0% and specificity of 74.1% at a cutoff value of 5.80 (AUC: 0.757, p<0.001), outperforming NLR, PLR, SII, and SIRI. Elevated AISI levels were independently associated with non-dipper blood pressure pattern in hypertensive patients with type 2 diabetes mellitus. These findings suggest that AISI may serve as a practical and integrative biomarker for identifying high-risk patients with impaired circadian blood pressure regulation.
In recent years, with a growing understanding of coronary microvascular dysfunction, myocardial infarction with nonobstructive coronary arteries (MINOCA) has been proposed as a distinct type of myocardial infarction. The management of atrial fibrillation (AF) coexisting with myocardial infarction remains a major challenge in clinical practice. This study aims to explore the association between the inflammatory marker aggregate index of systemic inflammation (AISI) and new-onset AF (NOAF) in patients with MINOCA. In this single-center, retrospective study, we consecutively enrolled patients with MINOCA from January 2019 to June 2025. AISI was calculated as (Neutrophil count × Platelet count × Monocyte count)/Lymphocyte count from procedural complete blood count. NOAF was defined as new-onset AF after admission in patients with no previous history of AF. Multivariable logistic regression was employed to screen for factors associated with NOAF. Restricted cubic spline was used to characterize the dose-response relationships between AISI and NOAF. Receiver operating characteristic curves were constructed to evaluate the discriminative performance of AISI. Among 409 patients with MINOCA, 38 (9.3%) developed NOAF. In multivariable analysis, AISI (odds ratio 2.335, 95% confidence interval [CI] 1.532-3.560, P < .001) and C-reactive protein (odds ratio 1.009, 95% CI 1.002-1.017, P = .015) remained independently associated with NOAF, which suggests that AISI provides additional information independent of the traditional inflammatory marker C-reactive protein in relation to NOAF. Restricted cubic spline analysis suggested an initial nonlinear dose-response relationship between AISI and NOAF in the unadjusted model; however, this association was no longer statistically significant after adjustment for relevant clinical covariates. In receiver operating characteristic analysis, AISI yielded an area under the curve of 0.712 with an optimal cutoff of 750 (sensitivity 0.737, specificity 0.650, 95% CI 0.617-0.808, P < .001). Higher AISI is independently associated with in-hospital NOAF in patients with MINOCA, although its discriminative performance is moderate, suggesting that AISI may serve as an adjunctive rather than a standalone risk marker.
Background. Hematological inflammatory indices from the complete blood count have been proposed as inexpensive prognostic markers in sepsis. The systemic immune-inflammation index (SII) and neutrophil-to-lymphocyte ratio (NLR) are the most studied, but the performance of monocyte-containing alternatives (SIRI, AISI) in the elderly, in whom immunosenescence may alter the leukocyte phenotype, remains poorly characterized. Methods. In a single-center retrospective cohort of patients aged ≥65 years admitted to a tertiary ICU with Sepsis-3-defined sepsis (n = 127, 33 deaths), we compared the discrimination of six indices (NLR, PLR, MLR, SII, SIRI, AISI) for 30-day all-cause mortality using AUROC with bootstrap confidence intervals and pairwise DeLong tests. Independent associations were assessed by logistic regression adjusted for APACHE II and age; incremental value over APACHE II was explored using IDI, cNRI, calibration and decision curve analysis, with bootstrap optimism correction. Results. Thirty-day mortality was 26.0%. The monocyte-containing indices (AISI, SIRI, MLR) discriminated better than SII and NLR, and AISI was significantly superior to SII, NLR and PLR on DeLong testing, though not to SIRI, MLR or APACHE II. After adjustment for APACHE II and age, AISI, SIRI and MLR remained independently associated with mortality, whereas SII and PLR did not. Adding AISI to APACHE II improved reclassification and calibration and yielded higher net clinical benefit across clinically relevant thresholds. Conclusions. In this exploratory, single-center analysis, monocyte-containing indices, particularly AISI, were more strongly associated with 30-day mortality in elderly ICU sepsis than SII or NLR. AISI, SIRI and MLR were strongly intercorrelated and near-equivalent, and AISI did not significantly exceed APACHE II in discrimination. These hypothesis-generating findings require prospective external validation before clinical use.
Acute stent thrombosis (ST) after primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) is uncommon but often fatal. We evaluated whether the Aggregate Index of Systwemic Inflammation (AISI) predicts acute ST and in-hospital mortality. In this retrospective cohort, 3055 consecutive STEMI patients underwent pPCI with stent implantation. Admission AISI was calculated as (neutrophils × monocytes × platelets)/lymphocytes. Multivariable logistic regression identified independent predictors; receiver operating characteristic (ROC) analysis assessed discrimination for acute ST. Acute ST occurred in 76 patients (2.5%) and was associated with higher in-hospital mortality (15.8% vs 3.8%, P < .001). AISI was higher in patients with acute ST (1314.2 vs 689.7, P < .001) and independently predicted acute ST (OR 1.03, 95% CI 1.02-1.05). AISI showed moderate discrimination area under the curve (AUC) 0.720; cut-off 904.97; sensitivity 64.2%; specificity 64.3%). Higher AISI was also independently associated with in-hospital mortality (OR 1.05, P < .001). Admission AISI is independently associated with acute ST and early death after pPCI for STEMI, supporting its use as a rapid, low-cost risk marker pending prospective validation.
This study aims to evaluate the associations of complete blood cell count-derived inflammatory markers-including monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune-Inflammation Index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI)-with acute gouty arthritis in males. A cross-sectional study was conducted in 380 males from the Department of Endocrinology and Department of Physical Examination, Central Hospital of Dalian University of Technology, between January 2022 and January 2024. Multivariable logistic regression models were used to investigate the independent associations between six inflammatory markers and acute gouty arthritis. Restricted cubic splines (RCS) were employed to model the dose-response relationships of inflammatory markers with acute gouty arthritis. Subgroup analyses were performed to identify susceptible populations. The diagnostic capabilities of the inflammatory markers were evaluated and compared using receiver operating characteristic (ROC) curves. A total of 380 male participants were included, with a mean age of 54 years. Among them, 108 participants had AGA, giving a prevalence of 28.4%. Significant associations with AGA were observed for monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune-Inflammation Index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI). Further analysis using RCS revealed nonlinear dose-response relationships between SII and AGA (p-nonlinear = 0.001), as well as between AISI and AGA (p-nonlinear <0.001). Subgroup analysis showed that inflammatory markers (NLR, PLR, SII, SIRI, and AISI) were more effective in assessing AGA onset among men with fatty liver. ROC analysis indicated that when compared with other inflammatory markers (MLR, NLR, PLR, and SIRI), SII and AISI demonstrated superior diagnostic accuracy and discriminatory power in assessing the risk of AGA in men. In men, AGA is closely associated with inflammatory markers. In addition, compared with other inflammatory markers (MLR, NLR, PLR, and SIRI), SII and AISI may serve as more accurate indicators for the diagnosis of AGA.
This study investigated the prognostic relevance of the Controlling Nutritional Status (CONUT) score and the Aggregate Index of Systemic Inflammation (AISI) for predicting all-cause mortality (ACM) in patients undergoing maintenance hemodialysis (MHD). Furthermore, the study aimed to identify independent prognostic indicators to aid clinical risk categorization and tailored therapeutic interventions. A retrospective cohort study was performed with a follow-up duration of 5 years. Extensive demographic data and clinical laboratory results were gathered, and patients were followed until December 2024, with ACM set as the principal endpoint. The predictive capabilities of the CONUT score and AISI for ACM among MHD patients were evaluated by receiver operating characteristic (ROC) curve analysis. Survival outcomes were depicted through Kaplan-Meier curves, and Cox proportional hazards regression was utilized to ascertain significant prognostic factors for five-year ACM. In total, 614 patients on MHD were enrolled. ROC analysis yielded areas under the curve (AUC) of 0.704 for the CONUT score and 0.694 for AISI, with optimal threshold values identified at 3.5 and 306.100, respectively. Patients exhibiting AISI below 306.100 had markedly better cumulative survival rates (χ 2 = 48.085, p < 0.001). Similarly, patients with CONUT scores equal to or greater than 3.5 displayed significantly reduced cumulative survival compared to those scoring below 3.5 (χ 2 = 65.147, p < 0.001). Multivariate Cox regression analyses demonstrated that central venous catheter (CVC) utilization, CONUT score ≥ 3.5, AISI ≥ 306.100, and elevated aspartate aminotransferase (AST) levels were independently associated with increased five-year ACM (p < 0.05). Conversely, being female and exhibiting elevated concentrations of hemoglobin (HGB), urea, and creatinine were protective against mortality (p < 0.05). Both AISI and the CONUT score provide significant prognostic information for predicting ACM in patients undergoing MHD. Their combined use constitutes a robust, accessible tool for identifying high-risk individuals in this population.
Postoperative pneumonia remains a frequent complication after esophagectomy for esophageal squamous cell carcinoma (ESCC). Simple preoperative inflammatory markers may help identify patients at higher perioperative risk. This retrospective cohort study included patients undergoing curative minimally invasive esophagectomy for ESCC from January 2023 to December 2025. The primary outcome was 30-day postoperative pneumonia or pneumonia during the index hospitalization, whichever occurred first. The aggregate index of systemic inflammation (AISI) was calculated from preoperative blood counts. Discriminatory performance was assessed using receiver operating characteristic (ROC) analysis and compared with neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR). Associations were evaluated using hierarchical multivariable logistic regression. Among 446 eligible patients, 140 developed postoperative pneumonia, with an incidence of 31.4%. AISI showed good discriminatory performance for postoperative pneumonia (AUC, 0.795; 95% CI, 0.753-0.837) and had a higher AUC than NLR and PLR. In the fully adjusted model, higher AISI remained independently associated with postoperative pneumonia (per 100-unit increase: adjusted OR, 1.416; 95% CI, 1.301-1.576; P < 0.001). Preoperative AISI was independently associated with 30-day postoperative pneumonia after minimally invasive esophagectomy for ESCC and showed good discriminatory performance. AISI may serve as a simple preoperative risk-stratification marker, but external validation and prospective evaluation are needed before clinical use.
Management of chronic spontaneous urticaria (CSU) remains challenging due to frequent patient refractoriness to high-dose H1-antihistamines, necessitating omalizumab therapy. At diagnosis, reliable and accessible biomarkers are critical to predict which patients will require treatment escalation. This study aimed to evaluate baseline hematological parameters and derive inflammatory indices for their capacity to predict maximum H1-antihistamine dose and subsequent need for omalizumab in a homogenous CSU cohort without major comorbidities. This single-center, retrospective cohort study included 185 adult CSU patients. Baseline inflammatory markers were analyzed relative to the primary outcome of omalizumab requirement and secondary outcome of intensity of antihistamine dose. Multivariate logistic regression and receiver operating characteristic analyses identified independent predictors and optimized cut-off values. Higher baseline levels of inflammatory markers, such as white blood cell count, neutrophils, neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and aggregate index of systemic inflammation (AISI), were significantly associated with the need for four-fold antihistamine dosing. Adjusted multivariate analysis identified AISI ≥ 346.8 (adjusted odds ratio [aOR] = 7.45) as an independent predictor of omalizumab requirement, while erythrocyte sedimentation rate (ESR) > 7.5 (aOR = 0.24) was identified as an independent protective factor against omalizumab requirement. As a standalone biomarker, AISI demonstrated an area under the curve (AUC) of 0.733 and a negative predictive value (NPV) of 96.4% at this threshold. In this cohort, baseline AISI was independently associated with omalizumab requirement and appears to be a promising marker that warrants external validation, whereas elevated ESR appears protective. Given the retrospective single-center design, these findings should be interpreted cautiously. A high NPV of the AISI cut-off suggests potential clinical utility for ruling out patients unlikely to require treatment escalation.
This cross-sectional study aimed to explore the associations among childhood trauma, inflammation and depressive severity, with a particular focus on the mediating role of a peripheral blood inflammatory marker (the Aggregate Index of Systemic Inflammation, AISI) in the relationship between childhood emotional neglect and depressive severity. A total of 236 patients with major depressive disorder (MDD) were enrolled in this study. All participants completed the Childhood Trauma Questionnaire (CTQ) and the 24-item Hamilton Depression Rating Scale (HAMD-24), and underwent routine blood tests. Using Hierarchical regression analysis, after controlling for fixed covariates (age, sex, education level, etc.), separate models were built for each indicator to compare their predictive ability for HAMD-24 scores. The PROCESS mediation model was employed to examine the mediating role of AISI in the relationship between childhood emotional neglect and depressive severity. MDD patients with a history of childhood trauma exhibited significantly higher levels of inflammatory markers and depressive severity than those without such a history. Among the dimensions of childhood trauma, emotional neglect exhibited the strongest predictive power for HAMD-24 scores (ΔR² = 0.111, ΔP < 0.001, AIC = 1691.663), and among inflammatory markers, AISI demonstrated the strongest predictive power for HAMD-24 scores (ΔR² = 0.230, ΔP < 0.001, AIC = 1654.19). Emotional neglect was positively correlated with AISI (r = 0.213, p < 0.001) and with HAMD-24 scores (r = 0.280, p < 0.001). Furthermore, the inflammatory marker AISI partially mediated the relationship between childhood emotional neglect and depressive severity, with a mediation effect of 28.07%. Childhood emotional neglect may be associated with depression severity through alterations in systemic inflammatory responses, supporting inflammation as a plausible mediating mechanism in this pathway. While causal relationships cannot be established, these results highlight the potential value of investigating anti-inflammatory strategies as adjunctive treatments for MDD in future prospective studies.
Drug hypersensitivity reactions (DHRs) range from mild cutaneous symptoms to life-threatening anaphylaxis, necessitating practical biomarkers for severity prediction and risk stratification. This study aimed to evaluate the predictive value of Systemic Immune-Inflammation Index (SII), Systemic Inflammation Response Index (SIRI), and Aggregate Index of Systemic Inflammation (AISI) measured during a stable period in patients with drug allergy. This study included 200 patients with DHRs, categorized into severe (anaphylaxis; n=67) and non-severe (n=133) groups. To reflect steady-state inflammatory status, hemogram parameters were obtained at least one month after resolution of acute symptoms. Diagnostic performances were assessed using age- and sex-adjusted logistic regression and ROC analysis. Baseline SII, SIRI, and AISI were all significantly higher in the severe group (SII: 516.8 vs 438.1, p=0.009; SIRI: 1.08 vs 0.88, p=0.012; AISI: 286.6 vs 221.9, p=0.001). In age- and sex-adjusted models, each index independently predicted anaphylaxis per 1-SD increase: SII OR 1.55 (95% CI 1.11-2.17), AISI OR 1.51 (95% CI 1.12-2.05), and SIRI OR 1.46 (95% CI 1.09-1.96). Using Youden-optimized thresholds, AISI ≥197 yielded the highest adjusted odds of anaphylaxis (aOR 4.11, 95% CI 2.00-9.07; p<0.001), followed by SII ≥333 (aOR 3.56, 95% CI 1.55-9.28; p=0.005) and SIRI ≥1.37 (aOR 3.11, 95% CI 1.59-6.15; p<0.001). Systemic inflammatory indices are independently associated with anaphylaxis severity in patients with immediate-type drug hypersensitivity. With AUC values ranging from 0.61 to 0.64, these indices demonstrate modest discriminatory performance and should be regarded as adjunctive screening tools rather than standalone diagnostic markers. Their elevation during the stable period may reflect a chronic pro-inflammatory state that predisposes individuals to more severe reactions upon drug exposure, a hypothesis requiring prospective validation in larger, multicenter cohorts.
Background and Objectives: Sepsis is a life-threating organ dysfunction condition caused by the body's uncontrolled response to an infection. Many traditional and novel inflammatory markers have been used to determine poor prognosis in patients' sepsis. The inflammatory prognostic index (IPI) is also a novel marker of inflammation. As there are no studies examining the association of the IPI with in-hospital mortality in patients with sepsis nor its performance compared with other inflammatory markers, we aimed to investigate the clinical importance of the IPI for predicting in-hospital mortality in sepsis patients. Materials and Methods: A total of 157 consecutive patients diagnosed with sepsis were retrospectively included in this study. The systemic immune-inflammation index (SII; platelet × neutrophil/lymphocyte), the systemic inflammatory response index (SIRI; neutrophil × monocyte/lymphocyte), the aggregate index of systemic inflammation (AISI; neutrophil × platelet × monocyte/lymphocyte) and the IPI (C-reactive protein × neutrophil-to-lymphocyte ratio [NLR]/albumin) were calculated for all patients. Patients were divided into two groups: survivors (n = 81) and non-survivors (n = 76). Results: Non-survivor patients had significantly higher SII (p = 0.002), SIRI (p < 0.001), AISI (p = 0.002) and IPI (p < 0.001) than survivors. The AUC of the IPI was significantly higher than those of the SII (0.751 vs. 0.645; p = 0.010) and the AISI (0.751 vs. 0.648; p = 0.021) and tended to be higher than that of the SIRI (0.751 vs. 0.687; p = 0.091). Based on logistic regression analysis, the IPI was found to be an independent predictor of mortality (OR: 1.007, 95%CI: 1.002-1.012, p = 0.006). Conclusions: The IPI is a novel combined inflammatory marker that can be easily obtained from laboratory parameters. We determined that the IPI had moderately higher discriminatory ability than the SII and the AISI in patients with sepsis, which indicates that it may be used for risk stratification in this population.