# Preoperative systemic inflammation response index may predict postoperative delayed extubation for elderly patients with aSAH: a retrospective cohort study

## TL;DR

This study shows that a pre-surgery blood marker called SIRI can help predict if elderly patients with aSAH will need longer breathing support after surgery.

## Contribution

The study is the first to show that preoperative SIRI is an independent predictor of delayed extubation in elderly aSAH patients.

## Key findings

- SIRI, along with GCS and lactic dehydrogenase, was identified as an independent predictor of delayed extubation.
- SIRI had a moderate predictive accuracy with an AUC of 0.772 for delayed extubation.
- The optimal SIRI cutoff value was 8.14, with high specificity but low sensitivity for predicting delayed extubation.

## Abstract

Aneurysmal subarachnoid hemorrhage (aSAH) is one common neurosurgical emergency and severe disease, with high morbidity and mortality. Delayed extubation (DE) is a confirmed risk factor for prolonged intensive care unit (ICU) stay and poor outcomes in patients undergoing neurosurgical operation. The systemic inflammation response index (SIRI) has emerged as a novel, valuable prognostic marker for various neoplastic and critical conditions.

This study aimed to investigate the association between pre-operative SIRI and post-operative DE in elderly patients underwent neurosurgical clipping or endovascular coiling for aSAH.

We conducted a retrospective analysis of elderly aSAH patients underwent neurosurgical clipping or endovascular coiling between Jan 2016 and Dec 2022. Patient epidemiologics, clinical variables, and potential influencing factors were assessed. Multivariate logistic regression and receiver operating characteristics (ROC) curve analyses were employed to determine SIRI’s predictive value for DE.

Among the 413 enrolled patients, 113 patients experienced DE, while 300 patients did not. Multivariate logistic regression analysis identified GCS (OR, 0.631; 95% CI, 0.454–0.879; P = 0.006); lactic dehydrogenase (OR, 1.008; 95% CI, 1.001–1.016; P = 0.042), and SIRI (OR, 1.171; 95% CI, 1.050–1.328; P = 0.006) as independent predictors of DE. ROC curve analysis demonstrated that SIRI effectively predicted postoperative DE (AUC = 0.772, 95% CI, 0.696–0.849, P < 0.001). The optimal SIRI cutoff value was 8.14, yielding a sensitivity of 42.0% and specificity of 95.0%.

Pre-operative SIRI is an independent risk factor for post-operative DE in elderly patients undergoing neurosurgical operation for aSAH.