# The association of the pan-immune-inflammation value with mortality in patients monitored in the intensive care unit after cardiopulmonary resuscitation

## TL;DR

This study found that a blood-based inflammation marker called PIV does not predict survival in ICU patients after cardiac arrest, despite being linked to other inflammation markers.

## Contribution

The study is the first to evaluate the prognostic value of PIV in post-cardiac arrest patients, showing it lacks independent predictive power.

## Key findings

- PIV was strongly correlated with other inflammation indices like SII and SIRI.
- PIV values on day 1 and day 3 of ICU admission were not independently associated with mortality.
- PIV showed low discriminatory ability in predicting survival.

## Abstract

Post–cardiac arrest syndrome (PCAS) involves rapid and complex inflammatory responses, yet accessible biomarkers to support early prognostication remain limited. The pan-immune-inflammation value (PIV), derived from routine hematologic indices, has shown prognostic relevance in other inflammatory and malignant conditions; however, its utility in PCAS has not been evaluated.

This retrospective observational study included 193 adult patients who achieved return of spontaneous circulation following cardiopulmonary resuscitation. Demographic, clinical, and laboratory variables were recorded, along with Sequential Organ Failure Assessment (SOFA) and Acute Physiology and Chronic Health Evaluation II (APACHE II) scores. PIV, Systemic Immune-Inflammation Index (SII), and Systemic Inflammation Response Index (SIRI) values were calculated on day 1 and day 3 of ICU admission. Statistical analyses included Mann–Whitney U, chi-square tests, Spearman correlation, ROC analysis, and multivariable logistic regression.

Of the 193 patients, 85 (44.0%) died within the first 2 days, and 108 (56.0%) survived ≥ 72 h. Non-survivors had significantly higher SOFA and APACHE II scores. PIV was strongly correlated with SII and SIRI; however, neither day 1 nor day 3 PIV values were independently associated with mortality. ROC analysis demonstrated low discriminatory ability for PIV.

Although PIV is an inexpensive and readily accessible marker reflecting systemic inflammation, it did not provide independent prognostic information beyond established clinical severity scores in patients with PCAS. Strong correlations with other leukocyte-based inflammatory indices suggest overlapping biological pathways rather than distinct predictive value. Future multicenter studies with protocolized, more frequent early sampling are needed to characterize early inflammatory responses and identify biomarkers that meaningfully contribute to multimodal prognostication. Until such evidence emerges, PIV should be regarded primarily as a descriptive marker rather than a prognostic tool in this setting.

This single-center retrospective study was approved by the Uşak University Ethics Committee (Decision No: 461-461-08, Date: 07/11/2024).