Study On The Relationship Between Systemic Immuneinflammation Index (SII) And Type 2 Diabetes Mellitus With Noncardiogenic Acute Cerebral Infarction

Objective:The purpose of this study was to investigate the association of novel inflammatory markers such as Systemic immune-inflammation index(SII)that is(platelet ×neutrophil)to lymphocyte ratio,neutrophil to lymphocyte ratio(NLR),and platelet to lymphocyte ratio(PLR)with type 2 diabetes mellitus(T2DM)combined with non-cardiogenic acute cerebral infarction(Non-Cardiogenic Acute Cerebral Infarction(NCACI),and to further investigate the risk factors and diagnostic value of T2 DM combined with NCACI.Methods:Clinical data were collected from 918 patients hospitalized in the Department of Neurology and the Department of Endocrinology at the first affiliated Hospital of Nanchang University between August 2017 and July 2021.Based on whether NCACI and/or T2 DM were combined,the above patients were divided into three groups:T2DM combined with NCACI(ACIDM group),NCACI without T2DM(NCACI group),and T2 DM without NCACI(T2DM group).Patients’ gender,age,hypertension,NIHSS score,triglycerides(TG),total cholesterol(TC),high-density lipoprotein cholesterol(HDL-C),low-density lipoprotein cholesterol(LDL-C),homocysteine(HCY),blood creatinine(CR),uric acid(UA),fasting glucose(FBG),fibrinogen(FIB),D-dimer blood cell-related parameters such as white blood cells(WBC),neutrophils(N),platelets(PLT),lymphocytes(L),and mean platelet volume(MPV),and calculated SII,PLR,NLR,platelet-to-neutrophil ratio(PNR),and platelet-to-white blood cell ratio(PWR).We compared the differences of each index between ACIDM group,NCACI group and T2 DM group,and used multi-factor logistic regression analysis and ROC curve method to Analyze the risk factors of ACIDM and its diagnostic value respectively,and then use Spearman rank correlation method to analyze the correlation between each index and the severity of NCACI.Results:1.A higher proportion of patients in the ACIDM group had combined hypertension compared with the NCACI and T2 DM groups(P<0.05).2.Compared with the NCACI group,patients in the ACIDM group had significantly higher WBC,N,MPV,FBG,TC,TG,LDL-C,and FIB(P<0.05),while PNR and PWR were significantly lower(P<0.05);compared with the T2 DM group,patients in the ACIDM group had significantly higher WBC,N,SII,NLR,PLR,FBG,TC,TG,LDL-C,HCY,FIB,and D-dimer were significantly higher(P<0.05),while PNR and PWR were significantly lower(P<0.05)in the ACIDM group compared with the T2 DM group.3.WBC,N,and SII were significantly higher in the T2 DM combined with NCACI group and NCACI group after admission than before admission(P<0.05),while MPV and PNR were significantly decreased(P<0.05).4.Multifactorial logistic regression analysis showed that hypertension(OR=3.666,P<0.001)、 SII(>452)(OR=3.494,P<0.001)、 HCY(OR=1.193,P<0.001)、 TC(OR=1.701,P<0.001)were independent risk correlates of ACIDM,while PNR was an independent protective correlate of ACIDM.5.The area under the curve of SII level in the ROC curve to identify noncardiogenic acute cerebral infarction occurring in T2 DM was 0.746,and the optimal critical value was 452,corresponding to a sensitivity and specificity of 65.9% and73.3%,respectively.Conclusions:1.SII,HCY,TC,and hypertension are risk correlates of non-cardiac acute cerebral infarction in patients with T2 DM,PNR is a protective correlate.2.SII>452 helps in early prediction of non-cardiac acute cerebral infarction in type 2 diabetes.