Predictive Role of the Systemic Immune-Inflammation Index in Catheter-Related Thrombosis among Neonates: A Retrospective Study

Document Type : Original Article

Authors

1 Division of Neonatology, Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkiye

2 Division of Pediatric Hematology and Oncology, Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkiye

3 Department of Biostatistics, Faculty of Medicine, Gulhane Faculty of Medicine, University of Health Sciences, Ankara, Turkıye

4 Department of Pediatrics, Eskisehir Osmangazi University Faculty of Medicine, Eskisehir, Turkiye

10.22038/ijn.2025.84800.2628

Abstract

Background: This study aimed to evaluate changes in hematological parameters and the systemic immune-inflammation index (SII) to determine their utility in predicting and monitoring catheter-related thrombosis (CRT) in neonatal intensive care unit (NICU). We expect that this study will provide novel insights into the potential role of inflammation-based indices in the management of neonatal thrombosis.
Methods: A retrospective case-control study was conducted in a tertiary NICU over five years. Infants were divided into three groups: those with CRT, those with central venous catheters but without thrombosis (non-CRT), and healthy controls. Serial complete blood counts (CBCs) were analyzed, including inflammatory indices such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and SII.
Results: Compared to the other groups, CRT infants had significantly lower baseline hemoglobin levels and higher levels of white blood cells (WBC), absolute neutrophil count (ANC), NLR, C-reactive protein (CRP), and SII over time (p < 0.05 for all). No significant changes were found in monocyte count, MLR, or mean platelet volume. While SII decreased over time in the control group, it showed a rising trend in CRT infants, indicating ongoing inflammation.
Conclusion: Serial measurements of WBC, ANC, NLR, and SII may serve as useful indicators of thrombotic risk in catheterized neonates. These indices may provide better predictive value than standard CBC parameters. Larger multicenter studies are warranted to validate these findings. Larger multicenter studies are needed to confirm these findings.

Keywords

References

  1. Chojnacka K, Krasiński Z, Wróblewska-Seniuk K, Mazela J. Catheter-related venous thrombosis in NICU: A case-control retrospective study. J Vasc Access. 2022;23(1):88-93.
  2. Camet CN, Yee DL. Focus on diagnosis: A primer on d-dimer. Pediatr Rev. 2011;32(1):31-33.
  3. Chalmers EA. Neonatal thrombosis. J Clin Pathol. 2000;53(6):419-423.
  4. Iba T, Levy JH. Inflammation and thrombosis: Roles of neutrophils, platelets and endothelial cells in thrombus formation during sepsis. J Thromb Haemost. 2018;16(2):231-241.
  5. Engelmann B, Massberg S. Thrombosis as an intravascular effector of innate immunity. Nat Rev Immunol. 2013;13(1):34-45.
  6. Angaji SG, Salim MA, Azizi A, Amiri N, Rastakhiz S, Jahani N, et al. The power of nanovaccines in immunotherapy of melanoma, lung, breast, and colon cancers: A comprehensive review. Res Biotechnol Environ Sci. 2023;2(4):55-64.
  7. Li S, Liu K, Gao Y, Zhao L, Zhang R, Fang H, et al. Prognostic value of systemic immune-inflammation index in acute/subacute patients with cerebral venous sinus thrombosis. Stroke Vasc Neurol. 2020;5(4):399-406.
  8. Zhang L, Liu X, Yang R, Yang Y, Chen X. The diagnostic value of the systemic immune-inflammation index for venous thromboembolism in lung cancer patients: a retrospective study. Mediators Inflamm. 2022;2022:1010708.
  9. Mermer M, Kaçer İ, Çağlar A. Prognostic value of systemic immune-inflammatory index in pulmonary embolism. Glob Emerg Crit Care. 2024;3(2):93-98.
  10. Huang YW, Yin XS, Li ZP. Association of the systemic immune-inflammation index (SII) and clinical outcomes in patients with stroke: a systematic review and meta-analysis. Front Immunol. 2022;13:1090305.
  11. Monagle P, Chan AK, Goldenberg NA, Ichord RN, Journeycake JM, Nowak-Göttl U, et al. Antithrombotic therapy in neonates and children: antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl).
  12. Inder TE, Perlman JM, Volpe JJ. Preterm intraventricular hemorrhage/posthemorrhagic hydrocephalus. In: Volpe JJ, editor. Volpe’s Neurology of the Newborn. 6th ed. Elsevier; 2018. 637-98.
  13. von Brühl ML, Stark K, Steinhart A, Chandraratne S, Konrad I, Lorenz M, et al. Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo. J Exp Med. 2012;209(4):819-835.
  14. Andrews RK, Berndt MC. Platelet physiology and thrombosis. Thromb Res. 2004;114(5-6):447-453.
  15. Yilmaz M, Tenekecioglu E, Arslan B, Bekler A, Ozluk OA, Karaagac K, et al. White blood cell subtypes and neutrophil-lymphocyte ratio in prediction of coronary thrombus formation in non-ST-segment elevated acute coronary syndrome. Clin Appl Thromb Hemost. 2015;21(5):446-452.
  16. Peng R, Yin W, Wang F, Cong X, Lu B, Hua L, et al. Neutrophil levels upon admission for the assessment of acute pulmonary embolism with inter-mediate- and high-risk: an indicator of thrombosis and inflammation. Thromb J. 2023;21:28.
  17. Özdemir ZC, Çetin N, Kar YD, Öcal HO, Bilgin M, Bör Ö, et al. Hematologic indices for predicting internal organ involvement in Henoch-Schönlein purpura (IgA vasculitis). J Pediatr Hematol Oncol. 2020;42(1): e46-9.
  18. Hu B, Yang XR, Xu Y, Sun YF, Sun C, Guo W, et al. Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma. Clin Cancer Res. 2014;20(23):6212-6222.
  19. Zhao E, Cheng Y, Yu C, Li H, Fan X, et al. The systemic immune-inflammation index was non-linear associated with all-cause mortality in individuals with nonalcoholic fatty liver disease. Ann Med. 2023;55(1):2197652.
  20. Ye Z, Hu T, Wang J, Xiao R, Liao X, Liu M, Sun Z, et al. Systemic immune-inflammation index as a potential biomarker of cardiovascular diseases: a sys-tematic review and meta-analysis. Front Cardiovasc Med. 2022;9:933913.
  21. Mangoni AA, Zinellu A. Systemic inflammation index, disease severity, and mortality in patients with COVID-19: A systematic review and meta-analysis. Front Immunol. 2023;14:1212998.
  22. Bitsadze V, Lazarchuk A, Vorobev A, Khizroeva J, Tretyakova M, Makatsariya N, et al. Systemic inflammatory response syndrome, thromboin-flammation, and septic shock in fetuses and neonates. Int J Mol Sci. 2025;26(7):3259.
  23. Khizroeva J, Makatsariya A, Vorobev A, Bitsadze V, Elalamy I, Lazarchuk A, et al. The hemostatic system in newborns and the risk of neonatal thrombosis. Int J Mol Sci. 2023;24(18):13864.
  24. Mineyko A, Nettel-Aguirre A, de Jesus P, Benseler S, Yusuf K, Narendran A, et al. Association of neonatal inflammatory markers and perinatal stroke subtypes. Neurology. 2020;95(9):e1163-1173.
  25. Nahrendorf M, Pittet MJ, Swirski FK. Monocytes: protagonists of infarct inflammation and repair after myocardial infarction. Circulation. 2010;121(22): 2437-2445.
  26. Chen H, Li M, Liu L, Dang X, Zhu D, Tian G. Monocyte/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients with non-ST-elevation myocardial infarction. Medicine. 2019;98(26): e16267.
  27. De Jong E, Strunk T, Burgner D, Lavoie PM, Currie A. The phenotype and function of preterm infant monocytes: implications for susceptibility to infection. J Leukoc Biol. 2017;102(3):645-656.
  28. Ujiie H, Kawasaki M, Suzuki Y, Kaibara M. Influence of age and hematocrit on the coagulation of blood. J Biorheol. 2009;23(2):111-114.
  29. Veldman A, Nold MF, Michel-Behnke I. Thrombosis in the critically ill neonate: incidence, diagnosis, and management. Vasc Health Risk Manag. 2008;4(6):1337-1348.
  30. El-Naggar W, Yoon EW, McMillan D, Afifi J, Mitra S, Singh B, et al, Canadian Neonatal Network Investigators. Epidemiology of thrombosis in Canadian neonatal intensive care units. J Perinatol. 2020;40(7):1083-1090.
  31. Coutinho JM, Zuurbier SM, Gaartman AE, Dikstaal AA, Stam J, Middeldorp S, et al. Association between anemia and cerebral venous thrombosis: case-control study. Stroke. 2015;46(10):2735-2740.
  32. Zhang H, Wu L, Cheng B. Preoperative anemia and deep vein thrombosis in patients with perioperative bone trauma: A cohort study. BMC Musculoskelet Disord. 2022;23(1):905.
  33. Sergueeva A, Miasnikova G, Shah BN, Song J, Lisina
    E, Okhotin DJ, et al. Prospective study of thrombosis and thrombospondin-1 expression in Chuvash polycythemia. Haematologica. 2017;102(5):e166.
  34. Grune T, Sommerburg O, Siems WG. Oxidative stress in anemia. Clin Nephrol. 2000 Feb 1;53(1 Suppl):S18-22.
  35. Gutmann C, Siow R, Gwozdz AM, Saha P, Smith A, et al. Reactive oxygen species in venous thrombosis. Int J Mol Sci. 2020;21(6):1918.
  36. Easterlin MC, Li Y, Yieh L, Gong CL, Jaffray J, Hall M, et al. Predictors of venous thromboembolism among infants in children’s hospitals in the United States: a retrospective Pediatric Health Information Study. J Perinatol. 2022;42(1):103–109.

 

 

 

Iranian Journal of Neonatology
Volume 16, Issue 3
July 2025
Pages 31-41

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