Front. Aging Neurosci. Frontiers in Aging Neuroscience Front. Aging Neurosci. 1663-4365 Frontiers Media S.A. 10.3389/fnagi.2022.1101574 Aging Neuroscience Correction Corrigendum: Systemic-immune-inflammation index as a promising biomarker for predicting perioperative ischemic stroke in older patients who underwent non-cardiac surgery Zhang Faqiang 1 † Niu Mu 2 † Wang Long 3 † Liu Yanhong 1 Shi Likai 1 Cao Jiangbei 1 Mi Weidong 1 Ma Yulong 1 * Liu Jing 1 * 1Anesthesia and Operation Center, The First Medical Center, Chinese PLA General Hospital, Beijing, China 2Department of Neurology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou Medical University, Xuzhou, China 3Department of Pain Medicine, The First Medical Center, Chinese PLA General Hospital, Beijing, China

Edited and reviewed by: Yujie Chen, Army Medical University, China

 *Correspondence: Yulong Ma yulongma123@163.com Jing Liu liuj301@163.com

This article was submitted to Neuroinflammation and Neuropathy, a section of the journal Frontiers in Aging Neuroscience

†These authors have contributed equally to this work

 08 12 2022 2022 14 1101574 18 11 2022 28 11 2022 Copyright © 2022 Zhang, Niu, Wang, Liu, Shi, Cao, Mi, Ma and Liu. 2022 Zhang, Niu, Wang, Liu, Shi, Cao, Mi, Ma and Liu

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 A corrigendum on Systemic-immune-inflammation index as a promising biomarker for predicting perioperative ischemic stroke in older patients who underwent non-cardiac surgery by Zhang, F., Niu, M., Wang, L., Liu, Y., Shi, L., Cao, J., Mi, W., Ma, Y., and Liu, J. (2022). Front. Aging Neurosci. 14:865244. doi: 10.3389/fnagi.2022.865244 systemic-immune-inflammation index (SII) perioperative stroke postoperative complication inflammation older patients biomarker

In the original article, there was a mistake in Figure 1 as published. “ASA physical status V” should be “ASA physical status ≥ IV.” In addition the corresponding n number was give as 391, but should be 1,091. In addition, the corresponding n number for “Missing data for any confounder” was 3,144 but should be 2,444. The revised Figure 1 appears below.

Study profile. ASA, American Society of Anesthesiologists; PSM, propensity score matching.

There was also an error in Materials and methods, “Inclusion and exclusion criteria,” Paragraph 1. “Patients who presented with an American Society of Anesthesiologists (ASA) classification of V” should be “Patients who presented with an American Society of Anesthesiologists (ASA) classification of ≥IV.” The corrected paragraph appears below:

“Patients who underwent non-cardiac surgery between January 2008 and August 2019 at Chinese PLA General Hospital were initially screened from a perioperative retrospective database. The inclusion criteria were as follows: (1) aged 65 yr or older; (2) underwent non-cardiac surgery; (3) received general anesthesia; and (4) were with duration of surgery > 60 min. Patients who presented with an American Society of Anesthesiologists (ASA) classification of ≥IV, were performed under regional anesthesia, or had missing clinical data were excluded. Among patients who underwent multiple surgeries during the study period, only the first eligible surgery was considered. A flow diagram of the patient selection process is displayed in Figure 1.” In the original article, there was also a mistake in the Abstract, “Conclusion” as published. The Abstract conclusion stated, “after non-cardiac surgery in elderly older patients.” This should be “after non-cardiac surgery in older patients.” The corrected paragraph appears below:

“Conclusion: Preoperative SII, which includes neutrophil, platelet, and lymphocyte counts obtained from routine blood analysis, was a potential prognostic biomarker for predicting perioperative ischemic stroke after non-cardiac surgery in older patients. An elevated SII, based on an optimal cut-off value of 583, was an independent risk factor for perioperative ischemic stroke.”

In the original article, there was also an error in Table 1 and Supplementary Tables 2–4. The covariates previously stated “Class III and IV” and “Arterial fibrillation.” The corrected covariates are “Class III” and “Atrial fibrillation or VHD.” The corrected Table 1 appears below. The corrected Supplementary Tables 2–4 appear in the Supplementary Material of the original article.

Baseline characteristics of unadjusted sample and propensity score-matched sample (patients from 2008–2019).

Characteristic Unadjusted sample (n = 40,670) PSM adjusted (1:1) (n = 21,652)
SII < 583 SII ≥583 P-value SMD SII < 583 SII ≥583 P-value SMD
(n = 29,060) (n = 11,610) (n = 10,826) (n = 10,826)
Demographics
Age, y† 70.0 (67.0,73.0) 70.0 (67.0,75.0) 0.126 0.152 70.0 (67.0,74.0) 70.0 (67.0,74.0) 0.556 0.004
Female (%)† 13651 (47.0) 4683 (40.3) < 0.001 0.134 4458 (41.2) 4427 (40.9) 0.679 0.006
BMI, kg/m2† 24.5 (22.3,26.9) 23.7 (21.5,26.0) 0.089 0.233 24.0 (21.6,26.4) 23.8 (21.5,26.0) 0.136 0.097
ASA classification (%)†
Class I 741 (2.5) 234 (2.0) < 0.001 0.197 261 (2.4) 230 (2.1) 0.356 0.022
Class II 22885 (78.8) 8255 (71.1) 7826 (72.3) 7793 (72.0)
Class III 5434 (18.7) 3121 (26.9) 2739 (25.3) 2803 (25.9)
Previous medical history
Hypertension (%)† 10874 (37.4) 4685 (40.4) < 0.001 0.060 4211 (38.9) 4360 (40.3) 0.257 0.021
Diabetes mellitus (%)† 6096 (21.0) 2756 (23.7) < 0.001 0.066 2436 (22.5) 2554 (23.6) 0.178 0.076
Prior ischemic stroke (%)† 1552 (5.3) 847 (7.3) < 0.001 0.080 682 (6.3) 765 (7.1) 0.228 0.068
Coronary heart disease (%)† 2879 (9.9) 1231 (10.6) 0.037 0.023 1070 (9.9) 1146(10.6) 0.093 0.023
Atrial fibrillation or VHD (%)† 454 (1.6) 202 (1.7) 0.215 0.014 165 (1.5) 180 (1.7) 0.447 0.011
Peripheral vascular disease (%)† 1996 (6.9) 892 (7.7) 0.004 0.031 811 (7.5) 802 (7.4) 0.836 0.003
Renal dysfunction (%)†* 338 (1.2) 234 (2.0) < 0.001 0.068 191 (1.8) 205 (1.9) 0.456 0.047
β-blockers medication (%)† 2051 (7.1) 999 (8.6) < 0.001 0.058 869 (8.2) 931 (8.6) 0.167 0.065
Aspirin medication (%)† 2553 (8.8) 1174 (10.1) < 0.001 0.045 1024 (9.5) 1086 (10.0) 0.293 0.043
Preoperative laboratory data
Hemoglobin, g/L† 132.0 (122.0,142.0) 125.0 (111.0,138.0) < 0.001 0.437 128.0 (114.0,140.0) 127.0 (113.0,139.0) 0.156 0.083
Albumin, g/L† 40.3 (38.1,42.5) 40.5 (38.2,43.0) 0.223 0.481 38.9 (36.2,41.4) 38.8 (36.0,41.7) 0.837 0.005
Total bilirubin, μmol/L† 10.9 (8.4,14.2) 10.6 (7.8,15.6) < 0.001 0.291 10.7 (8.3,14.6) 10.6 (7.7,14.9) 0.202 0.093
Prothrombin time, s† 13.1 (12.6,13.6) 13.2 (12.7,13.9) 0.123 0.176 13.2 (12.7,13.8) 13.2 (12.7,13.8) 0.600 0.028
Surgical and anesthetic factors
Preoperative MAP, mmHg 95.7 (88.7,103.0) 95.0 (87.3,102.3) 0.098 0.070 95.0 (87.3,102.3) 95.0 (88.0,102.7) 0.169 0.024
Surgical procedures (%)
Trauma surgery 433 (1.5) 602 (5.2) < 0.001 0.352 404 (3.7) 353 (3.3)
Spine 2751 (9.5) 715 (6.2) 758 (7.0) 711 (6.6) 0.258 0.041
Intra-abdominal surgery 9652 (33.2) 5159 (44.4) 4688 (43.3) 4690 (43.3)
Joint arthroplasty 3726 (12.8) 1031 (8.9) 987 (9.1) 1027 (9.5)
Urologic or gynecologic 3972 (13.7) 1219 (10.5) 1138 (10.6) 1209 (11.1)
Neurosurgery 1380 (4.7) 523 (4.5) 516 (4.8) 515 (4.8)
Thoracic or vascular 3362 (11.6) 1225 (10.5) 1172 (10.8) 1199 (11.1)
Other (plastic surgery, etc.) 3784 (13.0) 1136 (9.8) 1163 (10.7) 1122 (10.3)
Duration of procedures, min 155.0 (110.0,215.0) 170.0 (120.0.0,235.0) < 0.001 0.162 168.0 (118.0,231.0) 170.0 (120.0,235.0) 0.356 0.076
Estimated blood loss, mL 100.0 (50.0,200.0) 150.0 (50.0,300.0) < 0.001 0.083 140.0 (90.0,280.0) 145.7 (100.0,300.0) 0.167 0.096
MAP ≤ 65 mmHg (%) 12600 (43.4) 5749 (49.5) < 0.001 0.070 5125 (47.3) 5285 (48.8) 0.234 0.072
Crystalloid infusion, ml/kg/h 8.6 (6.5,11.4) 8.9 (6.6,11.8) 0.167 0.073 8.8 (6.6,11.7) 8.8 (6.5,11.7) 0.845 0.006
Colloid infusion, ml/kg/h 2.9 (1.3,4.3) 3.1 (1.8,4.5) < 0.001 0.123 3.0 (1.6,4.4) 3.0 (1.8,4.5) 0.111 0.066
Blood transfusion (%) 3902 (13.4) 2322 (20.0) < 0.001 0.177 1998 (18.5) 2082 (19.2) 0.189 0.052
NSAIDs (%) 20502 (70.6) 8366 (72.1) 0.003 0.033 7667 (70.8) 7709 (71.2) 0.539 0.009
Glucocorticoid (%) 23749 (81.7) 9557 (82.3) 0.165 0.015 8905 (82.3) 8932 (82.5) 0.643 0.007
Opioid dose, mg‡ 120.0 (9.0,150.0) 135.0 (105.0,165.0) < 0.001 0.081 135.0 (100.0,150.0) 135.0 (105.0,165.0) 0.256 0.047
Volatile anesthetic (%) 27098 (93.2) 10819 (93.2) 0.840 0.002 10097 (93.3) 10110 (93.4) 0.744 0.005
Preoperative NLR
< 3 27796 (95.7) 4098 (35.3) < 0.001 1.643 10215 (94.4) 3951 (36.5) < 0.001 1.583
≥3 1264 (4.3) 7512 (64.7) 611 (5.6) 6875 (63.5)
Preoperative PLR
< 119 18897 (65.0) 959 (8.3) < 0.001 1.458 6821 (63.0) 914 (8.4) < 0.001 1.385
≥119 10163 (35.0) 10651 (91.7) 4005 (37.0) 9912 (91.6)
Perioperative ischemic stroke (%) 126 (0.434) 111 (0.956) < 0.001 0.856 49 (0.453) 107 (0.988) < 0.001 0.939

The data are presented as the median (inter-quartile range), mean (standard deviation) or n (%).

Creatinine > 177 μm/l.

Variables included in the propensity score.

Including those prescribed intraoperatively and postoperatively (until 7 days after surgery).

SII, systemic-immune-inflammation index; PSM, propensity score matching; SMD, standardized mean difference; BMI, body mass index; ASA, American Society of Anesthesiologists; VHD, valvular heart disease; MAP, mean arterial pressure; NSAIDs, non-steroid anti-inflammatory drugs; NLR, neutrophil-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio.

In the original article there was also an error in Materials and methods, “Clinical outcome.” The definition of perioperative ischemic stroke was incomplete. The following information was not provided: “Diagnoses of stroke are confirmed by a combination of neuroimaging and clinical evidence of cerebrovascular ischemia during hospital stay.” The corrected paragraph appears below:

“The primary outcome of interest was perioperative ischemic stroke, defined as an episode of neurological dysfunction, such as motor, sensory, or cognitive dysfunction, caused by focal cerebral, spinal, or retinal infarction within 30 postoperative days (Sacco et al., 2013). Diagnoses of stroke are confirmed by a combination of neuroimaging and clinical evidence of cerebrovascular ischemia during hospital stay. In our study, perioperative ischemic stroke patients were identified if discharge records included at least 1 ICD-9-CM/ICD-10-CM diagnosis code for stroke (Supplementary Table 1).”

We apologize for these errors and state that this does not change the scientific conclusions of the article in any way. The original article has been updated.

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