Murat YUCEL, Hakan COMAKLI, Gokay DENIZ, Muhammet Fethi SAGLAM, Kemal Esref ERDOGAN, Emrah UGUZ, Bahadir BENLI
Turkish Journal of Vascular Surgery - 2026;35(1):38-47
Aim: Despite advances in diagnostic strategies, easily accessible biomarkers that can reliably predict pulmonary embolism (PE) in patients with deep vein thrombosis (DVT) are lacking. Recently, systemic inflammatory indices, such as the systemic immune-inflammation index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI), have been investigated as potential prognostic tools. This study aimed to evaluate the predictive value and clinical applicability of these markers in identifying PE in patients with lower extremity DVT. Material and Methods: A retrospective propensity score-matched cohort study was conducted in patients diagnosed with acute proximal lower extremity DVT. Two groups were compared: patients with isolated DVT and those with concurrent DVT and PE were compared. Propensity score matching yielded 290 patients in each group. Novel systemic inflammatory indices derived from hematological parameters (SII, SIRI, and AISI) were evaluated together with neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and traditional biomarkers (C-reactive protein (CRP) and D-dimer). Comparative analyses, logistic regression, and receiver operating characteristic (ROC) curve assessments were performed. Results: Inflammatory indices (NLR, PLR, SII, and SIRI) and conventional biomarkers (CRP and D-dimer) were higher in the DVT and PE group compared to the isolated DVT group (all p<0.001). Multivariate analysis identified NLR, CRP, and D-dimer as independent predictors of PE. Receiver operating characteristic (ROC) analysis demonstrated the strongest diagnostic accuracy for CRP (AUC 0.811), followed by D-dimer (AUC 0.746) and NLR (AUC 0.735) levels. Conclusion: Easily measurable and low-cost biomarkers, particularly NLR, along with CRP and Ddimer, provide significant predictive value for PE in patients with DVT. These parameters may support early risk stratification and assist in clinical decision-making when advanced imaging is not readily available.
