Association Between Preoperative Systemic Inflammation Response Index and Postoperative Recurrence in Patients With Intrahepatic Bile Duct Stones

AIM: Intrahepatic bile duct stones (IHBDS) are characterized by a high postoperative recurrence rate. Their pathophysiological core lies in a vicious cycle of bile stasis, infection, and inflammation. Inflammatory responses play a crucial role in the onset, progression, and recurrence of IHBDS. This study aimed to evaluate the predictive performance of the preoperative systemic inflammation response index (SIRI) for postoperative recurrence in patients with IHBDS. METHODS: This retrospective study analyzed 152 patients with IHBDS who underwent surgical resection between January 2018 and December 2024. Data, including demographic characteristics, comorbidities, and preoperative laboratory parameters, were collected. Receiver operating characteristic (ROC) curve analysis was used to determine the optimal cut-off values for the systemic immune-inflammation index (SII), SIRI, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and platelet-to-lymphocyte ratio (PLR). Furthermore, multivariate logistic regression analysis was performed to identify independent risk factors for postoperative recurrence. RESULTS: ROC analysis demonstrated that SIRI had superior predictive performance compared with SII, NLR, MLR, and PLR, with an area under the curve (AUC) of 0.756 (95% confidence interval [CI]: 0.671–0.842). Multivariate analysis identified prior IHBDS-related surgical history (odds ratio [OR] = 3.06, 95% CI: 1.28–7.34, p = 0.012), preoperative SIRI (OR = 1.81, 95% CI: 1.21–2.72, p = 0.004), and total bilirubin level (OR = 1.07, 95% CI: 1.02–1.13, p = 0.011) as independent risk factors for postoperative recurrence. CONCLUSIONS: Preoperative SIRI is a novel, independent, and readily detectable biomarker for predicting postoperative recurrence in patients with IHBDS. When combined with a history of prior biliary surgery and total bilirubin levels, SIRI can aid in risk stratification and guide surgical planning and postoperative management.