Association of systemic immune-inflammation index and systemic inflammation response index with chronic kidney disease: observational study of 40,937 adults

Sex-Specific Impact of Inflammation and Nutritional Indices on AVF Blood Flow and Maturation: A Retrospective Analysis

Background: Arteriovenous fistula (AVF) failure rates are consistently higher in females, although the underlying mechanisms remain incompletely understood. Inflammatory processes play a key role in AVF remodeling and venous arterialization, yet their influence may differ by sex. This study aimed to evaluate the impact of inflammatory indices on AVF blood flow and maturation, with a focus on sex-specific differences. Methods: This retrospective analytical study included 110 patients (50 females, 60 males) undergoing initial surgical AVF creation. Postoperative assessments occurred at the fourth and sixth weeks. Patients demonstrating insufficient maturation (blood flow < 600 mL/min) at the fourth week were re-evaluated after two weeks without any intervening procedures or additional interventions. Results: Intraoperative Transit-Time Flow Measurement (TTFM) revealed significantly higher median AVF blood flow in males compared to females (289 mL/min vs. 200 mL/min; p < 0.001). Doppler ultrasonography (DUS) findings confirmed these sex-related differences, demonstrating consistently lower blood flow rates in female patients. An elevated neutrophil-to-lymphocyte ratio (NLR) was associated with approximately a 31% reduction in AVF blood flow among females, whereas an increased C-reactive protein-to-albumin ratio (CrA) correlated with an approximate 9% decline. In males, an elevated systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) were significantly associated with decreased AVF blood flow. Conversely, a higher prognostic nutritional index (PNI) positively correlated with AVF blood flow in both sexes. Risk factors associated with inadequate AVF maturation (<600 mL/min at sixth week) included female sex, advanced age, obesity, smoking, anemia, low vitamin D levels, and elevated inflammatory indices (NLR, SII, and SIRI). Conclusions: Inflammatory and nutritional indices derived from routine laboratory tests may assist in estimating AVF maturation likelihood. While DUS reliably assesses AVF blood flow, complementary evaluation methods may be required to assess the broader vascular status. Further research is needed to clarify sex-specific inflammatory mechanisms influencing AVF outcomes and to guide individualized management strategies.

Systemic immune indicators for predicting renal damage in newly diagnosed type 1 diabetic children

BACKGROUND

Early kidney damage is a significant complication in children with newly diagnosed type 1 diabetes mellitus (T1DM). Systemic inflammation plays a key role in the development of diabetic nephropathy. Several inflammatory markers, including the systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR), have been proposed as potential indicators of diabetic complications.

AIM

To investigate the association between SII, NLR, PLR, and early kidney damage in newly diagnosed T1DM children without pre-existing albuminuria, assessing their utility as predictive biomarkers.

METHODS

A longitudinal cohort study was conducted on 102 children aged 3-18 years with newly diagnosed T1DM [baseline urinary albumin-to-creatinine ratio (UACR) < 30 mg/g] recruited between January 2020 and June 2023. Participants were followed biannually for up to three years. Demographic, clinical, and laboratory data, including inflammatory markers (SII, NLR, PLR), were collected at baseline and follow-up. Logistic regression and receiver operating characteristic analyses were used to evaluate the predictive utility of these markers for early kidney damage, defined as UACR ≥ 30 mg/g.

RESULTS

SII emerged as a significant independent predictor of early kidney damage [odds ratio = 1.002, 95% confidence interval (CI): 1.0008-1.0033, P = 0.0016], with an area under the curve of 0.719 (95%CI: 0.612-0.826, P < 0.001). Using an SII threshold of ≥ 624.015 achieved a sensitivity of 59.6% and specificity of 92%. Combining SII with NLR and PLR improved predictive accuracy (area under the curve = 0.787), with sensitivity and specificity of 63.5% and 96%, respectively. Correlation analyses revealed significant associations between SII, metabolic markers (triglycerides, glycated hemoglobin), and UACR.

CONCLUSION

SII is a reliable biomarker for early kidney damage in T1DM children, offering high specificity for identifying at-risk patients. Combining SII with NLR and PLR enhances diagnostic precision, supporting its integration into clinical practice. Longitudinal monitoring of these markers may facilitate early interventions to mitigate renal complications in pediatric T1DM.

Effect of CBC-Derived Inflammatory Indicators in Predicting Chronic Kidney Disease Risk in Hypertrophic Cardiomyopathy Patients

Background: Hypertrophic cardiomyopathy (HCM) is a prevalent condition that often coexists with chronic kidney disease (CKD), significantly impacting patient prognosis. This study aimed to investigate the predictive value of complete blood cell counts derived inflammatory indicators in assessing CKD risk in HCM patients. Methods: This study enrolled HCM patients and categorized them into CKD and non-CKD group based on discharge diagnoses. Analyzed indicators included systemic inflammation response index (SIRI), systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR). Least absolute shrinkage and selection operator (LASSO) logistic and multivariable logistic regression were employed to identified independent risk factors for CKD, which were subsequently utilized to develop a nomogram. Results: A total of 1795 HCM patients were included, including 112 (6.24%) individuals assigned to the CKD group. In univariate analyses, NLR (AUC: 0.755; 95%CI: 0.711-0.800) demonstrated superior accuracy compared to others. Eighteen baseline characteristics exhibiting statistical difference were incorporated into LASSO-logistic regression. Six factors were further selected by multivariable logistic regression. The results identified male gender (OR: 2.622; 95% CI: 1.565-4.393, p < 0.001), Hb (OR: 0.972; 95% CI: 0.962-0.981, p < 0.001), Pro-BNP (OR: 1.000; 95% CI: 1.000-1.000, p < 0.001), SIRI (OR: 1.037; 95% CI: 1.026-1.049, p < 0.001), and SII (OR: 1.000; 95% CI: 1.000-1.001, p = 0.003) as risk factors. These five factors were used to construct a nomogram, which exhibited good accuracy and consistency. Conclusions: Male gender, Hb, Pro-BNP, SIRI, and SII were identified as risk factors for CKD risk in HCM patients. A nomogram was developed using these factors, which may facilitate early identification and management of high-risk individuals.

Sedentary behavior is associated with systemic immune-inflammation index and systemic inflammation response index levels: a cross-sectional analysis of the NHANES 2011-2018

Background

Sedentary behavior (SB), has been closely linked to numerous detrimental health effects. While the individual and combined impacts of such behaviors on immune-inflammatory responses remain ambiguous, innovative indices like the Systemic Immune-Inflammation Index (SII) and the Systemic Inflammation Response Index (SIRI) are considered as comprehensive tools to assess inflammation. This study endeavors to elucidate the potential correlations between SB, SII, and SIRI, thereby contributing to a deeper understanding of how lifestyle choices influence systemic inflammation profiles.

Methods

This research entailed a retrospective, cross-sectional examination of 39,156 adult participants sourced from 2011 to 2018 of the National Health and Nutrition Examination Survey (NHANES). SASB was used as the independent variable and SII and SIRI as dependent variables. Weighted linear regression was used to assess the correlation between the independent and dependent variables. Smoothed curve fitting and threshold effect analyses were also performed to determine to identify if there was a non-linear relationship between SII and SIRI and SASB. Subgroup analyses were then performed to identify sensitive populations.

Results

A total of 15,789 individuals ≥18 years old were included. Elevated SB levels were correlated with a rise in SII levels in three models (p < 0.05). There was a positive correlation of SB and SII (as a continuous variable). At the same, higher SB was associated with increased SIRI level in three models (p < 0.05). However, there was a non-linear correlation between SB and SIRI with 485 min (min) being the inflection point.

Conclusion

Among US adults, SII and SIRI exhibited a positive correlation with heightened SB, underscoring the need for more extensive, prospective studies to further elucidate SB's impact on these inflammation indices.

Association between the aggregate index of systemic inflammation and CKD: evidence from NHANES 1999-2018

Purpose

We aimed to investigate the potential association between the aggregate index of systemic inflammation (AISI) and chronic kidney disease (CKD).

Patients and methods

This study analyzed data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. CKD was defined as either an estimated glomerular filtration rate (eGFR) of less than 60 mL/min/1.73 m2 or the presence of albuminuria, defined as a urine albumin-to-creatinine ratio (ACR) of 30 mg/g or higher. Low eGFR is an eGFR of less than 60 mL/min/1.73 m2. Multivariate regression analysis, smoothed curve fitting, and subgroup analyses were conducted to investigate the relationship between the Inflammatory status index (AISI) and CKD. The receiver operating characteristic (ROC) curve analysis was used to evaluate its ability to identify CKD and low eGFR. The AISI was transformed using the natural logarithm (Ln) for statistical analysis.

Results

Of the 50,768 recruits, 49.86% were male. The prevalence of CKD and low eGFR was 20.31% and 8.57%, respectively. Ln-AISI was positively associated with CKD (OR = 1.24; 95% CI: 1.19, 1.28) and low eGFR (OR = 1.17; 95% CI:1.11, 1.24). Smooth curve fitting revealed a positive association between AISI and CKD and low eGFR. Subgroup analysis and interaction tests indicated that stratifications did not significantly alter the association between AISI and CKD and low eGFR. Threshold effect analysis indicated that this relationship became more pronounced when Ln-AISI exceeded 5.2 (AISI > 181.27). The ROC analysis showed that AISI had better discrimination and accuracy for identifying CKD and low eGFR compared to other inflammatory indicators [lymphocyte count (LYM), systemic immune-inflammation index (SII), platelet-to-lymphocyte ratio (PLR), and the product of platelet count and neutrophil count (PPN)].

Conclusion

AISI was significantly and positively correlated with the prevalence of CKD, and this relationship was more potent when AISI was greater than 181.27. Compared with other inflammatory indicators, AISI was more effective in identifying CKD.

Systemic immune-inflammation index and long-term mortality in patients with hypertension: a cohort study

OBJECTIVE

The objective of this study was to examine the relationship between systemic inflammation and long-term mortality in patients with hypertension.

METHODS

The study employed a retrospective cohort design. The study population was derived from the National Health and Nutrition Examination Survey (NHANES), and the mortality data for this population was acquired from the National Death Index (NDI) database. Systemic inflammation was quantified by the Systemic Immune Inflammation Index (SII) and the Systemic Inflammatory Response Index (SIRI), which were then categorized into four groups (Q1-Q4, with Q4 representing the highest level of SII or SIRI). Weighted Cox regression models were constructed to investigate the association between mortality and SII and SIRI, with hazard ratios (HRs) subsequently calculated.

RESULTS

A total of 7431 participants were included in the analysis. The highest quantile (Q4) of SII was associated with a higher risk of all-cause mortality (hazard ratio 1.36, 95% CI 1.1-1.69, P  < 0.001). After adjustment for important covariates, the association remained significant (hazard ratio 1.70, 95% CI 1.27-2.30, P  < 0.001). The highest quantile (Q4) of SIRI was also associated with the highest risk of mortality (hazard ratio 2.11, 95% CI 1.64-2.70, P  < 0.001), and this association remained significant after adjustment for important covariates (hazard ratio 1.64, 95% CI 0.61-1.22, P  = 0.001).

CONCLUSION

Both SII and SIRI scores were found to be associated with mortality rates in patients with hypertension. The findings suggest that these scores may serve as complementary biomarkers to the neutrophil-to-lymphocyte ratio (NLR) for assessing mortality risk in patients with hypertension. Further investigation is warranted to elucidate the underlying mechanisms that underpin this association.

Association between systemic immune inflammation index and adolescent obesity in a cross-sectional analysis

Obesity is a prevalent health issue among adolescents, characterized by chronic low-grade inflammation, which increases the risk of developing various chronic diseases in the future. The systemic immune-inflammation index (SII) serves as an indicator of inflammation and immune response. This study conducted a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2016, including 5,676 participants. A multivariate logistic regression model, Generalized Additive Models (GAM), and subgroup analysis were used to examine the relationship between obesity and SII. The multivariate logistic regression results revealed a significant positive correlation between log SII and adolescent obesity (1.254 [1.024-1.537]). Furthermore, the risk of obesity increased with higher quartiles of SII. Subgroup analysis and interaction tests showed that this positive association persisted across various factors, including female gender, race (Non-Hispanic White and Mexican American), non-hyperlipidemia, normal white blood cell count, and PIR < 1. Additionally, a U-shaped relationship between log SII and obesity was observed, with a turning point at 6.410. The findings suggest that an increase in the systemic immune-inflammation index is significantly associated with obesity in adolescents. However, further validation through large-scale prospective studies is needed.

Development of Predictive Models for Progression from Diabetic Kidney Disease to End-Stage Renal Disease in Type 2 Diabetes Mellitus: A Retrospective Cohort Study

Aim

The aim of this study was to develop a predictive model for the progression of diabetic kidney disease (DKD) to end-stage renal disease (ESRD) and to evaluate the effectiveness of renal pathology and the kidney failure risk equation (KFRE) in this context.

Methods

The study comprised two parts. The first part involved 555 patients with clinically diagnosed DKD, while the second part focused on 85 patients with biopsy-proven DKD. Cox regression analysis and competing risk regression were employed to identify independent predictors. Time-dependent receiver operating characteristic (ROC) was used to evaluate prediction performance, and the area under the curve (AUC) was calculated to assess the model's accuracy.

Results

The Cox regression model developed for the 555 patients clinically diagnosed with DKD identified 5 predictors (body mass index (BMI), estimated glomerular filtration rate (eGFR), 24-hour urinary total protein (UTP), systemic immune-inflammatory index (SII), and controlling nutritional status (CONUT), whereas the Competing risks model included 4 predictors (BMI, eGFR, UTP, CONUT). Among 85 patients with biopsy-proven diabetic DKD, the combined prognostic model integrating KFRE, interstitial fibrosis and tubular atrophy (IFTA), SII and BMI demonstrated enhanced predictive ability at 5 years. The developed models offer improved accuracy over existing methods by incorporating renal pathology and novel inflammatory indices, making them more applicable in clinical settings.

Conclusion

The predictive model proved to be effective in assessing the progression of DKD to ESRD. Additionally, the combined model of KFRE, IFTA, SII, and BMI demonstrates high predictive performance. Future studies should validate these models in larger cohorts and explore their integration into routine clinical practice to enhance personalized risk assessment and management.

Selective peroxisome proliferator-activated receptor-α modulator improves hypertriglyceridemia and muscle quality in patients with chronic kidney disease: A retrospective observational study

BACKGROUND & AIMS

Patients with chronic kidney disease (CKD) often have additional health problems, including sarcopenia and sarcopenic obesity. These conditions involve ectopic fat accumulation within muscles. This ectopic fat deposition reduces muscle quality, leading to weaker muscle strength and poorer physical performance. Persistent hypertriglyceridemia contributes to ectopic fat accumulation. Metabolic abnormalities, including dyslipidemia, are major factors in CKD development. Triglycerides (TG) and muscle quality are thus important factors in CKD management. Recently developed selective peroxisome proliferator-activated receptor α modulator (SPPARMα) hold promises for improving hypertriglyceridemia. However, their effectiveness and impact on muscle quality in CKD patients remain unclear. This study aimed to evaluate the effect of SPPARMα on muscle quality and its efficacy in CKD patients.

METHODS

This retrospective observational study involved CKD patients with dyslipidemia. We included patients who initiated medications for hypertriglyceridemia. We compared changes in lipid profiles, renal function, and muscle quality, assessed by phase angle, over six months between two groups: those receiving this type of medication and those receiving conventional treatment.

RESULTS

Among 245 patients diagnosed with CKD and hypertriglyceridemia, 52 started medications for hypertriglyceridemia. Of these, 26 received SPPARMα, and 26 received conventional lipid-lowering medications (statins, ezetimibe, eicosapentaenoic acid, and fibrates). SPPARMα significantly reduced TG (from 296.8 ± 106.1 to 153.0 ± 86.1, p < 0.001) without affecting glomerular filtration rate or urinary protein levels. Conventional treatment also improved TG (from 261.6 ± 89.5 to 173.6 ± 81.3, p < 0.001). Only patients treated with SPPARMα showed significant improvement in muscle quality. Their phase angle increased from 5.41 ± 0.6 to 5.55 ± 0.6 after six months of treatment (p < 0.05).

CONCLUSIONS

Our study demonstrates that the newly developed SPPARMα significantly lowers TG levels in CKD patients without harming their kidneys. Additionally, only patients treated with SPPARMα showed improvement in muscle quality. These findings suggest that SPPARMα may be a valuable treatment option for CKD patients with dyslipidemia, particularly those with low muscle quality.

Epigenetic regulation of macrophage function in kidney disease: New perspective on the interaction between epigenetics and immune modulation

The interaction between renal intrinsic cells and macrophages plays a crucial role in the onset and progression of kidney diseases. In recent years, epigenetic mechanisms such as DNA methylation, histone modification, and non-coding RNA regulation have become essential windows for understanding these processes. This review focuses on how renal intrinsic cells (including tubular epithelial cells, podocytes, and endothelial cells), renal cancer cells, and mesenchymal stem cells influence the function and polarization status of macrophages through their own epigenetic alterations, and how the epigenetic regulation of macrophages themselves responds to kidney damage, thus participating in renal inflammation, fibrosis, and repair. Moreover, therapeutic studies targeting these epigenetic interaction mechanisms have found that the application of histone deacetylase inhibitors, histone methyltransferase inhibitors, various nanomaterials, and locked nucleic acids against non-coding RNA have positive effects on the treatment of multiple kidney diseases. This review summarizes the latest research advancements in these epigenetic regulatory mechanisms and therapies, providing a theoretical foundation for further elucidating the pathogenesis of kidney diseases and the development of novel therapeutic strategies.

Progress in the application of novel inflammatory indicators in chronic kidney disease

Chronic kidney disease has become a public health problem endangering the health of all humans because of its high prevalence, high mortality and high medical burden. The chronic micro-inflammatory state is recognized as a significant component of CKD, playing a key role in disease progression. Intervening in chronic inflammation during the disease course can enhance prognosis. Recent studies have demonstrated that novel inflammatory indices, such as the neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and systemic immune-inflammatory index are closely associated with CKD, meanwhile may serve as prognostic monitors of all-cause death and poor renal prognosis for the disease. This article comprehensively reports on the mechanisms of micro-inflammation in CKD, the relationship between inflammatory indicators and CKD, and their impact on prognosis.

Predictive value of the systemic immune inflammation index in recurrence of atrial fibrillation after radiofrequency catheter ablation

The recurrence of atrial fibrillation (AF) in patients after successful radiofrequency catheter ablation (RFCA) appears to be an unresolved clinical issue and needs to be clearly elucidated. There are many factors associated with AF recurrence, such as duration of AF, male sex, concomitant heart failure, hemodynamic parameters, chronic obstructive pulmonary disease, hypertension, obstructive sleep apnea, hyperthyroidism, smoking and obesity. However, the inflammatory changes are strongly associated with electrical and structural cardiac remodeling, cardiac damage, myocardial fibrotic changes, microvascular dysfunction and altered reparative response. In this context, biomarkers reflecting the different stages of AF pathogenesis deserve thorough investigation. The authors of the retrospective study revealed that one-year recurrence rate of non-valvular AF in the high systemic immune inflammation (SII) index group was significantly increased compared to that of the low SII index group and provided additional predictive value to the APPLE. Furthermore, the authors suggest that this biomarker may help physicians to optimize the selection of AF patients and to develop a personalized treatment approach. In conclusion, the SII index may serve as a valuable indicator of recurrent AF in patients after RFCA and may be a biomarker with plausible predictive value for poor clinical outcomes.

Dietary Patterns, Kidney Function, and Sarcopenia in Chronic Kidney Disease

Sarcopenia is a condition characterized by the loss of muscle mass and function. It is a risk factor for adverse clinical outcomes, including falls, disability, and mortality in patients with chronic kidney disease (CKD). The progression of CKD leads to metabolic disturbances and pathophysiological changes. These alterations, such as metabolic acidosis, dysregulated muscle proteostasis, and excessive inflammation, contribute to accelerated muscle wasting, resulting in sarcopenia. Proper nutritional interventions are essential in the management of sarcopenia in patients with CKD. Appropriate dietary intake of protein and specific micronutrients, carefully considering the needs and restrictions of CKD, may help maintain muscle mass and function. Specific dietary patterns, such as an anti-inflammatory diet, Dietary Approaches to Stop Hypertension diet, and a plant-based diet, may be beneficial for attenuating muscle wasting in CKD patients. The underlying mechanisms of how these dietary patterns affect sarcopenia are multifaceted, including inflammation, oxidative stress, and defects in muscle protein homeostasis. This review summarizes the current evidence on the relationship between dietary patterns and sarcopenia, as well as the underlying mechanisms of how dietary patterns modulate sarcopenia in CKD patients.

Association between systemic immune-inflammation index and the risk of all-cause, cancer and non-cancer mortality in the general population: results from national health and nutrition examination survey 2005-2018

BACKGROUND

Inflammation plays an important role in the progression of cancer and other diseases, such as diabetes and cardiovascular and cerebrovascular diseases. The systemic immune-inflammation index (SII) was recognized as an objective biomarker reflecting immunoinflammatory status. This study aimed to identify the association between SII with all-cause, cancer and non-cancer mortality among general population in the United States.

METHODS

25,955 participants (≥ 20 years) were included from 2005 to 2018 National Health and Nutrition Examination Survey (NHANES) and were divided into four groups according to the SII quartiles. Weighted multivariate Cox regression was used to assess the correlation between SII and mortality. Subgroup analyses were conducted to identify the effects of other covariates on the relationship between SII and mortality. A restricted cubic spline (RCS) model was subsequently used to explore the dose-response relationship between SII and mortality. Survival analysis was assessed using Kaplan-Meier method.

RESULTS

In fully adjusted model, the adjusted hazard ratio (aHR) and 95% confidence intervals (CIs) of individuals in Q4 were 1.24 (1.09, 1.41) for all-cause mortality and 1.41 (1.23, 1.63) for non-cancer mortality compared with Q1. Besides, the aHR and 95% CIs in Q2 of SII were 0.70 (0.50, 0.99) and in Q3 were 0.68 (0.52, 0.87) compared with Q1 for cancer mortality. In RCS analysis, non-linear relationships of J-shaped curves were observed in the association between SII with all-cause and non-cancer mortality. Additionally, a U-shaped curve was identified between SII and cancer mortality with a threshold value of 445.22.

CONCLUSION

Our findings imply that SII can serve as a potential prognosis indicator among general population. Elevated SII is associated with higher all-cause and non-cancer mortality. Furthermore, both the lowest and highest quartiles of the SII exhibit a correlation with heightened cancer mortality.

Systemic inflammation response index association with gout in hyperuricemic adults: NHANES 2007-2018

Background

Hyperuricemia is the underlying condition of gout. Previous studies have indicated that specific strategies may be effective in preventing the progression of hyperuricemia to gout. However, there is a lack of widely applicable methods for identifying high-risk populations for gout. Gout is linked to inflammation, especially in the hyperuricemic population. Systemic inflammation response index (SIRI) is a novel method for evaluating an individual's systemic inflammatory activity. However, the association between SIRI and gout in the hyperuricemic population has not been studied.

Methods

The study utilized data from the National Health and Nutrition Examination Survey (NHANES) 2007-2018.SIRI was log2-transformed before analysis. Multivariable logistic regression, subgroup analysis, and smooth curve fitting were employed to comprehensively evaluate the correlation between SIRI and gout prevalence in the hyperuricemic population. Additionally, we compared SIRI with other inflammatory markers.

Result

A total of 6,732 hyperuricemic patients were included, of which 3,764 were men. After adjusting for all covariates, SIRI was found to be significantly positively correlated with gout prevalence in the female group ([OR = 1.385, 95% CI (1.187, 1.615), p < 0.001]), and its diagnostic performance was superior to other inflammatory markers. In the male group, the correlation between log2-SIRI and gout prevalence was not significant ([OR = 0.994, 95% CI (0.892, 1.108), p = 0.916]). But there were significant positive correlations in the 20-45 age group ([OR = 1.362, 95% CI (1.021, 1.818), p = 0.036]). Subgroup analyses revealed that the results were largely consistent when the individuals were divided into different subgroups (FDR adjusted p for interaction >0.05 for all).

Conclusion

Our study suggests that the Systemic Inflammation Response Index (SIRI) has potential as a predictive marker for gout risk in hyperuricemic women. However, given the higher gout prevalence in men, the potential of SIRI as a predictive marker for gout risk in this population may be limited. Subgroup analyses, however, indicated that the relationship between SIRI and gout prevalence, as well as its statistical significance, varied across different age groups. Future research could further explore this association by investigating the relationship between SIRI and gout prevalence in different age cohorts.

Systemic immune-inflammation states in US adults with seropositivity to infectious pathogens: A nutrient-wide association study

BACKGROUND

Limited understanding exists regarding the association between daily total dietary nutrient intakes and immune-inflammation states in US adults exposed to various pathogens. This study sought to examine the correlation between nutrient intakes and immune-inflammation indicators and to assess their performance in distinguishing immune-inflammation states.

METHODS

This study was derived from the National Health and Nutrition Examination Survey (NHANES), which included 33,804 participants aged 20 years or older between 2005 and 2018. Multivariable linear regression and restricted cubic spline regression were conducted to evaluate the association between nutrient intakes and immune-inflammation indicators. Receiver operating characteristic curve analysis was performed to evaluate the discriminatory performance of identified nutrients for various immune-inflammation states measured by the systemic immune-inflammation index (SII).

RESULTS

Ten key nutrients were significantly associated with immune-inflammation responses, including calcium, saturated fatty acid (SFA) 4:0, SFA 6:0, SFA 12:0, SFA 14:0, SFA 16:0, vitamin B2, total SFAs, retinol, and lutein + zeaxanthin, which show potential as dietary indicators. The area under the curve for discriminating various immune-inflammation states was improved by at least 0.03 compared with a model that included only covariates, with all P values <0.05 in the Delong tests, indicating a significant enhancement in model performance.

CONCLUSIONS

Ten nutrients, including calcium, various SFAs, vitamin B2, retinol, and lutein + zeaxanthin, exhibit significant association with SII and potential as dietary indicators for distinguishing between different immune-inflammation states in US adults with seropositivity to various viruses.

Analyzing the potential targets and mechanisms of chronic kidney disease induced by common synthetic Endocrine Disrupting Compounds (EDCs) in Chinese surface water environment using network toxicology and molecular docking techniques

Long-term exposure to NP and OP, as common synthetic endocrine-disrupting chemicals (EDCs) in surface water environments in China, is closely associated with the development of chronic kidney disease (CKD). However, their potential targets and toxicological mechanisms for inducing CKD remain unknown. This study utilizes network toxicology and molecular docking techniques to explore the potential toxic targets and molecular mechanisms of CKD induction by NP and OP. We identify 49 core targets of NP and OP action in CKD using the Comparative Toxicogenomics Database (CTD) and GeneCards databases. Using the STRING database and Cytoscape software, we identify five hub genes: MAPK3, TNF, BCL2, ESR1, and FOS. We construct a nomogram model based on the CKD dataset GSE66494, utilizing these five hub genes. Calibration and ROC curves demonstrate that the model has good diagnostic value for CKD, and the DCA curve indicates that the model has high clinical utility. Single-gene GSEA enrichment analysis identifies five hub genes that influence the development of CKD through multiple biological pathways, revealing that several immune-regulatory signaling pathways are activated. The CIBERSORT algorithm identifies eight types of immune cell infiltration levels that change significantly during CKD development, and correlation analyses suggest that the five hub genes are strongly associated with multiple immune cell infiltrations. The molecular docking results suggested that ESR1, MAPK3, and TNF had the lowest binding energies and high binding affinities with NP and OP. The results of molecular dynamics simulations similarly confirmed the stability of the interactions between ESR1, MAPK3 and TNF proteins with NP and OP. The results of this study provide a theoretical basis for understanding the potential toxicity targets and mechanisms of NP- and OP-induced CKD and promote the application of network toxicology and molecular docking techniques in the study of environmental pollutants.

Flavonoids and Other Polyphenols: Bioactive Molecules from Traditional Medicine Recipes/Medicinal Plants and Their Potential for Phytopharmaceutical and Medical Application

Currently, natural bioactive ingredients and/or raw materials are of significant interest to scientists around the world. Flavonoids and other polyphenols are a major group of phytochemicals that have been researched and noted as bioactive molecules. They offer several pharmacological and medical benefits. This current review aims to (1) illustrate their benefits for human health, such as antioxidant, anti-aging, anti-cancer, anti-inflammatory, anti-microbial, cardioprotective, neuroprotective, and UV-protective effects, and also (2) to perform a quality evaluation of traditional medicines for future application. Consequently, keywords were searched on Scopus, Google Scholar, and PubMed so as to search for related publications. Then, those publications were carefully checked in order to find current and non-redundant studies that matched the objective of this review. According to this review, researchers worldwide are very interested in discovering the potential of flavonoids and other polyphenols, used in traditional medicines and taken from medicinal plants, in relation to medical and pharmaceutical applications. Many studies focus on the health benefits of flavonoids and other polyphenols have been tested using in silico, in vitro, and in vivo models. However, few studies have been carried out using clinical trials that have trustworthy subject sizes and are in accordance with clinical practice guidelines. Additionally, interesting research directions and perspectives for future studies are highlighted in this work.

The systemic immune-inflammation index and systemic inflammation response index are useful for predicting mortality in patients with diabetic nephropathy

BACKGROUND

This study investigated the correlation between the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) and all-cause, cardiovascular, and kidney disease mortality in patients with diabetic nephropathy (DN). It aimed to provide a new predictive assessment tool for the clinic and a scientific basis for managing inflammation in DN.

METHODS

The data utilized in this study were obtained from the National Health and Nutrition Examination Survey (NHANES) database, spanning 1999 to 2018. A total of 2641 patients diagnosed with DN were included in the analysis. The association between SII and SIRI levels and mortality in patients with DN was investigated using multivariate Cox proportional risk regression models. These relationships were further validated by Kaplan-Meier survival curves and restricted cubic spline (RCS) modeling, and subgroup analyses were performed to explore the heterogeneity among different characteristic subgroups.

RESULTS

The multivariate Cox regression analysis indicated that SII and SIRI levels were independently associated with all-cause mortality and cardiovascular mortality in patients with DN. SIRI levels were found to be an independently associated factor with kidney disease mortality in patients with DN. Patients in the highest quartile of SII and SIRI exhibited a 1.49-fold and 1.62-fold increased risk of all-cause mortality, respectively, compared to patients in the lowest quartile. The risk of cardiovascular mortality was 1.31 and 1.73 times higher than that in patients in the lowest quartile, respectively. The risk of kidney disease mortality in patients in the highest quartile of SIRI was 2.74 times higher than that in patients in the lowest quartile. Kaplan-Meier survival curve and RCS analyses further confirmed the positive association between SII and SIRI and mortality and a significant nonlinear relationship between SII and all-cause mortality. The SII and SIRI indices offer incremental value in model predictive power for mortality in patients with DN. Subgroup analyses demonstrated that the correlation between SII and SIRI and mortality risk was stable but heterogeneous across different subgroups.

CONCLUSION

SII and SIRI can be utilized as biomarkers for forecasting the likelihood of all-cause and cardiovascular mortality in patients with DN.

Chronic systemic inflammation predicts long-term mortality among patients with fatty liver disease: Data from the National Health and Nutrition Examination Survey 2007-2018

BACKGROUND

Low-grade systemic inflammation (SI) in patients with fatty liver disease (FLD) is an important hallmark of disease onset and progression. This study aims to evaluate the prognostic significance of novel SI markers in FLD.

METHODS

This was a retrospective cohort study. We included adult patients with FLD with complete data and analyzed the association between chronic SI and long-term mortality in patients with FLD. Systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were evaluated based on peripheral blood counts and FLD was determined by the Fatty Liver Index.

RESULTS

A total of 5497 patients with FLD were included in the final analysis. SII and PIV (but not SIRI) were found to be associated with all-cause and cardiovascular mortality in univariate analysis. Multivariate Cox regression analysis and KM analysis demonstrated that SII and PIV were associated with all-cause mortality, with SII showing a nonlinear correlation in RCS. PIV (but not SII) was associated with the cardiovascular-related survival probability over time. Stratified analysis indicated that the positive correlation between SII and PIV and all-cause mortality was not altered by subgroups.

CONCLUSIONS

SII and PIV are strongly and consistently associated with all-cause mortality in patients with FLD, with PIV potentially showing a closer association with cardiovascular mortality.

Systemic Immune-Inflammation Index and Systemic Inflammation Response Index Predict the Response to Radioiodine Therapy for Differentiated Thyroid Cancer

Purpose

This research sought to evaluate the clinical value of systemic immune-inflammation index and systemic inflammation response index in predicting the response to radioactive iodine (RAI) therapy in individuals diagnosed with differentiated thyroid cancer.

Patients and Methods

This retrospective study included 406 patients with differentiated thyroid cancer who received initial RAI therapy and follow-up from December 2019 to December 2023. Patients were divided into two groups based on imaging and serum indicators to evaluate the response to radioactive iodine treatment: the ER group (excellent response) and the non-ER group (suboptimal response). Systemic immune-inflammation index and systemic inflammation response index were calculated based on peripheral blood cell counts before treatment. Multivariable logistic regression analysis was used to assess the independent associations of these indices with the therapeutic response to radioiodine treatment. Receiver operating characteristic (ROC) curves were graphed and the area under the curve (AUC) was calculated to evaluate their predictive ability.

Results

Compared to the ER group, patients in the non-ER group had significantly elevated systemic immune-inflammation index and systemic inflammation response index levels (p < 0.001). After adjusting for confounding factors, there was a significant association between these indices and the response to radioactive iodine treatment in patients with differentiated thyroid cancer. The optimal cutoff values for predicting the response to RAI treatment were 668.91 for systemic immune-inflammation index (AUC=0.692, sensitivity 58.2%, specificity 73.1%, 95% CI: 0.639-0.745, p < 0.001) and 0.47 for systemic inflammation response index (AUC=0.664, sensitivity 85.6%, specificity 42.7%, 95% CI: 0.612-0.717, p < 0.001).

Conclusion

Systemic immune-inflammation index and systemic inflammation response index could be valuable for predicting the response to RAI treatment in individuals diagnosed with differentiated thyroid cancer. Further research is needed to explore their practical utility, and these novel inflammation markers could serve as adjunct tools in clinical practice.

Cardiovascular health metrics and diabetic nephropathy: a nationally representative cross-sectional study

BACKGROUND

The pathogenesis of diabetic nephropathy is well-documented to be multifactorial. However, research available on the association between cardiovascular health and diabetic nephropathy is limited. Thus, this study aimed to investigate these potential associations and provide guidance for disease prevention.

METHODS

We applied Life's Essential 8 (LE8) identified by the American Heart Association, which integrates multiple health behaviors and health factors to measure cardiovascular health. This study covered 4207 adults with diabetes from the National Health and Nutrition Examination Survey spanning 2007-2018. Weighted regression models assessed the estimated effect of LE8 score on the prevalence of diabetic nephropathy as well as their corresponding clinical indicators. Weighted restricted cubic spline models discussed the possible nonlinear dose-response relationships further. Subgroup analyses clarified the effects of other covariates on correlations.

RESULTS

After adjusting for all covariates, participants with moderate or high cardiovascular health showed a decreased prevalence of diabetic nephropathy (odds ratio [OR]:0.52; 95% confidence interval [CI]:0.42-0.63), and also a decrease in the urinary albumin-to-creatinine ratio [UACR] (β: - 0.83; 95% CI:- 1.00 to - 0.65). The prevalence of diabetic nephropathy and the level of UACR tended to decrease linearly as the total LE8 score increased (P for nonlinear > 0.05). Subgroup analyses showed that the effects of increased overall LE8 score and the specific cardiovascular health construct varied across age and obesity strata.

CONCLUSION

Elevated overall LE8 score was significantly associated with a lower prevalence of diabetic nephropathy in U.S. adults, and the effects of the specific cardiovascular health construct on diabetic nephropathy and their corresponding clinical indicators varied. In all, maintaining good cardiovascular health by refining LE8 metrics may help reduce the adverse effects.

Association Between Orthostatic Hypotension With Coronary Slow Flow in Patients With Chest Pain: A Single Center Experience

BACKGROUND

Orthostatic hypotension (OH) is associated with different cardiovascular diseases, however, the association between OH and coronary slow flow (CSF) has never been evaluated before.

MATERIALS AND METHODS

Chest pain patients who underwent coronary angiography (CAG) and with normal coronary arteries in our department from January 1st, 2022 to August 31st, 2023 were retrospectively enrolled. Patients were divided into the CSF group and the normal blood flow (NBF) group. Relative clinical information, laboratory test results as well as the results of CAG were collected and analyzed. Both uni-variable and multi-variable logistic regression analyses were used to evaluate the association between OH and CSF in these patients.

RESULTS

Four thousand six hundred and twenty-seven patients underwent CAG and 655 patients had normal coronary arteries. In which, sixty-nine patients were diagnosed with CSF while 586 patients were diagnosed with NBF. Uni-variable analysis revealed that higher body weight index, faster heart rate in sitting position, accompanied with chronic kidney disease, did not take Antidiabetic therapy, higher level of aspartate transaminase, uric acid, triglyceride, total cholesterol, ApoB1, low-density lipoprotein cholesterol, homocysteine, B-type natriuretic peptide as well as OH are the risk factors for CSF in these patients. Multi-variable logistic regressing analysis further demonstrated that OH was the independent risk factor for predicting CSF in these patients.

CONCLUSIONS

Our finding suggests OH might be a useful predictor for CSF in patients with chest pain but normal coronary arteries.

Independent and joint influence of depression and advanced lung cancer inflammation index on mortality among individuals with chronic kidney disease

Background

The combined effect of depression and nutritional-inflammatory status on mortality in the chronic kidney disease (CKD) population is unclear.

Methods

We prospectively analyzed 3,934 (weighted population: 22,611,423) CKD participants from the National Health and Nutrition Examination Survey (2007-2018). Depression and nutritional-inflammatory status were assessed with Patient Health Questionnaire 9 (PHQ-9) and Advanced Lung Cancer Inflammation Index (ALI), respectively. Weighted multivariate COX regression models, restricted cubic splines (RCS) models, and stratified analyses were used to investigate the association of PHQ-9 scores and ALI with all-cause mortality.

Results

During a median follow-up of 5.8 years (interquartile range 3.4-8.6 years), a total of 985 patients died (25.0%). Each point increase in a patient's PHQ-9 score increased the risk of all-cause mortality by 4% (HR, 1.04; 95% CI, 1.02-1.06; p < 0.001), in the full adjusted model. However, an increase in ALI levels was associated with a decreased risk. HRs (95% CI) of 0.76 (0.65-0.90), 0.70 (0.57-0.86), and 0.51 (0.41-0.64) in the Q2, Q3, and Q4 of ALI compared with the Q1 of ALI, respectively. In addition, the joint analysis showed that CKD patients without depression and with higher ALI were associated with a reduced risk of all-cause mortality. Namely, patients in the highest ALI group (Q4) without depression had the lowest risk (HR, 0.32; 95% CI, 0.21-0.48). Furthermore, this combined effect was consistent across all subgroups, and no significant interaction was found (p > 0.05 for interaction).

Conclusion

In a nationally representative sample of US patients with CKD, coexisting depression and poorer nutrition-inflammation were associated with a significantly increased risk of all-cause mortality.

Associations between serum 25-hydroxyvitamin D and prognosis of chronic kidney disease: a prospective cohort study

BACKGROUND AND OBJECTIVES

25-hydroxyvitamin D [25(OH)D] deficiency is prevalent in patients with chronic kidney disease (CKD), the associations between serum 25(OH)D levels and mortality in patients with CKD remain unclear, and this study aimed to explore these associations further.

METHODS

4989 participants with CKD were enrolled in the study, and the Cox regression model was used to assess the effects of serum 25(OH)D concentrations on mortality risk. A restricted cubic spline model was used to explore the dose-response relationships, and threshold effect analysis was performed based on inflection points identified by a two-piecewise linear regression model. In addition, subgroup and sensitivity analyses were employed.

RESULTS

1255 participants died during a mean follow-up period of 70 months. Compared with the 25(OH)D-deficient group, the fully adjusted hazard ratios and 95% confidence intervals for the 25(OH)D-adequate group were 0.631 (0.545, 0.730) for all-cause mortality, 0.569 (0.435, 0.743) for cardiovascular mortality, 0.637 (0.461, 0.878) for hypertension mortality, and cancer mortality was 0.596 (0.426, 0.834). The inflection points of serum 25(OH)D concentration affecting all-cause and cardiovascular mortality were 89 nmol/L, and 107 nmol/L, respectively. Subgroup analyses and interaction tests suggested that the effects varied across populations. The results of sensitivity analyses indicated a reliable correlation.

CONCLUSION

We found an association between serum 25(OH)D concentrations and the prognosis of patients with CKD as a reliable predictor of early intervention and intensive care.

Chronic kidney diseases and inflammation research: a bibliometric analysis

Background

Chronic kidney diseases (CKD) is a severe public health problem. This study aimed to explore the field of inflammation-related research in CKD from a bibliometric perspective.

Methods

Relevant literature published between 2004 and 2023 were searched from the Web of Science database. The bibliometric analysis were performed to summarize countries, institutions, authors, journals and keywords using VOSviewer and CiteSpace.

Results

A total of 9,287 publications on CKD and inflammation were included. Publications were mainly from the United States, China, Italy, Germany, and Japan. The findings revealed that the United States had the highest number of publications in this field, followed by China. There is strong collaboration between the two countries. The most productive institutions included the University of California system and the US Department of Veterans Affairs. Research hotspots primarily focused on inflammation mechanisms, biomarkers, and interventions.

Conclusion

This study revealed the basic knowledge structure and provided a comprehensive insight into the research field of CKD and inflammation through bibliometric methods. Future studies should focus on early diagnosis, prevention, and treatment strategies of CKD, and explore more inflammation associated biomarkers and therapeutic targets for CKD.

Association between the systemic inflammation response index and mortality in the asthma population

Background

As a novel indicator of inflammation, the relationship between the systemic immune-inflammation index (SIRI) and mortality in patients with asthma remains uncertain. Our study aimed to explore the association between SIRI and mortality in asthma patients.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) for US adults from 2001 to 2018 were included in this study. Then, we divided all patients into three groups based on SIRI tertiles and used multivariable weighted Cox regression analysis, smoothing curve fitting, survival curve analysis, and subgroup analysis to investigate the relationship between SIRI and asthma.

Results

A total of 6,156 participants were included in the study, with each SIRI tertile consisting of 2052 individuals. Asthma patients with higher SIRI levels were older, had a higher level of education, were more likely to be married, and had a higher chance of being smokers. In Cox proportional-hazards models, the highest SIRI group showed higher hazard ratios (HRs) for all-cause mortality in individuals with asthma after adjusting for potential confounders. The restricted cubic spline analysis indicated a non-linear relationship between SIRI and all-cause mortality. The Kaplan-Meier survival curves showed that patients with higher SIRI levels had a higher risk of all-cause mortality. Subgroup analyses revealed SIRI's association with all-cause mortality across various demographics, including age, sex, race, education levels, smoking status, and marital status.

Conclusion

Our study provides evidence for the relationship between SIRI and mortality in asthma patients. SIRI may potentially serve as a predictive tool for evaluating asthma mortality rates.

Systemic immune inflammation index and all-cause mortality in chronic kidney disease: A prospective cohort study

BACKGROUND

The aim of this study was to investigate the association between systemic immune-inflammation index (SII) and all-cause mortality in individuals with chronic kidney disease (CKD).

PATIENTS AND METHODS

This prospective cohort study was carried out among 9303 participants with CKD from the National Health and Nutrition Examination Survey cycles spanning 1999 to 2018. The mortality data were ascertained by linking participant records to the National Death Index up to December 31, 2019. Complex sampling-weighted multivariate Cox proportional hazards models were employed to estimate the association between SII level and all-cause mortality, providing hazard ratios (HR) and 95% confidence intervals (CI). A restricted cubic spline analysis was conducted to explore potential nonlinear correlation. Subgroup analyses and sensitivity analyses were also conducted.

RESULTS

During a median follow-up period of 86 months, 3400 (36.54%) all-cause deaths were documented. A distinctive "J"-shaped relationship between SII level and all-cause mortality was discerned among individuals with CKD, with the nadir observed at an SII level of 478.93 within the second quartile. After adjusting for potential covariates, the risk of all-cause mortality escalated by 13% per increment of one standard deviation of SII, once SII exceeded 478.93 (HR = 1.13; 95% CI = 1.08-1.18). An elevated SII was associated with an increased risk of all-cause mortality among patients with CKD (Q4 vs. Q2: HR = 1.23; 95% CI = 1.01-1.48). Subgroup analyses indicated that the correlation between SII and CKD mortality was particularly pronounced among participants over 60 years old and individuals with diabetes. Sensitivity analyses revealed a linear positive association between SII and all-cause mortality after removing the extreme 5% outliers of SII.

CONCLUSIONS

A distinctive "J"-shaped relationship between SII level and all-cause mortality was identified among individuals with CKD. Further research is warranted to validate and expand upon these findings.