U-shaped association of systemic immune-inflammation index levels with cancer-related and all-cause mortality in middle-aged and older individuals with frailty

Associations between naples prognostic score and stroke and mortality among older adults

BACKGROUND

Inflammation and malnutrition in the body are closely related to the incidence of stroke. Older adults often suffer from malnutrition and inflammation. Naples Prognostic Score (NPS), a novel inflammation-malnutrition score, can effectively assess the inflammation and nutritional status of the body. The aim of this study is to explore the connection between NPS and stroke among older adults, as well as the association between NPS and mortality in older adults.

METHODS

Participants eligible for the study were collected from National Health and Nutrition Examination Survey(NHANES) data from 1999 to 2018. Logistic regression models were employed to investigate the link between NPS and stroke. Additionally, restricted cubic spline was utilized to explore the correlations. Subgroup analysis was adopted in order to ensure the credibility of the results. Kaplan-Meier Survival curve and cox regression models and were utilized to evaluate the link between NPS and mortality among older adults.

RESULTS

16,940 older adults qualified for analysis. The participants with stroke had higher levels of NPS. In the logistic regression model, NPS was positively related to stroke (high NPS vs. low NPS, OR = 1.70 (95% CI 1.24-2.35), P < 0.001). Restricted cubic spline revealed a positive non-linear relationship (P for overall < 0.001, P for non-linear < 0.001). Subgroup analysis showed that the association between NPS and the incidence of stroke is more significant in the non-diabetes population (P < 0.001). The Kaplan-Meier curve shows that patients with high NPS have a significantly higher risk of all-cause mortality and cardiovascular mortality (P < 0.001). In the Cox regression model, a positive correlation was observed between NPS and mortality among older adults (all-cause mortality: HR = 1.36 (95% CI 1.30-1.42); cardiovascular mortality:HR = 1.59 (95% CI 1.45-1.75)).

CONCLUSIONS

A positive link was observed between NPS and stroke and mortality. Routine NPS screening may enhance risk stratification in geriatric clinics.

Inverse L-shaped association of triglyceride glucose index with all-cause and cerebral cardiovascular-related mortality in osteoarthritis patients: a cohort of 4145 patients

BACKGROUND

Currently, osteoarthritis (OA) is recognized as a systemic disease, wherein metabolic disturbances play a part in joint degeneration and elevated risk of mortality. This study investigates the prognostic value of the triglyceride-glucose (TyG) index in determining all-cause and cerebral cardiovascular mortality among OA patients, accentuating the necessity for customized interventions.

METHODS

A cohort of osteoarthritis patients from the 1999-2018 NHANES was linked to the 2019 National Death Index (NDI) for mortality confirmation. TyG index correlation with all-cause and cerebral cardiovascular mortality was assessed using Cox regression and Kaplan-Meier curves. Non-linear associations were examined with restricted cubic splines, and a two-piecewise Cox model was built around the inflection point.

RESULTS

A total of 4145 OA patients were followed for a median of 89 months, during which 1109 all-cause deaths and 427 cerebral cardiovascular-related deaths were observed. Restricted cubic splines showed an inverse L-shaped relationship between the TyG index and both types of mortality. The critical point was identified as 9.48, with a 1-unit increase associated with a 71% and 91% rise in adjusted all-cause and cerebral cardiovascular mortality, respectively (HR 1.71; 95% CI 1.30, 2.26 and HR 1.91; 95% CI 1.28, 2.86). Subgroup analyses revealed significant associations between the TyG index and elevated mortality risks among non-white OA patients and those with concurrent diabetes.

CONCLUSION

In OA patients, the TyG index and mortality (both all-cause and cerebral cardiovascular) share an inverse L-shaped relationship, with identified thresholds at 9.48. This threshold offers valuable insight for risk assessment, thus promoting a shift towards personalized healthcare strategies founded on metabolic status for enhanced outcomes within OA populations. Key points • The TyG index predicts all-cause and cerebral cardiovascular mortality in OA patients. • An inverse L-shaped relationship between the TyG index and mortality was found, with a critical threshold of 9.48. • Non-white OA patients and those with diabetes show significant associations with elevated mortality risks, highlighting the importance of personalized care.

Association of systemic immune-inflammatory index with all-cause and cancer mortality in Americans aged 60 years and older

Background

This research delved into the association between the systemic immune-inflammatory index (SII) and both all-cause and cancer-specific mortality among individuals aged 60 years and above in the United States during the period from 1999 to 2018, with follow-up extending until 31 December 2019. The data utilized was sourced from 4295 population-based participants in the National Health and Nutrition Examination Survey (NHANES).

Methods

To analyze the relationship between SII and mortality, the study employed Cox proportional-risk models, restricted cubic spline curves, survival curves, and subgroup analyses.

Results

The average age of the participants was 70.7 (±7.6) years, the median follow-up duration was 131.7 (±59.8) months, and the all-cause mortality rate stood at 50.5%. Findings from the Cox regression model indicated that, after adjusting for covariates, SII was significantly and linearly related to all-cause mortality (hazard ratio HR = 1.31, 95% confidence interval CI = 1.15-1.48). Moreover, the relationship between SII and cancer mortality exhibited a U-shaped pattern. Results from the survival curves suggested that a higher SII was associated with an augmented risk of both all-cause mortality and cancer mortality.

Conclusion

There is a significant association between higher SII levels and increased risk of all-cause and cancer-specific mortality in the US population aged 60 years and older.

Systemic immune inflammation index with all-cause and cause-specific mortality: a meta-analysis

IMPORTANCE

Studies have reported an association among systemic immune inflammation index (SII), all-cause and cause-specific mortality, but the results are inconsistent.

OBJECTIVE

To comprehensively explore the association between Systemic Immune Inflammation (SII) and the risk of all-cause mortality, cardiovascular disease (CVD), and cancer mortality.

EVIDENCE REVIEW

A meta-analysis was conducted by reviewing existing literature. The search encompassed prominent databases including PubMed, Embase, Cochrane, and the Web of Science, with the cutoff date set at March 1, 2024. Furthermore, subgroup analyses and dose-response assessments were undertaken to provide a nuanced exploration of mortality risk factors.

FINDINGS

A total of 33 articles were included (427,819 participants). In the study, SII was associated with an increased risk of all-cause mortality (HR = 1.45, 95%CI [1.36,1.54], P < 0.05). SII increased the risk of CVD mortality (HR = 1.44, 95%CI [1.29,1.60], P < 0.05). The Linear independence shows that for every 100 units increase in SII, the risk of all-cause and CVD death increases by 5% and 6%. SII was not associated with a statistically significant risk of cancer death (HR = 1.09, 95%CI [0.96,1.23], P < 0.05).

CONCLUSIONS AND RELEVANCE

Meta-analysis showed that SII was associated with all-cause mortality and CVD mortality. More data and basic research are needed to confirm the association.

Association between complete blood count-derived inflammatory markers and the risk of frailty and mortality in middle-aged and older adults

Objective

This study aimed to evaluate the association between six complete blood count (CBC)-derived inflammatory markers [neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI), and pan-immune inflammation value (PIV)] and the risk of frailty and mortality.

Methods

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Mortality was identified using the National Death Index until December 31, 2019. Multiple logistic regression analysis was conducted to evaluate the association between six CBC-derived inflammatory markers and frailty. The Cox regression model assessed the association between six CBC-derived inflammatory markers and mortality in frail populations. Restricted cubic spline (RCS) was used to visualize the association of the six CBC-derived inflammatory markers with mortality risk. The predictive value of CBC-derived inflammatory markers for mortality was further assessed using a random survival forest (RSF) approach.

Results

This study analyzed data from a total of 16,705 middle-aged and older participants. Among them, 6,503 participants were frail, with a mortality rate of 41.47%. Multiple logistic regression analysis showed that NLR, MLR, PLR, SII, SIRI, and PIV were positively associated with frailty risk. The Cox regression model revealed that participants in the highest quartile had a significantly increased risk of death compared to those in the lowest quartile: NLR (HR = 1.73, 95% CI:1.54, 1.94), MLR (HR = 1.71, 95% CI:1.51, 1.93), PLR (HR = 1.28, 95%CI: 1.15, 1.43), SII (HR = 1.50, 95%CI:1.34, 1.68), SIRI (HR = 1.88, CI 95%:1.67, 2.12), PIV (HR = 1.55, 95%CI:1.38, 1.73). Random survival forest (RSF) analyses demonstrated that MLR had the highest predictive value for mortality risk middle-aged and older adult frail participants.

Conclusion

The results suggest that CBC-derived inflammatory markers are associated with a higher risk of frailty as well as mortality in the middle and old-aged population of the United States.

The association of urinary heavy metal exposure with frailty susceptibility and mortality in middle-aged and older adults: a population-based study

Heavy metals' presence as environmental pollutants has a close link to adverse health effects. Frailty, a clinical syndrome hallmarked by elevated vulnerability to stressors, presents a substantial challenge in healthcare. However, the association between exposure to heavy metals and frailty largely remains unexplored. Utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2018 and correlated with the U.S. National Death Index (NDI) from 2019, we investigated mortality outcomes. Logistic regression, Cox regression, Kaplan-Meier survival curves, weighted quantile-sum (WQS) regression, and Bayesian kernel machine regression (BKMR) were employed to assess the association between heavy metal exposure and frailty incidence and mortality in the frail population. Eight metals were measured in urine using inductively coupled plasma mass spectrometry with values adjusted for urinary creatinine, which was used to reflect heavy metal exposure. The cohort incorporated 5370 female participants aged 45 and above, with 1518 diagnosed with frailty. The findings indicated a substantial correlation between exposure to specific heavy metals, namely tungsten (odds ratio [OR]: 1.94, 95% confidence interval [CI]: 1.31-2.89), cobalt (OR: 1.64, 95% CI: 1.40-1.93), cadmium (OR: 1.93, 95% CI: 1.52-2.43), and uranium (OR: 7.36, 95% CI: 1.53-35.28), and an elevated risk of frailty. WQS and BKMR regression models identified cadmium, cobalt, and tungsten as main contributors to frailty. Cox regression analysis, after adjustment for covariates, suggested that the higher the exposure levels to cadmium and lead, the higher the risk of death in frail patients, with associated hazard ratios (HR) of 95% CI: 1.96 (1.53, 2.52) and 1.30 (1.13, 1.49), respectively. Our study revealed a significant positive correlation between exposure to heavy metal mixtures and frailty onset in middle-aged and older adults, along with increased mortality in frail patients. Cobalt, cadmium, and tungsten emerged as prominent contributors to frailty, with cobalt and cadmium directly impacting the long-term life expectancy of frail patients.