Dynamic Status of SII and SIRI Alters the Risk of Cardiovascular Diseases: Evidence from Kailuan Cohort Study

Inflammatory and metabolic markers mediate the association of hepatic steatosis and fibrosis with 10-year ASCVD risk

BACKGROUND AND AIMS

Liver steatosis and fibrosis increase the predicted 10-year atherosclerotic cardiovascular disease (ASCVD) risk, though the roles of chronic inflammation and metabolic dysregulation remain unclear. This cross-sectional study quantitatively assesses this association and evaluates the mediating effects of metabolic dysregulation and chronic inflammation.

METHODS

In this study, we enrolled 6110 adults from ten communities in Canton, China. Hepatic steatosis and fibrosis were assessed using vibration-controlled transient elastography (VCTE) through controlled attenuation parameter (CAP) and liver stiffness measurement (LSM), while predicted 10-year ASCVD risk was calculated using the China-PAR project model. Associations between CAP/LSM values and predicted 10-year ASCVD risk were analyzed. Mediation analysis quantified the effects of high-sensitivity C-reactive protein (hs-CRP), homeostasis model assessment of insulin resistance (HOMA-IR), remnant cholesterol (RC), and non-high-density lipoprotein cholesterol (non-HDL-C). The main statistical methods used included logistic regression, restricted cubic splines (RCS) analysis, interaction calculations, and mediation analysis to examine the relationships and mediators.

RESULTS

The study population had a mean age of 50.1 years (SD = 9.7), with 3927 females (64.3%) and 2183 males (35.7%). Additionally, 808 participants (13.2%) had type 2 diabetes, and 1911 participants (31.3%) had hypertension. Compared to the first CAP quartile (Q1), higher CAP quartiles showed increased odds ratios (OR) for predicted moderate to high 10-year ASCVD risk: 1.14 (0.89, 1.45), 1.37 (1.08, 1.73), and 2.44 (1.93, 3.10). Mediation analysis showed hs-CRP and HOMA-IR mediated CAP's link to ASCVD risk, with mediation proportions of 15.40% and 27.37%. RC and non-HDL-C mediated this association at 7.12% and 6.26%. Among patients with hepatic steatosis (CAP ≥ 248 dB/m), LSM Q4 participants had a significantly higher predicted 10-year ASCVD risk than those in LSM Q1 (OR 2.22, [1.52, 3.25]), with hs-CRP and HOMA-IR mediating 2.62% and 13.75%, respectively.

CONCLUSION

Liver steatosis and fibrosis were associated with the increased predicted ASCVD risk, with mediation effects from hs-CRP, HOMA-IR, RC, and non-HDL-C.

Association of systemic immune-inflammation index with in-hospital mortality of cardiogenic shock patients supported with extracorporeal membrane oxygenation

PURPOSE

The systemic immune-inflammation index (SII) is a useful predictor in cardiovascular diseases. The purpose of this study was to investigate the association of SII with in-hospital mortality in patients with cardiogenic shock (CS) supported with extracorporeal membrane oxygenation (ECMO).

PATIENTS AND METHODS

A total of 126 CS patients received ECMO implantation between January 2020 and December 2023. SII was calculated as follows: SII ​= ​neutrophil count × platelet count / lymphocyte count at admission. Participants were divided into high or low SII group based on the cut-off value of SII. In-hospital mortality was compared between the groups.

RESULTS

The optimal SII cut-off value for predicting in-hospital mortality in CS patients supported with ECMO was 1735.9 (AUC 0.68, p ​= ​0.001). In-hospital mortality was significantly higher in the high SII group compared to the low SII group (59.09 % vs. 21.67 %, p <0.001). The univariate and multivariate logistic regression analyses had shown that SII and left ventricular ejection fraction (LVEF) were identified as independent predictors of in-hospital mortality in CS patients supported with ECMO (OR: 1.001, 95 % CI: 1.000-1.002, p ​= ​0.007 and OR: 0.881, 95 % CI: 0.803-0.966, p ​= ​0.007, respectively). SII combined with LVEF offered a superior prognostic capability compared to SII alone (AUC 0.707, v. s. AUC 0.68).

CONCLUSION

We demonstrated that elevated admission SII was independently associated with in-hospital mortality in CS patients supported with ECMO. These findings highlight the potential role of SII as an indicator of mortality risk in this population.

A nomogram risk prediction model for ischemic mitral regurgitation after primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction

AIM

This study developed a nomogram to predict the risk of ischemic mitral regurgitation (IMR) after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI) patients and evaluate their long-term prognosis.

METHODS

Data from 342 STEMI patients were collected. Logistic regression identified independent risk factors for IMR during hospitalization, while Cox regression assessed risk factors during follow-up. The nomogram was developed based on these factors. ROC evaluated its predictive value, and decision curve analysis/clinical impact curves assessed clinical utility. Kaplan-Meier analysis evaluated the model's prognostic value.

RESULTS

The independent risk factors for hospitalized IMR after PCI in STEMI patients included Gensini score (OR 1.009; P = 0.047), left ventricular ejection fraction (LVEF) (OR 0.941; P = 0.007), albumin (OR 0.941; P = 0.046), and systemic immune-inflammatory index (SII) (OR 1.096; P < 0.001). During follow-up, diabetes mellitus (HR: 1.154; P = 0.019), hemoglobin (HR: 0.991; P = 0.028), Gensini score (HR: 1.007; P = 0.022), LVEF (HR: 0.972; P = 0.015), and SII/100 (HR: 1.034; P < 0.001) were identified as independent predictors of IMR. The nomogram showed strong clinical benefit, good calibration, and predictive value. Patients with lower scores had better long-term outcomes.

CONCLUSION

This nomogram effectively predicts the occurrence of IMR after PCI in STEMI patients, providing valuable prognostic insights.

Atherogenic and Inflammatory Markers in Recent Small Subcortical Infarcts: Associations with Location, Morphology, and Short-Term Recurrence

Background

Recent small subcortical infarcts (RSSIs) have emerged as a growing public health concern due to their poor long-term clinical outcomes. This study aimed to investigate the associations between the atherogenic index of plasma (AIP), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) with the occurrence and recurrence of RSSIs.

Methods

Three hundred forty-two patients with RSSIs who met the eligibility criteria were included in the cross-sectional analysis. Comprehensive demographic, laboratory, and neuroimaging data were collected at baseline. Patients were categorized into subcortical white matter, basal ganglia, and brainstem RSSIs based on lesion location. Lesions were further classified by shape (round/oval or tubular) and diameter (≤15 mm or >15 mm). Of these, 336 patients completed follow-up at six months. Logistic regression models were established to assess the relationships between AIP, SII, and SIRI with the occurrence and recurrence of RSSIs, considering variations in lesion location and morphology. The short-term prognostic performances of individual and combined risk factors were evaluated using receiver operating characteristic curve analysis.

Results

Cross-sectional analysis revealed a significant positive correlation between AIP and basal ganglia RSSIs (OR: 3.269, 95% CI: 1.209-8.839), as well as between SIRI and brainstem RSSIs (OR: 1.472, 95% CI: 1.012-2.143) and tubular RSSIs (OR: 1.440, 95% CI: 1.043-1.989), after adjusting for potential confounders. In the longitudinal analysis, multivariate regression indicated that hypertension, periventricular white matter hyperintensities, and SII were independently associated with RSSI recurrence. The predictive model demonstrated strong performance, with an area under the curve of 0.853 (95% CI: 0.738-0.968), sensitivity of 90.9%, and specificity of 75.4%.

Conclusion

Atherogenic and inflammatory markers are associated with specific locations and morphologies of RSSIs and serve as potential predictive factors for short-term RSSI recurrence. These findings may enhance our understanding of the mechanisms underlying RSSIs and inform early prevention strategies.

Association between the atherogenic index of plasma and the systemic immuno-inflammatory index using NHANES data from 2005 to 2018

The atherogenic index of plasma (AIP) is used to evaluate the risk of atherosclerosis, while the systemic immune-inflammation index (SII) measures inflammation. The AIP and SII are indicators used to predict diseases in various areas. This study aims to explore the relationship between AIP and SII. A cross-sectional study design was used to recruit 70,190 participants from the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2018, excluding AIP missing data, SII missing data, participants under 20 years of age, and participants with missing covariates to eventually include 8163 participants. We used weighted multiple linear regression analysis, trend test, smooth curve fitting and threshold effect analysis to examine the relationship between AIP and SII. Among the 8163 participants included in the study, the mean (± SD) age was 48.412 ± 16.842 years. The mean SII (± SD) for all participants was 519.910 ± 316.974. In a model adjusted for all covariates (Model 3), AIP showed a significant positive correlation with SII [β (95% CI) 32.497 (5.425, 59.569), P = 0.021]. The smooth curve fitting results of AIP and SII are an "inverted U-shape" non-linear relationship, and the inflection point is at AIP = 0.82. This positive association between AIP and SII was found only in females and participants under 50. Specifically, for females, the positive correlation between AIP and SII was linear [β (95% CI) 80.791 (44.625, 116.958); P < 0.001]. In participants under 50, the positive correlation between AIP and SII was [β (95% CI) 34.198 (3.087, 65.310); P = 0.034], and there was also an "inverted U-shape" non-linear relationship with an inflection point of AIP = 0.549. For participants aged 20-50 years and males, the smooth curve showed a "down-flat-down" non-linear relationship. There is a significant positive correlation between AIP and SII. A positive association between AIP and SII was observed exclusively in females and among participants under 50. Furthermore, AIP and SII demonstrated a nonlinear relationship that resembles an "inverted U-shape". These findings offer new insights into the prevention, treatment, and management of cardiovascular disease. However, further comprehensive cohort studies are necessary to validate the relationship between AIP and SII.

Dynamic Status of Systemic Immune Inflammation Index Is Associated With Metabolic Dysfunction-Associated Steatotic Liver Disease: An Evidence From a Ten-Year Prospective Longitudinal Cohort Study

Objective

Previous research studies have linked the systemic immune inflammation index (SII), derived from a complete blood count, to metabolic dysfunction-associated steatotic liver disease (MASLD). However, evidence on the relationship between longitudinal changes in SII and MASLD remains limited. This study aimed to explore distinct SII trajectories and their association with MASLD incidence.

Methods

A longitudinal study analyzed 25,600 individuals who underwent periodic health assessments at a Dalian City hospital between 2014 and 2023. MASLD was diagnosed via ultrasound. The SII was calculated using the formula SII = (platelet count × neutrophil count) / lymphocyte count. Group-based trajectory modeling was used to identify SII trajectories, and restricted cubic spline (RCS) analysis was employed to assesse the dose-response relationship. Stratified analyses and sensitivity analyses were also conducted.

Results

Three SII trajectories were identified: "low stable" (50.6%), "moderate stable" (35.1%), and "high stable" (8.9%). After adjustments, the hazard ratios (HR) for MASLD incidence were 1.118 (95% CI: 1.057-1.182, P<0.001) for the "moderate stable" group and 1.284 (95% CI: 1.172-1.408, P<0.001) for the "high stable" group. These associations persisted after adjusting for lifestyle factors. A significant non-linear relationship between SII and MASLD risk was found in both the overall population and among different genders. Subgroup and sensitivity analyses consistently confirmed these findings.

Conclusion

Elevated SII levels are significantly associated with an increased risk of MASLD, particularly among individuals under 45 and women. Regular SII monitoring may improve risk stratification and facilitate targeted prevention strategies for those at higher risk of MASLD.

Predictive Value of First-Trimester Aggregate Index of Systemic Inflammation (AISI) and Other Inflammatory Indices for Gestational Diabetes Mellitus and Associated Obstetric Outcomes

PROBLEM

To investigate the value of the first-trimester aggregate index of systemic inflammation (AISI) and other combined inflammatory markers in the prediction of gestational diabetes mellitus (GDM) and related obstetric outcomes.

METHOD OF STUDY

The data of pregnant women diagnosed with GDM between September 2021 and November 2024, as well as an equal number of control patients, were retrospectively analyzed. The patients' AISI, neutrophil lymphocyte ratio (NLR), systemic immune-inflammatory index (SII), and systemic inflammatory response index (SIRI) values were calculated from the hemogram parameters of the participants at 11-14 weeks of gestation. The clinical characteristics, laboratory results, combined inflammatory indices, obstetric outcomes, the need for neonatal intensive care unit (NICU) admission, and the presence of composite adverse perinatal outcome (CAPO) of the groups were then compared. Receiver operating characteristic (ROC) curve analyses were performed to investigate the value of the indices that reached statistical significance in predicting GDM.

RESULTS

The GDM group exhibited significantly higher SII and AISI values, rate of NICU admission, and CAPO compared to the control group (p = 0.036, p = 0.011, p < 0.01, and p < 0.01, respectively). The gestational age at birth was significantly lower in the GDM group compared to the control group, while the neonatal weight was higher (p < 0.01, p < 0.01, respectively). The ROC curve analyses yielded an area under the curve (AUC) of 0.566 and 0.581 for SII and AISI for GDM prediction, respectively (p = 0.036 and p = 0.011, respectively).

CONCLUSIONS

First-trimester AISI and SII may be useful markers for identifying pregnancies at high risk for developing GDM.

Association Between Systemic Immune-Inflammation Index and Outcomes of Acute Myocardial Infarction: A Systemic Review and Meta-Analysis

Objective: To assess the link between systemic immune-inflammation index (SII) and risk of major adverse cardiovascular events (MACE), contrast-induced nephropathy (CIN), and overall mortality in patients with acute myocardial infarction (AMI). Patients and Methods: Electronic search of PubMed, EMBASE, Web of Science, and Scopus databases was done for observational studies with the data on the association of SII and outcomes, such as MACE, and CIN in adult (≥18 y) patients with AMI. A random-effects model was used, and the pooled effect sizes were expressed as relative risk (RR) with corresponding 95% confidence intervals (CI). Subgroup analysis was conducted on the basis of the type of AMI (ST elevation myocardial infarction and non-ST elevation myocardial infarction), sample size (≥500 and <500), and study design. GRADE assessment was used to evaluate the certainty of the evidence. Results: The analysis included 23 studies. Most studies were conducted in China (n = 13), followed by Turkey (n = 10). Majority of the studies (n = 20) had a retrospective cohort design. Patients with high SII had increased risk of MACE (RR 2.95, 95% CI: 1.25, 6.99; n = 5, I2 = 97.5%), overall mortality (RR 2.59, 95% CI: 1.64, 4.07; n = 6, I2 = 58.0%), and CIN (RR 4.58, 95% CI: 3.44, 6.10; n = 4, I2 = 0.0%), compared with patients with lower SII. Egger's test detected publication bias for MACE (p = 0.047) and overall mortality (p = 0.012) but not for CIN. These associations remained valid in subgroup analysis. Conclusion: Findings suggest that higher SII in patients with AMI is associated with increased risks of MACE, CIN, and overall mortality. This underscores SII's potential as a prognostic marker in AMI.

Mucosal-associated invariant T cells correlate with myocardial ischaemia and remodelling in coronary artery disease

Objectives

Myocardial ischaemia and remodelling are major contributors to the progression and mortality of coronary artery disease (CAD). Previous studies have shown immune cell alterations in CAD patients, but their characteristics and associations with myocardial ischaemia and remodelling remain unclear.

Methods

We compared immune cell changes among patients without CAD, those with CAD and those with CAD and heart failure (HF).

Results

We found a progressive reduction in circulating mucosal-associated invariant T (MAIT) cells across the three patient groups. MAIT cells exhibited increased expression of activation markers (CD69 and PD-1) and cytotoxic molecules (such as granzyme B). The features of MAIT cells were correlated positively with worsening clinical indicators of myocardial ischaemia and remodelling, including the Gensini score, cTnI, NT-proBNP, LVEF and E/e'. Additionally, the reduction, activation and cytotoxicity of MAIT cells were associated with indicators of myocardial fibrosis (sST2, Gal-3, PICP and PIIINP), a central pathological mechanism of myocardial remodelling. Finally, we preliminarily explored potential triggers for MAIT cell abnormalities in CAD patients and found that impaired intestinal barrier function and increased circulating bacterial antigens may contribute to these changes.

Conclusions

During CAD progression, we observed a decrease in circulating MAIT cells. Enhanced activation and cytotoxicity of MAIT cells are associated with myocardial ischaemia and remodelling in CAD patients with heart failure, potentially triggered by gut microbial leakage. Our findings suggest a novel strategy for monitoring and intervention in disease progression.

Association of systemic inflammation response index with latent tuberculosis infection and all-cause mortality: a cohort study from NHANES 2011-2012

Background

The Systemic Inflammatory Response Index (SIRI) is a promising inflammatory marker; however, the relationship between SIRI and latent tuberculosis infection (LTBI), as well as its association with mortality rates, remains unclear. The present study aimed to explore the associations of the SIRI with LTBI and all-cause mortality.

Methods

We conducted a prospective cohort study using data from National Health and Nutrition Examination Survey (NHANES) cycles from 2011 to 2012. We explored the association between SIRI and LTBI prevalence using Multiple logistic regression models. We used Multivariate Cox proportional hazards model to analyze the association between SIRI and all-cause mortality. In addition, Kaplan-Meier curves, restricted cubic splines (RCS), stratified analysis, and interaction tests were performed.

Results

The study included a total of 4,983 adults who participated in NHANES 2011-2012. The mean follow-up period was 92.35 ± 16.82 months, and there were 525 deaths, representing a mortality rate of 10.54%. The occurrence of LTBI is significantly associated with low SIRI levels(OR=0.76, 95% CI: 0.66-0.89), after adjusting for confounders. Among LTBI patients, elevated SIRI levels are significantly correlated with an increased risk of all-cause mortality (adjusted HR = 1.48, 95% CI: 1.01-2.15). RCS revealed a linear relationship between SIRI and all-cause mortality in patients with LTBI (P =0.059[overall] and P = 0.391 [Nonlinear]). Furthermore, within the LTBI population, the area under the curve (AUC) of SIRI for all-cause mortality are 0.731 (1-year), 0.640 (3-year), and 0.634 (5-year).

Conclusion

The findings of this study indicate that elevated SIRI levels are independently associated with an increased risk of all-cause mortality in patients with LTBI. Notably, SIRI was significantly inversely associated with the incidence of LTBI. Therefore, SIRI may serve as an effective tool for risk stratification in adults with LTBI in the United States. Further research is needed to elucidate the underlying mechanisms and to explore any therapeutic implications of these findings.

Development and evaluation of a machine learning model for post-surgical acute kidney injury in active infective endocarditis

Introduction

Acute kidney injury (AKI) is notably prevalent after cardiac surgery for patients with active infective endocarditis. This study aims to create a machine learning model to predict AKI in this high-risk group, improving upon existing models by focusing specifically on endocarditis-related surgeries.

Methods

We analyzed medical records from 527 patients who underwent cardiac surgery for active infective endocarditis from January 2012 to December 2023. Feature selection was performed using LASSO regression. These features informed the development of machine learning models, including logistic regression, linear and radial basis function support vector machines, XGBoost, decision trees, and random forests. The optimal model was selected based on ROC curve AUC. Model performance was assessed through discrimination, calibration, and clinical utility, with explanations provided by SHAP values.

Results

Post-surgical AKI was observed in 261 patients (49.53%). LASSO regression identified 25 significant features for the models. Among the six algorithms tested, the radial basis function support vector machine (RBF-SVM) had the highest AUC at 0.771. The 15 most critical features were valve replacement, pre-operative hypertension, large vegetations, NYHA class, alcoholism, age, post-operative low cardiac output syndrome, TyG index, pre-operative creatinine clearance, cardiopulmonary bypass duration, intra-operative red blood cell transfusion, intra-operative urine output, pre-operative hemoglobin levels, and timing of surgery.

Conclusion

Compared to standard cardiac surgery, AKI occurs more frequently and with a more complex etiology in surgeries for active infective endocarditis. Machine learning models enable early prediction of post-surgical AKI, facilitating targeted perioperative optimization and risk stratification in this distinct patient group.

The association between systemic inflammatory response index and contrast-associated acute kidney injury in patients undergoing elective percutaneous coronary intervention

BACKGROUND

The systemic inflammatory response index (SIRI), served as a novel inflammatory biomarker, is the synthesis of neutrophils, monocytes and lymphocytes.

AIMS

We hypothesized that SIRI has predictive value for contrast-associated acute kidney injury (CA-AKI) and long-term mortality in patients undergoing elective percutaneous coronary intervention (PCI).

METHODS

We retrospectively observed 5685 patients undergoing elective PCI from January 2012 to December 2018. Venous blood samples were collected to obtain the experimental data on the day of admission or the morning of the next day. SIRI = neutrophil count × monocyte count/lymphocyte count. CA-AKI was defined as an increase of 50% or 0.3 mg/dl in SCr from baseline within 48 h after contrast exposure.

RESULTS

The incidence of CA-AKI was 6.1% (n = 352). The best cutoff value of SIRI for predicting CA-AKI was 1.39, with a sensitivity of 52.3% and a specificity of 67.3%. [AUC: 0.620, 95% confidence interval (CI): 0.590-0.651, p < 0.001]. After adjusting for potential confounders, multivariate analysis showed that the high SIRI group (SIRI > 1.39) was a strong independent predictor of CA-AKI in patients undergoing elective PCI compared with the low SIRI group (SIRI ≤ 1.39) (odds ratio = 1.642, 95% CI: 1.274-2.116, p < 0.001). Additionally, COX regression analysis showed that SIRI > 1.39 was significantly associated with long-term mortality at a median follow-up of 2.8 years. [Hazard ratio (HR)=1.448, 95%CI: 1.188-1.765; p < 0.001]. Besides, Kaplan-Meier survival curve also indicated that the cumulative rate of mortality was considerably higher in the high SIRI group.

CONCLUSIONS

High levels of SIRI are independent predictors of CA-AKI and long-term mortality in patients undergoing elective PCI.

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.

Prognostic Value of Systemic Inflammation Response Index and N-Terminal Pro-B-Type Natriuretic Peptide in Patients with Myocardial Infarction with Nonobstructive Coronary Arteries- A Retrospective Study

Background

The Systemic Inflammation Response Index (SIRI) and N-terminal Pro-B-type natriuretic peptide (NT-proBNP) have been proposed as reliable predictors of poor prognosis in cardiovascular disease and all-cause mortality, However, their validity has not been extensively evaluated in patients with myocardial infarction with nonobstructive coronary arteries (MINOCA).

Patients and Methods

259 patients diagnosed with MINOCA were enrolled in this study from January 2015 to December 2022, and serum levels of SIRI and NT-proBNP were detected. The primary endpoints were major adverse cardiovascular events (MACE). According to the occurrence of MACE during the follow-up period, patients were grouped into MACE and Non-MACE groups, and divided by the median values for SIRI and NT-proBNP into groups: low SIRI, high SIRI, low NT-proBNP, and high NT-proBNP.

Results

A statistically significant difference in the levels of SIRI and NT-proBNP was observed between the MACE group and the non-MACE group. Kaplan-Meier survival curve analysis revealed that patients with high SIRI and high NT-proBNP had a significantly higher risk of MACE (log-rank P < 0.001). Furthermore, even after adjusting for covariates, the high SIRI and high NT-proBNP were associated with an increased risk of MACE (P<0.001, HR: 3.188, 95% CI 1.940-5.241; P<0.001, HR: 2.245, 95% CI 1.432-3.519). Additionally, the combined prognosis prediction of SIRI and NT-proBNP was superior to a single prediction, and adding SIRI and NT-proBNP to the traditional risk factor model improved the model's predictive value.

Conclusion

High levels of SIRI and NT-proBNP exhibit a significant correlation with an increased risk of MACE, thereby suggesting that SIRI can be used as a reliable inflammatory indicator for predicting the risk in MINOCA patients, with significantly improved prognostic value when combined with NT-proBNP.

Assessing systemic inflammatory markers in psoriasis: A retrospective study

BACKGROUND

Psoriasis is a chronic inflammatory disease often associated with serious cardiovascular comorbidities. The aim of this study was to investigate the systemic inflammatory burden in psoriasis by examining various inflammatory markers and to assess the relationship between these markers and the severity of the disease.

METHODS

This retrospective study was conducted on medical records of patients who visited the dermatology outpatient clinic between 1 January 2016 and 31 December 2022. The study included patients with psoriasis vulgaris and healthy volunteers. Demographic data, Psoriasis Area and Severity Index score, C-reactive protein, monocyte-high-density lipoprotein cholesterol ratio, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, and Systemic Inflammation Response Index were analysed and compared.

RESULTS

A total of 278 psoriasis patients and 90 healthy volunteers were analysed. Compared to the control group, psoriasis patients showed significantly higher systemic immune-inflammation index, Systemic Inflammation Response Index, neutrophil-to-lymphocyte ratio, monocyte-high-density lipoprotein cholesterol ratio, serum C-reactive protein levels, neutrophil count, monocyte count, body mass index, and waist circumference (p < 0.001, p = 0.001, p < 0.001, p = 0.014, p < 0.001, p < 0.001, p = 0.046, p < 0.001, and p = 0.011, respectively). Among patients with severe psoriasis (Psoriasis Area and Severity Index >10), systemic immune-inflammation index, neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and serum C-reactive protein levels were significantly higher compared to patients with mild/moderate psoriasis (Psoriasis Area and Severity Index ≤10). In the ROC curve analysis, the optimal cut-off (AUC, sensitivity, specificity) values for neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, and platelet-to-lymphocyte ratio were found to be 2.11 (0.592, 62%, 57%), 552.9 (0.579, 61%, 58%), and 111.9 (0.578, 64%, 46%), respectively. The inflammatory parameters that showed correlation with Psoriasis Area and Severity Index were systemic immune-inflammation index, Systemic Inflammation Response Index, neutrophil-to-lymphocyte ratio, monocyte-high-density lipoprotein cholesterol ratio, monocyte-to-lymphocyte ratio, and C-reactive protein.

CONCLUSION

The findings of this study suggest that systemic immune-inflammation index, Systemic Inflammation Response Index, neutrophil-to-lymphocyte ratio, monocyte-high-density lipoprotein cholesterol ratio, and C-reactive protein values have the potential to serve as simple and cost-effective markers for assessing the inflammatory burden in individuals with psoriasis.

The effect of dietary oxidation balance scores and volatile organic compounds exposures on inflammation

BACKGROUND

Inflammation is a significant factor in adverse health outcomes, but the combined effects of diets with varying oxidation levels and exposure to volatile organic compounds (VOCs) on inflammation are not well understood. This study aimed to elucidate the effects of the recognized Dietary Oxidative Balance Score (DOBS) and five VOCs on the systemic immune-inflammation index (SII) and C-reactive protein (CRP).

METHODS

This cross-sectional study included data from participants in three cycles (2003-2004, 2005-2006, 2009-2010) of the National Health and Nutrition Examination Survey (NHANES). We used Spearman correlation, logistic regression, and trend tests to explore the associations between DOBS, VOCs, SII, and CRP. Additionally, we conducted restricted cubic spline (RCS) analysis to assess dose-response relationships between exposure and effect. G-computation and stratified analyses were performed to further elucidate these associations.

RESULTS

We included 7033 eligible participants, with 48.8 % males and 51.2 % females. Spearman correlation revealed that DOBS was negatively correlated with SII and CRP, while the five VOCs were positively correlated with SII and CRP. Although fully adjusted logistic regression models did not yield statistically significant results, trend tests indicated a gradual decrease in SII and CRP with increasing DOBS, a finding validated by RCS analysis. G-computation results demonstrated that the combined effect of DOBS and VOCs on inflammation was positive, with DOBS exerting a negative effect and benzene, ethylbenzene, and 1,4-dichlorobenzene exerting positive effects. Stratified analysis showed that maintaining physical activity significantly influenced the effects of DOBS and VOCs on inflammation.

CONCLUSION

This study suggests that adjusting dietary structure and reducing daily exposure to VOCs can effectively reduce inflammation in the body.

Inflammatory Hematological Indices, Cardiovascular Disease and Mortality: A Narrative Review

Cardiovascular diseases (CVDs) are the leading cause of death worldwide, which generates a significant economic burden of billions per year on the healthcare system. Chronic inflammation is known for its importance in the pathogenesis of atherosclerosis and CVDs. Currently, inflammatory hematologic indices, obtained through the results of the complete blood count (CBC), have been characterized as potential prognostic factors for mortality in CVD. These indexes are calculated from neutrophil, lymphocyte, platelet, and monocyte counts, are easily accessible, have simple calculations, and have low cost, which facilitates their application in practice. The aim of this paper was prepare a synthesis of studies that investigated the relationship of inflammatory hematologic indices with cardiovascular risk and mortality. The search was been conducted in PubMed, Scopus, Embase, Web of Science, and Virtual Health Library (VHL) databases. Studies that investigated the association between inflammatory hematologic indices with cardiovascular risk and mortality were been selected. 1,470 studies were obtained in the search, with only 23 being eligible. We found that the hematological index most associated with overall mortality, cardiovascular events, and cardiovascular mortality was the systemic immune-inflammation index (SII) followed by the systemic inflammatory response index (SIRI). The hematological inflammatory indices proved advantageous for screening and identifying patients who have high cardiovascular risk and mortality risk, and may be useful in directing the treatment of these patients, obtaining information about prognosis, and improving risk stratification.

Associations between SII, SIRI, and cardiovascular disease in obese individuals: a nationwide cross-sectional analysis

Background

Systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) are comprehensive markers of inflammatory status. However, the correlation between SII and SIRI and the prevalence of cardiovascular disease (CVD) in populations with obesity remains unknown.

Methods

This is a cross-sectional study with data obtained from the National Health and Nutrition Examination Survey from 1999 to 2018. SII and SIRI were calculated using the following equations: SII = (platelet count × neutrophil count)/lymphocyte count. SIRI = (neutrophil count × monocyte count)/lymphocyte count. Spearman's rank correlation coefficient was used to assess the relationship between SII and SIRI and baseline variables. Logistic regression models and generalized additive model (GAM) with a spline smoothing function were used to evaluate the association between SIRI and CVD prevalence. Nomogram and receiver operating characteristic curve (ROC) analysis were used to assess the value of the risk prediction model.

Results

A total of 17,261 participants with obesity and SII and SIRI publicly available data were used for this study. Multivariate logistic regression analysis revealed that SIRI, rather than SII, was an independent risk factor for CVD prevalence. For every standard deviation increase in SIRI, there was a 13%, 15%, and 28% increase in the odds ratios of CVD prevalence (OR = 1.13, 95% CI: 1.04-1.22, P = 0.01), coronary heart disease (OR = 1.15, 95% CI: 1.05-1.26, P = 0.002), and congestive heart failure (OR = 1.28, 95% CI: 1.16-1.41, P < 0.001). ROC results demonstrated that SIRI had a certain accuracy in predicting CVD prevalence (AUC = 0.604), especially when combined with other variables used in the nomogram (AUC = 0.828). The smooth curve fitting regression analysis demonstrated a significant linear association between the risk of SIRI and the odds ratio of CVD prevalence (P for nonlinear = 0.275).

Conclusions

SIRI is a relatively stable indicator of inflammation and is independently associated with the prevalence of CVD. It may serve as a novel inflammatory indicator to estimate CVD prevalence in populations with obesity.

Usefulness of the Systemic Inflammation Response Index and the Systemic Immune Inflammation Index in Predicting Restenosis After Stent Implantation

Purpose

The systemic inflammation response index (SIRI) and the systemic immune inflammation index (SII) are indicators that reflect the body's overall systemic inflammatory response. Inflammation plays an important role in the pathogenesis of in-stent restenosis (ISR). The aim of this study was to investigate the predictive value of preoperative SIRI and SII for the occurrence of ISR in patients undergoing coronary stent implantation.

Materials and Methods

We retrospectively analyzed the clinical, hematological, and angiographic data of 387 patients who underwent coronary angiography for recurrent angina after coronary stent implantation at Qilu Hospital of Shandong University. Receiver operating characteristic curve (ROC) analysis was used to determine the optimal cutoff values for SIRI and SII to predict ISR. Based on the optimal cutoff values for SIRI and SII, patients were categorized into high-SIRI, low-SIRI, high-SII, and low-SII groups. Multivariate logistic regression models were constructed to assess the predictive value of SIRI and SII for ISR >50% and ISR >70%.

Results

This study included a total of 387 patients who underwent coronary angiography and follow-up at Qilu Hospital of Shandong University. Patients in the high-SIRI group had a higher incidence of ISR than those in the low-SIRI group (ISR >50%: 44.8% vs 30.7%, p = 0.018; ISR >70%: 41.5% vs 4.5%, p < 0.001). In addition, ISR occurred more frequently in patients with a higher SII than in patients with a lower SII (ISR >50%: 52.6% vs 35.7%, p = 0.001; ISR >70%: 51.9% vs 23%, p < 0.001). In multivariate logistic regression analysis, SIRI and SII were found to be independent predictive factors for ISR, both as continuous and categorical variables. In the ROC analysis, the optimal cutoff value for SIRI was set at 0.54 (sensitivity: 84.5%, specificity: 27%), and the optimal cutoff value for SII was set at 545.29 (sensitivity: 44.1%, specificity: 71.7%).

Conclusion

Elevated preoperative SIRI and SII values help predict ISR and may serve as a useful screening tool to perform interventional procedures based on the patient's risk of ISR after stent implantation.

Systemic immune-inflammation index mediates the association between metabolic dysfunction-associated fatty liver disease and sub-clinical carotid atherosclerosis: a mediation analysis

Background

Limited research has been conducted to quantitatively assess the impact of systemic inflammation in metabolic dysfunction-associated fatty liver disease (MAFLD) and sub-clinical carotid atherosclerosis (SCAS). The systemic immune-inflammation index (SII), which integrates inflammatory cells, has emerged as a reliable measure of local immune response and systemic inflammation Therefore, this study aims to assess the mediating role of SII in the association between MAFLD and SCAS in type 2 diabetes mellitus (T2DM).

Method

This study prospectively recruited 830 participants with T2DM from two centers. Unenhanced abdominal CT scans were conducted to evaluate MAFLD, while B-mode carotid ultrasonography was performed to assess SCAS. Weighted binomial logistic regression analysis and restricted cubic splines (RCS) analyses were employed to analyze the association between the SII and the risk of MAFLD and SCAS. Mediation analysis was further carried out to explore the potential mediating effect of the SII on the association between MAFLD and SCAS.

Results

The prevalence of both MAFLD and SCAS significantly increased as the SII quartiles increased (P<0.05). MAFLD emerged as an independent factor for SCAS risk across three adjusted models, exhibiting odds ratios of 2.15 (95%CI: 1.31-3.53, P < 0.001). Additionally, increased SII quartiles and Ln (SII) displayed positive associations with the risk of MAFLD and SCAS (P < 0.05). Furthermore, a significant dose-response relationship was observed (P for trend <0.001). The RCS analyses revealed a linear correlation of Ln (SII) with SCAS and MAFLD risk (P for nonlinearity<0.05). Importantly, SII and ln (SII) acted as the mediators in the association between MAFLD and SCAS following adjustments for shared risk factors, demonstrating a proportion-mediated effect of 7.8% and 10.9%.

Conclusion

SII was independently correlated with MAFLD and SCAS risk, while also acting as a mediator in the relationship between MAFLD and SCAS.

Association between oxidative balance score, systemic inflammatory response index, and cardiovascular disease risk: a cross-sectional analysis based on NHANES 2007-2018 data

Background

There is limited research on the relationship between Systemic Oxidative Stress (SOS) status and inflammatory indices. Adding onto existing literature, this study aimed to examine the association between dietary Oxidative Balance Score (OBS) and lifestyle OBS (which make up the overall OBS), and Cardiovascular Disease (CVD) prevalence at different Systemic Immune Inflammation Index (SII) and Systemic Inflammatory Response Index (SIRI) levels.

Methods

This study involved 9,451 subjects selected from the National Health and Nutrition Examination Survey (NHANES) 2007-2018. The OBS comprised 20 dietary and lifestyle factors. Statistical methods included Weighted Linear Regression Analysis (WLRA), Logistic Regression Analysis (LRA), Sensitivity Analysis (SA), and Restricted Cubic Spline (RCS) analysis.

Results

The multivariate WLRA revealed that OBS was significantly negatively correlated with both SII (β = -5.36, p < 0.001) and SIRI (β = -0.013, p < 0.001) levels. In SA, removing any single OBS component had no significant effect on the WLRA results of SII and SIRI. Further subgroup analyses revealed that OBS was more impactful in lowering SII in women than in men. Additionally, OBS was more significantly negatively correlated with SII and SIRI in the low-age group than in the high-age group. Moreover, RCS analysis confirmed this linear relationship. Compared to dietary OBS, lifestyle OBS exerted a more significant effect on Coronary Artery Disease (CAD) (OR: 0.794, p = 0.002), hypertension (OR: 0.738, p < 0.001), Congestive Heart Failure (CHF) (OR: 0.736, p = 0.005), Myocardial Infarction (MI) (OR: 0.785, p = 0.002), and stroke (OR: 0.807, p = 0.029) prevalence. Furthermore, SIRI exhibited a significant interaction in the relationship between overall OBS, dietary OBS, and CHF (P for interaction < 0.001). On the other hand, SII had a significant interaction in the relationship between overall OBS, dietary OBS, and MI (P for interaction < 0.05).

Conclusion

OBS, including lifestyle and dietary OBS, were significantly negatively associated with SII and SIRI. Higher lifestyle OBS was associated with reduced risks of CAD, hypertension, CHF, MI, and stroke.

Association of systemic inflammatory response index with bone mineral density, osteoporosis, and future fracture risk in elderly hypertensive patients

OBJECTIVES

This study sought to investigate the relationship between the systemic inflammatory response index (SIRI) and bone mineral density (BMD), osteoporosis, and future fracture risk in elderly hypertensive patients.

METHODS

Elderly hypertensive patients (age ≥60 years) who attended our hospital between January 2021 and December 2023 and completed BMD screening were included in the study. Analyses were performed with multivariate logistic and linear regression.

RESULTS

The multiple linear regression indicated that SIRI levels were significantly negatively correlated with lumbar 1 BMD (β = -0.15, 95% CI: -0.24, -0.05), lumbar 2 BMD (β = -0.15, 95% CI: -0.24, -0.05), lumbar 3 BMD (β = -1.35, 95% CI: -0.23, -0.02), lumbar 4 BMD (β = -0.11, 95% CI: -0.30, -0.10), femur neck BMD (β = -0.11, 95% CI: -0.18, -0.05) and Ward's triangle BMD (β = -0.12, 95% CI: -0.20, -0.05) among elderly hypertensive patients, after fully adjusting for confounders. Furthermore, we observed that SIRI was positively associated with future fracture risk in elderly hypertensive patients. Specifically, SIRI was associated with an increased risk of major osteoporotic fractures (β = 0.33) and hip fractures (β = 0.25). The logistic regression analysis indicated that there is an association between the SIRI level and an increased risk of osteoporosis (OR = 1.60, 95% CI = 1.37, 1.87), after fully adjusting for confounders.

CONCLUSIONS

Our findings indicate a potential association between SIRI and BMD, osteoporosis, and the risk of future fractures in elderly hypertensive patients. However, further studies are warranted to confirm these findings.

Association between inflammatory biomarkers and mortality in individuals with type 2 diabetes: NHANES 2005-2018

PURPOSE

This study aimed to examine independent association between inflammatory biomarkers and all-cause mortality as well as cardio-cerebrovascular disease (CCD) mortality among U.S. adults with diabetes.

METHODS

A cohort of 6412 U.S. adults aged 20 or older was followed from the start until December 31, 2019. Statistical models such as Cox proportional hazards model (Cox) and Kaplan-Meier (K-M) survival curves were employed to investigate the associations between the inflammatory biomarkers and all-cause mortality and CCD mortality.

RESULTS

After adjusting for confounding factors, the highest quartile of inflammatory biomarkers (NLR HR = 1.99; 95 % CI:1.54-2.57, MLR HR = 1.93; 95 % CI:1.46-2.54, SII HR = 1.49; 95 % CI:1.18-1.87, SIRI HR = 2.32; 95 % CI:1.81-2.96, nLPR HR = 2.05; 95 % CI:1.61-2.60, dNLR HR = 1.94; 95 % CI:1.51-2.49, AISI HR = 1.73; 95 % CI:1.4 1-2.12)) were positively associated with all-cause mortality compared to those in the lowest quartile. K-M survival curves indicated that participants with an inflammatory biomarker above a certain threshold had a higher risk of both all-cause mortality and CCD mortality (Log rank P < 0.05).

CONCLUSION

Some biomarkers such as NLR, MLR, SII, AISI, SIRI, and dNLR, are significantly associated with all-cause mortality and CCD mortality among U.S. adults with diabetes. The risk of both outcomes increased when the biomarkers surpassed a specific threshold.

The Associations of Two Novel Inflammation Biomarkers, SIRI and SII, with Mortality Risk in Patients with Chronic Heart Failure

Background

The associations of two novel inflammation biomarkers, systemic inflammation response index (SIRI) and systemic immune inflammation index (SII), with mortality risk in patients with chronic heart failure (CHF) are not well-characterized.

Methods

This retrospective cohort study included patients with CHF in two medical centers of Chinese People's Liberation Army General Hospital, Beijing, China. The outcomes of this study included in-hospital mortality and long-term mortality. Associations of SIRI and SII with mortality were assessed using multivariable regressions and receiver operating characteristic (ROC) analyses.

Results

A total of 6232 patients with CHF were included in the present study. We documented 97 cases of in-hospital mortality and 1738 cases of long-term mortality during an average 5.01-year follow-up. Compared with patients in the lowest quartile of SIRI, those in the highest quartile exhibited 134% higher risk of in-hospital mortality (adjusted odds ratio, 2.34; 95% confidence interval [CI], 1.16-4.72) and 45% higher risk of long-term mortality (adjusted hazard ratio, 1.45; 95% CI, 1.25-1.67). Compared with patients in the lowest quartile of SII, those in the highest quartile exhibited 27% higher risk of long-term mortality (adjusted hazard ratio, 1.27; 95% CI, 1.11-1.46). In ROC analyses, SIRI showed better prognostic discrimination than C-reactive protein (area under the curve: 69.39 vs 60.91, P = 0.01, for in-hospital mortality; 61.82 vs 58.67, P = 0.03, for 3-year mortality), whereas SII showed similar prognostic value with C-reactive protein.

Conclusion

SIRI and SII were significantly associated with mortality risk in patients with CHF. SIRI may provide better prognostic discrimination than C-reactive protein.

Risk Factors and Dynamic Nomogram Development for Surgical Site Infection Following Open Wedge High Tibial Osteotomy for Varus Knee Osteoarthritis: A Retrospective Cohort Study

Background

As the worldwide population ages, the population receiving open wedge high tibial osteotomy (OWHTO) is growing, and surgical site infection (SSI) is a rare but fatal surgical complication. This study aimed to identify risk factors independently associated with SSI following OWHTO and develop a predictive nomogram.

Methods

Clinical data of patients who received OWHTO and followed up for more than 12 months in our hospital were retrospectively reviewed. Multivariable logistic regression was performed to determine independent risk factors for SSI and to construct predictive nomograms. The study further illustrated the predictive performance of the model by using the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA).

Results

A total of 1294 eligible patients were included in the study. Multivariate analysis revealed tobacco consumption (OR=3.44, p=0.010), osteotomy size ≥12 mm (OR=3.3, p=0.015), the use of allogeneic bone or artificial bone graft substitutes (allogeneic bone vs none, OR=4.08, p=0.037; artificial bone vs none, OR=5.16, p=0.047), Kellgren-Lawrence (K-L) grade IV (OR=2.5, p=0.046), systemic immune-inflammation index (SII) >423.62 (OR=6.2, p<0.001), high-sensitivity C-reactive protein (HCRP) >2.6 mg/L (OR=2.42, p=0.044), and a higher level of fasting blood glucose (FBG) (OR=1.32, p=0.022) were the independent predictors of SSI. The cutoff score of the model was 148, with a sensitivity of 76.0% and specificity of 81.0%. The concordance index (C-index) and Brier score of the nomogram were 0.856 and 0.017, and the corrected values after 1000 bootstrapping validations were 0.820 and 0.018, respectively. Furthermore, the ROC curve, calibration curve, and DCA exhibited excellent predictive accuracy and clinical applicability of the model.

Conclusion

This study developed a dynamic nomogram based on seven predictors, which allowed surgeons to individualize risk stratification of patients and intervene promptly to reduce SSI rates.

Unveiling the predictive capacity of inflammatory and platelet markers for central retinal artery occlusion

OBJECTIVES

Cell counting in peripheral blood samples and their combinations have gained wide usage in clinical research due to their convenient and minimally invasive sampling method. This study aims to evaluate the predictive value of neutrophil-to-lymphocyte ratio (NLR), systemic Immunoinflammatory Index (SII), and systemic Inflammatory Response Index (SIRI), and platelet distribution width (PDW) for the occurrence of non-arteritic Central retinal artery occlusion (NA-CRAO).

METHODS

We included 123 patients diagnosed with NA-CRAO and 120 age-, sex- and blood pressure-matched individuals in this study. All participants underwent a comprehensive ophthalmic assessment. Peripheral blood samples were retrospectively analysed to obtain patients' blood counts and platelet-related indices, and further NLR, SII and SIRI were calculated.

RESULTS

NLR, SII, SIRI, and PDW were all found to be elevated and significantly different in NA-CRAO patients compared to controls (p < 0.05). Notably, elevated NLR and PDW were identified as independent influences on the development of NA-CRAO, with a combined predicted AUC of 0.876.

CONCLUSION

The utilization of NLR and PDW in NA-CRAO prediction may prove to be more effective compared to SII and SIRI.

Exploring the Correlation Between the Systemic Immune Inflammation Index (SII), Systemic Inflammatory Response Index (SIRI), and Type 2 Diabetic Retinopathy

Purpose

Systemic immune inflammation index (SII), systemic inflammatory response index (SIRI) are new inflammation indicators calculated after integrating multiple indicators in blood routine. This study aims to investigate the correlation between the SII, SIRI and type 2 diabetic retinopathy (T2DR) and the diagnostic significance of these indices in T2DR.

Patients and Methods

A retrospective analysis involved 500 patients diagnosed with type 2 diabetes (T2DM), categorized into two groups based on fundus examination results: the non-diabetic retinopathy group (NDR, n=256) and the diabetic retinopathy group (DR, n=244). We calculated SII and SIRI, and analyzed their associations with T2DR.

Results

The DR group exhibited significantly higher SII and SIRI values compared to the NDR group (P<0.001). Mantel-Haenszel's chi-square trend analysis revealed a notable linear trend (P<0.001) between SII, SIRI, and DR. SII and SIRI exhibited moderate positive correlations with DR, (r=0.354, P<0.001; r=0.469, P<0.001), respectively. Binary logistic regression analysis identified SII and SIRI as independent risk factors for DR. Restrictive cubic spline analysis demonstrated a significant linear relationship between SII and DR (P total trend <0.001, P nonlinear = 0.0657). Stratification by gender indicated that SII is more sensitive to the onset of DR in men. A significant nonlinear relationship was observed between SIRI and DR (P total trend <0.001, P nonlinear = 0.0025), with no gender-related differences in SIRI's association with DR. ROC curve analysis demonstrated that the combined use of SII and SIRI achieved the highest diagnostic accuracy for DR, with an AUC of 0.782, 74.6% sensitivity, and 69.9% specificity.

Conclusion

Our findings suggested that SII and SIRI as independent risk factors for DR. The high accuracy of SII combined with SIRI in diagnosing DR underscores their potential as early biological indicators for DR diagnosis.

U-Shaped Association Between Monocyte-Lymphocyte Ratio and Risk of Cardiac Conduction Block

Purpose

Inflammation plays a critical role in the development of cardiac conduction block (CCB), which is associated with an increased risk of morbidity and mortality. The monocyte-lymphocyte ratio (MLR) acts as a novel inflammatory marker; however, its association with CCB has not yet been studied. This study aimed to investigate the association between MLR and CCB risk.

Patients and Methods

In total, 82,472 CCB-free participants were identified from the Kailuan study. MLR was calculated using the monocyte count/lymphocyte count. The participants were stratified based on quartiles of MLR levels. Incident CCB and its subtypes were ascertained from electrocardiograms at biennial follow-up visits. The Cox proportional hazards model and restricted cubic spline analysis were used to investigate the association between MLR with CCB and its subtypes.

Results

During a median follow-up of 10.4 years, 3222 incident CCB cases were observed. A U-shaped association was observed between MLR and CCB risk (Pnonlinearity <0.05). After multivariate adjustment, individuals in the highest MLR quartile had a hazard ratio (HR) of 1.212 (95% CI: 1.097-1.340; Q4 vs Q2), while those in the lowest MLR quartile had an HR of 1.106 (95% CI: 1.000-1.224; Q1 vs Q2). Sensitivity and subgroup analyses yielded consistent results. The U-shaped association persisted for atrioventricular block (AVB) in subtype analyses.

Conclusion

MLR was significantly associated with an increased risk of new-onset CCB. Assessing MLR may have clinical relevance for predicting CCB risk, providing valuable insights for preventive strategies and patient management.

Pre-Registered Clinical Trial Number

The pre-registered clinical trial number is ChiCTR-TNC-11001489.

Systemic Inflammation Response Index as a Predictor of Stroke Risk in Elderly Patients with Hypertension: A Cohort Study

Objective

This study aimed to evaluate the relationship between the systemic inflammation response index (SIRI) and the risk of stroke and its subtypes in elderly patients with hypertension and to explore its predictive accuracy and any potential effect modifiers.

Methods

The study included 4749 participants with no history of stroke at baseline. Cox regression was used to estimate adjusted hazard ratios (HR) and 95% confidence intervals (CIs). Interaction tests and subgroup analyses were conducted. The predictive performance of various inflammatory indicators for stroke was compared using the area under the curve (AUC), continuous net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results

During a median follow-up period of 3.2 years, 640 strokes were recorded, of which 526 were ischemic and the remainder hemorrhagic. After adjustment for confounders, compared to the reference group, the HRs (95% CI) of stroke were 1.28 (95% CI, 1.01-1.64) and 1.46 (95% CI, 1.14-1.88) for participants in the second and third tertiles, respectively. We observed interactions between SIRI and homocysteine levels (< 15 vs. ≥ 15 μmol/L) (p for interaction = 0.014) on ischemic stroke risk. Furthermore, the AUC, NRI, and IDI analyses demonstrated that SIRI exhibited better predictive value for stroke risk when compared to other indicators. Similar results were observed for both ischemic and hemorrhagic strokes.

Conclusion

Elevated SIRI levels were significantly associated with the risk of stroke and its subtypes in elderly patients with hypertension, suggesting its potential as a promising indicator for stroke risk in this population. However, larger prospective studies are needed to confirm these findings.

System inflammation response index: a novel inflammatory indicator to predict all-cause and cardiovascular disease mortality in the obese population

AIM

This study aims to investigate the relationship between two novel inflammatory markers, namely, the Systemic Inflammatory Response Index (SIRI) and the Systemic Immune Inflammatory Index (SII), as well as the all-cause and cardiovascular disease (CVD) mortality in the obese population.

MATERIALS AND METHODS

We conducted a prospective cohort study based on the data of 13,026 obese adults (age ≥ 18 years) from the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2014 and followed until December 2019. SIRI was calculated by the formula: (neutrophil count × monocyte count) / lymphocyte count, while that of SII was: (platelet count × neutrophil count)/lymphocyte count. The association of SIRI and SII with all-cause and CVD mortality was evaluated using Cox regression. In addition, the nomogram was performed to predict 10-year survival probability.

RESULTS

During a median follow-up of 137 months, 1959 and 553 all-cause and CVD deaths were recorded, respectively. Spearman correlation analysis indicated that SIRI and SII were unrelated to almost all baseline characteristics (r < 0.15). Multivariate Cox regression models displayed that each standard deviation (SD) increase in SIRI was associated with a 16% (HR 1.16; 95% CI 1.09-1.24) and 22% (HR 1.22; 95% CI 1.10-1.36) increase in the risk of all-cause and CVD mortality, respectively. Likewise, every SD increase in SII was correlated with a 9% (HR 1.09; 95% CI 1.02-1.16) and 14% (HR 1.14; 95% CI 1.04-1.26) increase in the risk of all-cause and CVD mortality, respectively. The predictive value of SIRI for all-cause and CVD mortality (AUC = 0.601 and 0.624) exceeded that of SII (AUC = 0.528 and 0.539). Moreover, the nomogram displayed a substantial predictive value for 10-year survival (AUC = 0.847) with sensitivity and specificity exceeding 75%.

CONCLUSIONS

In the obese population, SIRI and SII are independent risk factors for all-cause and CVD mortality. Notably, the predictive ability of SIRI for both all-cause and CVD mortality significantly outperforms that of SII, suggesting that SIRI is a more valuable marker of inflammation.

Systemic Immune-Inflammatory Index as a Novel Biomarker of Carotid Artery Stenosis

In this manuscript, we discussed some points about systemic immune-inflammatory index (SII) and carotid artery stenosis (CAS) and put forward our comments.

Association between systemic immune-inflammation index and risk of lower extremity deep venous thrombosis in hospitalized patients: a 10-year retrospective analysis

Background

The systemic immune-inflammation index (SII), as a novel inflammatory biomarker, has recently attracted attention in cardiovascular disease research. However, the relationship between SII and risk of lower extremity deep venous thrombosis (LEDVT) remains unclear to date. Thus, this study aimed to explore the association in a large sample over a 10-year period (2012-2022).

Methods

All hospitalized patients undergoing lower extremity compression ultrasonography (CUS) examination were consecutively screened by searching our hospital information system database. The receiver operating characteristic (ROC) curve analysis was used to identify the optimal cut-off value for high and low SII group. Multivariate logistic regression analyses were performed to investigate the relationship between SII and LEDVT risk. Propensity score matching (PSM), subgroup and sensitivity analyses were also conducted. Moreover, restricted cubic spline (RCS) regression and two-piecewise linear regression models were used to assess the dose-response relationship between natural log transformed SII [ln(SII)] and risk of LEDVT.

Results

A total of 16,725 consecutive hospitalized patients were included, and 1,962 LEDVT events occurred. After adjusting for confounding factors, patients in the high SII group (≥ 574.2 × 10⁹/L) showed a 1.740-fold risk of LEDVT (95% CI: 1.546-1.959, P < 0.001), and elevated ln(SII) was associated with a 36.1% increased risk of LEDVT (95% CI: 1.278-1.449, P < 0.001). PSM, subgroup and sensitivity analyses confirmed the robustness of the association. A non-linear relationship was observed (P _non-linear< 0.001), with a threshold value of 5.6 × 10⁹/L for all LEDVT events. Above the threshold, each unit increase in ln(SII) had a 1.369-fold higher risk of LEDVT (95% CI: 1.271-1.475, P < 0.001). The association also existed in both distal and proximal LEDVT.

Conclusion

Elevated SII is significantly associated with an increased risk of LEDVT in hospitalized patients. Additionally, the association is non-linear and exhibit a threshold effect.

Assessing the Relationship between Systemic Immune-Inflammation Index and Metabolic Syndrome in Children with Obesity

Childhood obesity represents a worldwide concern as many countries have reported an increase in its incidence, with possible cardiovascular long-term implications. The mechanism that links cardiovascular disease to obesity is related to low-grade inflammation. We designed this study to investigate the diagnostic utility of inflammatory indices (NLR, neutrophil-to-lymphocyte ratio; PLR, platelet-to-lymphocyte ratio; SII, systemic immune-inflammation index; SIRI, systemic inflammation response index) in obese children with metabolic syndrome (MetS) and their relationship with cardiometabolic risk biomarkers, such as the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR), triglyceride-to-high-density lipoprotein cholesterol (TG:HDL-C), and non-high-density lipoprotein cholesterol (non-HDL-C). A total of 191 obese children from one large Romanian reference center was included in the study. Patients were classified in two groups according to the presence (MetS group) or absence (non-MetS group) of metabolic syndrome. According to our results, the SII index proved to have diagnostic value in distinguishing MetS patients among children with obesity (AUC = 0.843, a sensitivity of 0.83, and a specificity of 0.63). Furthermore, the SII was positively associated with cardiometabolic risk biomarkers (HOMA-IR, p < 0.001; TG:HDL-C, p = 0.002; non-HDL-C, p = 0.021), highlighting its possible role as an additional measure of cardiometabolic instability in obese children.

Assessment of Systemic Immune-Inflammation Index and Systemic Inflammation-Response Index in Different Coronary Artery Plaque Types

Coronary computed tomography angiography can evaluate coronary arterial plaque composition with high resolution. We aimed to determine and compare the values of systemic immune-inflammation index (SII) and systemic inflammation-response index (SIRI) in different plaque types. Highest values of SIRI and SII were found in mixed plaque type followed by non-calcified plaque type. SII value of 463.07 predicted one-year major adverse cardiac events (MACE) with a sensitivity of 72.7% and specificity of 64.3% and SIRI value of 1.14 predicted one-year MACE with a sensitivity of 93% and specificity of 62%. Paired analysis of area under the curve (AUC) of the receiver operating characteristic curves showed that SIRI had higher AUC than coronary calcium score and SII. Univariate logistic regression results showed that age, creatinine level, coronary calcium score, SII, and SIRI were the independent predictors of one-year MACE. According to the results of multivariate regression analysis, after adjusting other factors, age, creatinine level, and SIRI were the independent predictors of one-year MACE. SIRI seemed to improve the risk prediction in coronary artery disease. Therefore, special attention may need to be paid to patients who have a high SIRI.

Association of Systemic Immune Inflammation Index with Estimated Pulse Wave Velocity, Atherogenic Index of Plasma, Triglyceride-Glucose Index, and Cardiovascular Disease: A Large Cross-Sectional Study

In the U.S. general population, there is a lack of understanding regarding the association between the systemic immune inflammation (SII) index and estimated pulse wave velocity (ePWV), atherogenic index of plasma (AIP), and triglyceride-glucose (TyG) index and cardiovascular disease (CVD). As a result, the objective of our research was to investigate the association between the SII index and ePWV, AIP, and TyG index and incident CVD. We used the National Health and Nutrition Examination Survey (NHANES) data from 1999 to 2018 to conduct this study. The correlation between the SII index and ePWV, AIP, and TyG index was examined using generalized additive models with smooth functions. In addition, the association between SII index and triglyceride (TC), high-density lipoprotein cholesterol (HDL-C), and fast glucose (FBG) also were explored. Finally, we further performed multivariable logistic regression analysis, restricted cubic spline (RCS) plots, and subgroup analysis to study the connection between the SII index and CVD. Our analysis included 17389 subjects from the NHANES database. A substantial positive association existed between SII, WV, and the TyG index. In addition, with the increase of the SII index, AIP showed a trend of decreasing first, then rising, and then decreasing. The SII index was inversely and linearly associated with triglyceride (TG), while positively and linearly associated with fast glucose (FBG). However, high-density lipoprotein cholesterol (HDL-C) had a tendency of first declining, then climbing, and finally falling with the rise in the SII index. After adjusting for potential confounders, compared with the lowest quartiles, the odds ratios with 95% confidence intervals for CVD across the quartiles were 0.914 (0.777, 1.074), 0.935 (0.779, 1.096), and 1.112 (0.956, 1.293) for SII index. The RCS plot showed an inverse U-shaped curve relationship between the SII index and CVD. Overall, this study found a strong correlation between a higher SII index and ePWV and the TyG index. Additionally, these cross-sectional data also revealed a U-shaped connection between the SII index and CVD.

Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All-Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults

BACKGROUND AND AIM

Chronic low-grade inflammation is associated with various health outcomes, including cardiovascular diseases (CVDs) and cancers. Systemic immune inflammation index (SII) and system inflammation response index (SIRI) have lately been explored as novel prognostic markers for all-cause mortality and cardiovascular mortality. However, studies on prediction value in nationwide representative population are scarce, which limit their generalization. To bridge the knowledge gap, this study aims to prospectively assess the association of SII, SIRI with all-cause mortality and cardiovascular mortality in the National Health and Nutrition Examination Survey (NHANES).

METHODS

From 1999 to 2018, 42,875 adults who were free of pregnancy, CVDs (stroke, acute coronary syndrome), cancers, and had follow-up records and participated in the NHANES were included in this study. SII and SIRI were quantified by calculating the composite inflammation indicators from the blood routine. To explore the characteristics of the population in different SII or SIRI levels, we divided them according to the quartile of SII or SIRI. The associations between SII, SIRI, and all-cause mortality and cardiovascular mortality events were examined using a Cox regression model. To investigate whether there was a reliable relationship between these two indices and mortalities, we performed subgroup analysis based on sex and age.

RESULTS

A total of 42,875 eligible individuals were enrolled, with a mean age of 44 ± 18 years old. During the follow-up period of up to 20 years, 4250 deaths occurred, including 998 deaths from CVDs. Cox proportional hazards modeling showed that adults with SII levels of >655.56 had higher all-cause mortality (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.18-1.41) and cardiovascular mortality (HR, 1.33; 95% CI, 1.11-1.59) than those with SII levels of <335.36. Adults with SIRI levels of >1.43 had higher risk of all-cause (HR, 1.39; 95% CI, 1.26-1.52) and cardiovascular death (HR, 1.39; 95% CI, 1.14-1.68) than those with SIRI levels of <0.68. In general population older than 60 years, the elevation of SII or SIRI was associated with the risk of all-cause death.

CONCLUSION

Two novel inflammatory composite indices, SII and SIRI, were closely associated with cardiovascular death and all-cause death, and more attention should be paid to systemic inflammation to provide better preventive strategies.

High systemic inflammation response index level is associated with an increased risk of lower extremity deep venous thrombosis: a large retrospective study

BACKGROUND

The association between inflammation and venous thromboembolism (VTE) has attracted increasing research interest. Recently, the systemic inflammation response index (SIRI) has been proposed as a novel inflammatory biomarker, but its potential association with lower extremity deep venous thrombosis (LEDVT) has not been investigated. Thus, this study aimed to explore the association between SIRI and LEDVT risk in a large sample over a 10-year period (2012-2022).

METHODS

All hospitalized patients who underwent lower extremity compression ultrasonography (CUS) examinations were consecutively identified from our hospital information system database. Multivariate logistic regression analysis was used to investigate the association between SIRI and LEDVT risk. Sensitivity, restricted cubic spline and subgroup analyses were also performed.

RESULTS

In total, 12643 patients were included, and 1346 (10.6%) LEDVT events occurred. After full adjustment, a higher SIRI level was significantly associated with an increased risk of LEDVT (odds ratio [OR] = 1.098, 95% confidence interval [CI]: 1.068-1.128, p < 0.001), and patients in quartile 4 had a 2.563-fold higher risk of LEDVT than those in quartile 1 (95% CI: 2.064-3.182, p < 0.001). A nonlinear relationship was observed (P for nonlinearity < 0.001), with an inflection point of 4.17. Below this point, each unit increase in SIRI corresponded to a 35.3% increase in LEDVT risk (95% CI: 1.255-1.458, p < 0.001). No significant difference was found above the inflection point (OR = 1.015, 95% CI: 0.963-1.069, p = 0.582). Sensitivity and subgroup analyses confirmed the robustness of the association. This association also existed in both distal and proximal LEDVT.

CONCLUSION

A High SIRI is significantly associated with an increased risk of LEDVT in hospitalized patients. Given that the SIRI is a readily available biomarker in clinical settings, its potential clinical use deserves further exploration.