Higher systemic immune-inflammation index and systemic inflammation response index levels are associated with stroke prevalence in the asthmatic population: a cross-sectional analysis of the NHANES 1999-2018

Abstract

Background: Significant evidence suggests that asthma might originate from low-grade systemic inflammation. Previous studies have established a positive association between the systemic immune-inflammation index (SII) and the systemic inflammation response index (SIRI) levels and the risk of stroke. However, it remains unclear whether SII, SIRI and the prevalence of stroke are related in individuals with asthma.

Methods: The present cross-sectional study used data from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2018. SII was calculated using the following formula: (platelet count × neutrophil count)/lymphocyte count. SIRI was calculated using the following formula: (neutrophil count × monocyte count)/lymphocyte count. The Spearman rank correlation coefficient was used to determine any correlation between SII, SIRI, and the baseline characteristics. Survey-weighted logistic regression was employed to calculate odds ratios (ORs) and 95% confidence intervals (CIs) to determine the association between SII, SIRI, and stroke prevalence. The predictive value of SII and SIRI for stroke prevalence was assessed through receiver operating characteristic (ROC) curve analysis, with the area under the ROC curve (AUC) being indicative of its predictive value. Additionally, clinical models including SIRI, coronary heart disease, hypertension, age, and poverty income ratio were constructed to evaluate their clinical applicability.

Results: Between 1999 and 2018, 5,907 NHANES participants with asthma were identified, of which 199 participants experienced a stroke, while the remaining 5,708 participants had not. Spearman rank correlation analysis indicated that neither SII nor SIRI levels exhibited any significant correlation with the baseline characteristics of the participants (r<0.1). ROC curves were used to determine the optimal cut-off values for SII and SIRI levels to classify participants into low- and high-level groups. Higher SII and SIRI levels were associated with a higher prevalence of stroke, with ORs of 1.80 (95% CI, 1.18-2.76) and 2.23 (95% CI, 1.39-3.57), respectively. The predictive value of SIRI (AUC=0.618) for stroke prevalence was superior to that of SII (AUC=0.552). Furthermore, the clinical model demonstrated good predictive value (AUC=0.825), with a sensitivity of 67.1% and specificity of 87.7%.

Conclusion: In asthmatics, higher levels of SII and SIRI significantly increased the prevalence of stroke, with its association being more pronounced in individuals with coexisting obesity and hyperlipidaemia. SII and SIRI are relatively stable novel inflammatory markers in the asthmatic population, with SIRI having a better predictive value for stroke prevalence than SII.

Keywords: asthma; cross-sectional; national health and nutrition examination survey; stroke; systemic immune-inflammation index; systemic inflammation response index.

Figure 1

The study flow.

Figure 2

(A) Comparison of the predictive value of SII and SIRI for stroke prevalence. (B) Nomogram of ROC curves for predicting stroke prevalence in asthmatic populations. ROC, receiver operating characteristic. (C) Nomogram for predicting the probability of stroke prevalence. The top horizontal line is the score column, and the total score added item by item according to the score of each item corresponds to the probability of stroke in a patient with asthma. Age, SIRI, and PIR indicate the value of an individual. In the coronary artery disease and hypertension groups, 0 indicates “no” and 1 indicates “yes”. SIRI, systemic inflammation response index; PIR, poverty income ratio.

Figure 3

(A) Subgroup analysis was performed by comparing the risk of stroke prevalence (odds ratios, 95% CIs) in the high SII and low SII groups. The results were expressed as the risk of stroke prevalence in the high SII group compared with the low SII group in the different strata. (B) Subgroup analysis was performed by comparing the risk of stroke prevalence (odds ratios, 95% CIs) in the high SIRI and low SIRI groups. The results were expressed as the risk of stroke prevalence in the high SIRI group compared with the low SIRI group in the different strata. ORs were fully adjusted by the following covariates including age, race, PIR, eGFR, education levels, diabetes mellitus, coronary heart disease, hyperlipidemia, hypertension, alcohol use, antihypertensive medication, diabetes medications.