Associations of CBC-Derived inflammatory indicators with sarcopenia and mortality in adults: evidence from Nhanes 1999 ∼ 2006

Abstract

Background: It has been proposed that inflammation plays a role in the development of sarcopenia. This study aimed to investigate the links of complete blood cell count (CBC) parameters and CBC-derived inflammatory indicators with sarcopenia and mortality.

Methods: Data pertaining to sarcopenia were extracted from the 1999-2006 National Health and Nutrition Examination Survey (NHANES), and mortality events were ascertained through the National Death Index up to December 31, 2019. The CBC-derived inflammatory indicators assessed in this study included the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-monocyte to lymphocyte ratio (NMLR), systemic inflammatory response index (SIRI), and systemic immune-inflammation index (SII). The prognostic significance of these CBC-derived inflammatory indicators was evaluated using the random survival forests (RSF) analysis.

Results: The study encompassed a cohort of 12,689 individuals, among whom 1,725 were diagnosed with sarcopenia. Among individuals with sarcopenia, 782 experienced all-cause mortality, and 195 succumbed to cardiovascular causes. Following adjustment for confounding variables, it was observed that elevated levels of NLR, dNLR, NMLR, SIRI, and SII were associated with an increased prevalence of sarcopenia. Among participants with sarcopenia, those in the highest quartile of NLR (HR = 1.336 [1.095-1.631]), dNLR (HR = 1.274 [1.046-1.550]), MLR (HR = 1.619 [1.290-2.032]), NMLR (HR = 1.390 [1.132-1.707]), and SIRI (HR = 1.501 [1.210-1.862]) exhibited an elevated risk of all-cause mortality compared to those in the lowest quartile of these inflammation-derived indicators. These associations were similarly observed in cardiovascular mortality (HR = 1.874 [1.169-3.003] for MLR, HR = 1.838 [1.175-2.878] for SIRI). The RSF analysis indicated that MLR exhibited the highest predictive power for both all-cause and cardiovascular mortality among individuals with sarcopenia.

Conclusions: Our findings underscore the association between CBC-derived inflammatory indicators and mortality in adults with sarcopenia. Of note, MLR emerged as the most robust predictor of all-cause and cardiovascular mortality in this population.

Keywords: CBC-derived inflammatory indicators; Mortality; NHANES; Random survival forests; Sarcopenia.

Fig. 1

Application of restricted cubic spline (RCS) regression to examine the association between complete blood cell (CBC)-derived indicators and all-cause mortality in the adult sarcopenic population. Model was adjusted as age (< 39, 40–59, or > 59), sex (male or female), race/ethnicity (Mexican American, Other Hispanic, Non-Hispanic White, Non-Hispanic Black or Other), education level (below high school, high school, or above high school), family poverty income ratio (≤ 1.0, 1.1–3.0, or > 3.0), drinking status (nondrinker, low-to-moderate drinker, or heavy drinker), smoking status (never smoker, former smoker, or current smoker), physical activity (inactive, insufficiently active, or active), total energy intakes (in quartiles), self-reported diabetes (yes or no), and self-reported hypertension (yes or no)

Fig. 2

Application of restricted cubic spline (RCS) regression to examine the association between complete blood cell (CBC)-derived indicators and cardiovascular mortality in the adult sarcopenic population. Model was adjusted as age (< 39, 40–59, or > 59), sex (male or female), race/ethnicity (Mexican American, Other Hispanic, Non-Hispanic White, Non-Hispanic Black or Other), education level (below high school, high school, or above high school), family poverty income ratio (≤ 1.0, 1.1–3.0, or > 3.0), drinking status (nondrinker, low-to-moderate drinker, or heavy drinker), smoking status (never smoker, former smoker, or current smoker), physical activity (inactive, insufficiently active, or active), total energy intakes (in quartiles), self-reported diabetes (yes or no), and self-reported hypertension (yes or no)

Fig. 3

Prognostic value of complete blood cell (CBC)-derived indicators. Spearman correlation analysis was used to calculate the correlation coefficients among CBC parameters and CBC-derived inflammatory indicators (A). The random survival forests (RSF) method was used to compare the value of CBC parameters and CBC-derived inflammatory indicators in predicting all-cause mortality (B) and cardiovascular mortality (C) among adults with sarcopenia. Model was adjusted as age (< 39, 40–59, or > 59), sex (male or female), race/ethnicity (Mexican American, Other Hispanic, Non-Hispanic White, Non-Hispanic Black or Other), education level (below high school, high school, or above high school), family poverty income ratio (≤ 1.0, 1.1–3.0, or > 3.0), drinking status (nondrinker, low-to-moderate drinker, or heavy drinker), smoking status (never smoker, former smoker, or current smoker), physical activity (inactive, insufficiently active, or active), total energy intakes (in quartiles), self-reported diabetes (yes or no), and self-reported hypertension (yes or no)