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. 2024 Nov 24;16(1):282.
doi: 10.1186/s13098-024-01536-0.

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

Fan Zhang  1   2   3 , Yan Han  1   2   3 , Yonghua Mao  1   2 , Wenjian Li  4   5
Affiliations

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

Fan Zhang et al. Diabetol Metab Syndr. .

Abstract

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.

Keywords: All-cause mortality; Cardiovascular mortality; Diabetic nephropathy; Kidney disease mortality; Systemic immune-inflammation index; Systemic inflammation response index.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The studies involving humans were approved by National Center for Health Statistics Ethics Review Board. The studies were conducted in accordance with the local legislation and institutional requirements. The participants provided their written informed consent to participate in this study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Participant screening flowchart. Abbreviations: SII: Systemic immune inflammation index; SIRI: Systemic inflammation response index
Fig. 2
Fig. 2
Levels of SII (A) and SIRI (B) of different CKD stages in patients with diabetic nephropathy. Abbreviations: SII: Systemic immune inflammation index; SIRI: Systemic inflammation response index; CKD: chronic kidney disease
Fig. 3
Fig. 3
Kaplan‒Meier curves illustrating the effect of the SII and SIRI on mortality outcomes. A, B: Kaplan‒Meier curves for all-cause mortality stratified by the SII and SIRI. C, D: Kaplan‒Meier curves for cardiovascular mortality stratified by the SII and SIRI. E, F: Kaplan‒Meier curves for kidney disease mortality stratified by the SII and SIRI. In the Kaplan-Meier curves, the population is stratified into four groups based on the quartiles of SII and SIRI, and statistical analysis is conducted using the log-rank test. Abbreviations: SII: Systemic immune inflammation index; SIRI: Systemic inflammation response index
Fig. 4
Fig. 4
Restricted cubic spline fitting for the association between mortality and the SII and SIRI. A, B: all-cause mortality according to the SII and SIRI; C, D: cardiovascular mortality according to the SII and SIRI. E, F: kidney disease mortality according to the SII and SIRI. Solid lines indicate HR, and shaded areas indicate 95% CI. These analyses were adjusted according to Model 3. Abbreviations: SII: Systemic immune inflammation index; SIRI: Systemic inflammation response index; HR: Hazard ratio; CI: Confidence interval
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