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. 2025 Feb 26;25(1):90.
doi: 10.1186/s12890-025-03525-z.

The systemic inflammation response index as risks factor for all-cause and cardiovascular mortality among individuals with respiratory sarcopenia

Ying Liu #  1 , Xuejun Yin #  2 , Yutong Guo  3 , Jixiong Xu  4 , Ruitai Shao  5 , Yunyuan Kong  6   7
Affiliations

The systemic inflammation response index as risks factor for all-cause and cardiovascular mortality among individuals with respiratory sarcopenia

Ying Liu et al. BMC Pulm Med. .

Abstract

Background: Respiratory sarcopenia is associated with poor outcomes, yet effective biomarkers for risk stratification remain limited. This study investigates the associations between complete blood count (CBC)-derived inflammatory biomarkers, including neutrophil-to-lymphocyte ratio (NLR), neutrophil-monocyte-to-lymphocyte ratio (NMLR), and systemic inflammation response index (SIRI) and both all-cause and cardiovascular mortality in patients with respiratory sarcopenia.

Methods: We conducted a cohort analysis of 1,673 adults with possible respiratory sarcopenia using data from the National Health and Nutrition Examination Survey (NHANES) from 2007 to 2012, with mortality follow-up through December 31, 2019. Possible respiratory sarcopenia was assessed via peak expiratory flow rate (PEFR). Multivariable Cox regression models evaluated associations between NLR, NMLR, SIRI, and mortality outcomes, adjusted for demographic, socioeconomic, and health-related covariates. Additional CBC-derived biomarkers (PLR, dNLR, MLR, SII) were analysed, and mediation analysis assessed albumin's role as a partial mediator of mortality.

Results: Over a median follow-up of 116 months, 263 deaths occurred, including 68 from cardiovascular causes. Elevated NLR, NMLR, and SIRI were significantly associated with increased risks of all-cause and cardiovascular mortality. SIRI emerged as the strongest predictor, with adjusted hazard ratios (HRs) of 1.65 (95% CI, 1.23-2.22) for all-cause mortality and 3.18 (95% CI, 1.83-5.53) for cardiovascular mortality. Albumin partially mediated the relationship between SIRI and all-cause mortality (12.1%).

Conclusion: Elevated NLR, NMLR, and SIRI are associated with increased mortality risks in respiratory sarcopenia, with SIRI demonstrating the highest predictive power. Integrating SIRI into clinical assessments may aid in identifying high-risk patients, allowing for targeted interventions.

Keywords: All-cause mortality; Cardiovascular mortality; Neutrophil-to-lymphocyte ratio; Neutrophil-to-monocyte-to-lymphocyte ratio; Respiratory sarcopenia; Systemic inflammation response index.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: Ethical clearance for the current study was granted by the National Center for Health Statistics Ethics Review Board, and all participants were required to provide written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of the sample selection from National Health and Nutrition Examination Survey (NHANES) 2007–2012
Fig. 2
Fig. 2
Kaplan–Meier Survival Curves for Mortality Stratified by NLR, NMLR, and SIRI in Patients with possible Respiratory Sarcopenia. A-C All-cause mortality; D-F Cardiovascular mortality. NLR, Neutrophil-to-Lymphocyte Ratio; NMLR, Neutrophil-Monocyte-to-Lymphocyte ratio; SIRI, Systemic Inflammation Response Index
Fig. 3
Fig. 3
Dose–Response Associations for the NLR, NMLR, and SIRI in relation to Mortality in Patients with possible Respiratory Sarcopenia. Adjusted for age, sex, ethnicity, smoking status, drinking status, education level, annual household income, BMI, diabetes, cardiovascular disease, stroke, hypertension, cancer history, eGFR, HDL, TG, TC and albumin. A-C All-cause mortality; D-F Cardiovascular mortality. BMI, body mass index; eGFR, estimated glomerular filtration rate; HDL, High density lipoprotein cholesterol; TC, Cholesterol; TG, Triglycerides; NLR, Neutrophil-to-Lymphocyte Ratio; NMLR, Neutrophil-Monocyte-to-Lymphocyte ratio; SIRI, Systemic Inflammation Response Index
Fig. 4
Fig. 4
The mediating effect of albumin on the relationship between SIRI and survival. Adjusted for age, sex, ethnicity, smoking status, drinking status, education level, annual household income, BMI, diabetes, cardiovascular disease, stroke, hypertension, cancer history, eGFR, HDL, TG, and TC. A All-cause mortality; B Cardiovascular mortality. BMI, body mass index; eGFR, estimated glomerular filtration rate; HDL, High density lipoprotein cholesterol; TC, Cholesterol; TG, Triglycerides; SIRI, Systemic Inflammation Response Index
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References

    1. Kera T, Kawai H, Hirano H, Kojima M, Watanabe Y, Motokawa K, Fujiwara Y, Ihara K, Kim H, Obuchi S. Definition of Respiratory Sarcopenia With Peak Expiratory Flow Rate. J Am Med Dir Assoc. 2019;20:1021–5. - PubMed
    1. Miyazaki S, Tamaki A, Wakabayashi H, Arai H. Definition, diagnosis, and treatment of respiratory sarcopenia. Curr Opin Clin Nutr Metab Care. 2024;27:210–8. - PubMed
    1. Nagano A, Wakabayashi H, Maeda K, Kokura Y, Miyazaki S, Mori T, Fujiwara D. Respiratory Sarcopenia and Sarcopenic Respiratory Disability: Concepts, Diagnosis, and Treatment. J Nutr Health Aging. 2021;25:507–15. - PMC - PubMed
    1. Sato S, Miyazaki S, Tamaki A, Yoshimura Y, Arai H, Fujiwara D, Katsura H, Kawagoshi A, Kozu R, Maeda K, Ogawa S, Ueki J, Wakabayashi H. Respiratory sarcopenia: A position paper by four professional organizations. Geriatr Gerontol Int. 2023;23:5–15. - PMC - PubMed
    1. Morisawa T, Kunieda Y, Koyama S, Suzuki M, Takahashi Y, Takakura T, Kikuchi Y, Matsuda T, Fujino Y, Sawa R, Sakuyama A, Saitoh M, Takahashi T, Fujiwara T. The Relationship between Sarcopenia and Respiratory Muscle Weakness in Community-Dwelling Older Adults. Int J Environ Res Public Health. 2021;18:13257. - PMC - PubMed

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