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. 2025 Jul 1;26(1):322.
doi: 10.1186/s12882-025-04223-y.

Prognostic implications of systemic immune-inflammation index and systemic inflammation response index in hemodialysis patients

Qianqian Zhu  1 , Liang Dai  2
Affiliations

Prognostic implications of systemic immune-inflammation index and systemic inflammation response index in hemodialysis patients

Qianqian Zhu et al. BMC Nephrol. .

Abstract

Objectives: Patients undergoing hemodialysis (HD) face high mortality, mainly from cardiovascular disease (CVD), infections, and dialysis withdrawal. Systemic inflammation contributes significantly to these outcomes. This study aimed to examine the associations between the systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) with all-cause, CVD, and infection-related mortality in HD patients, and to evaluate their prognostic value.

Methods: We conducted a retrospective analysis of 1190 HD patients recruited between January 2012 and December 2016. Kaplan-Meier survival curves, Cox regression analysis, and restricted cubic spline (RCS) models were employed to explore the associations between SII, SIRI, and all-cause, CVD, and infection-related mortality. In addition, receiver operating characteristic (ROC) curves was used to determine the predictive accuracy of SII and SIRI.

Results: Among the 1190 patients (median age 62.0 years; 64.0% male), the all-cause mortality rate was 38.2%, while the CVD mortality rate was 16.9%. Adjusted Cox regression analyses revealed that patients in the highest SIRI quartile (quartile 4) had significantly elevated risks of all-cause (hazard ratio [HR] 2.29, 95% CI 1.38-3.80, P = 0.001), CVD (HR 3.78, 95% CI 1.43-10.01, P = 0.007), and infection-related mortality (HR 2.42, 95% CI 1.70-3.01, P < 0.001) compared to those in the lowest SIRI quartile. Similar associations were found for SII (P < 0.001). Kaplan-Meier curves demonstrated comparable results. RCS analysis revealed nonlinear relationships between SII, SIRI, and mortality risk (P < 0.05). ROC analysis highlighted that Both SII and SIRI demonstrated moderate to strong prognostic value, with SIRI consistently offering the best risk stratification.

Conclusions: Elevated levels of SII and SIRI are linked to higher risks of all-cause, CVD, and infection-related mortality in HD patients. SIRI appears to be a more reliable predictor of mortality risk. Future studies should explore the underlying mechanisms and validate the predictive value of SII and SIRI for mortality risk among HD patients.

Clinical trail number: Not applicable.

Keywords: All-cause mortality; Cardiovascular disease mortality; Hemodialysis; Systemic immune-inflammation index; Systemic inflammation response index.

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Conflict of interest statement

Declarations. Human ethics and consent to participate declarations: Ethics Committee of The Traditional Chinese Medicine Hospital of Pujiang County approved the study (2024C04), Written informed consent was obtained from all study subjects in accordance with the Declaration of Helsinki. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of patient inclusion and exclusion for this study. HD, hemodialysis
Fig. 2
Fig. 2
Restricted cubic spline analysis between SIRI and the risk of all-cause mortality (A), CVD mortality (C), and infection-related mortality (E) in participants with hemodialysis. Restricted cubic spline analysis between SII and the risk of all-cause mortality (B), CVD mortality (D), and infection-related mortality (F) in participants with hemodialysis. Blue lines represent references for odds ratios, and blue areas represent 95% confidence intervals. The model was adjusted for age, sex, body mass index, time on dialysis, primary kidney disease, marital status, education level, smoking and drinking status, annual family income, hypertension, diabetes mellitus, hypotension, cardiovascular disease, hemoglobin, albumin, calcium, phosphate, creatinine, C-reactive protein, ferritin, blood urea nitrogen, uric acid, estimated glomerular filtration rate, fasting blood-glucose, total cholesterol, triglycerides, high-density lipoprotein cholesterol, and low-density lipoprotein cholesterol
Fig. 3
Fig. 3
Kaplan-Meier analysis of all-cause mortality (A), CVD mortality (C), and infection-related mortality (E) based on SII groups among individuals with hemodialysis. Kaplan-Meier analysis of all-cause mortality (B), CVD mortality (D), and infection-related mortality (F) based on SIRI groups among individuals with hemodialysis
Fig. 4
Fig. 4
The time-dependent ROC curves for displaying the predictive abilities of different systemic inflammatory indicators (SII and SIRI). SII: systemic immune-inflammation index; SIRI: systemic inflammation response index; ROC: receiver operating characteristic
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