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. 2025 Jul 1;25(1):460.
doi: 10.1186/s12876-025-04064-x.

Pan-immune-inflammation value and mortality in the US adult MASLD: a nonlinear NHANES analysis

Qing Zhou  1 , Jisu Xue  2 , Lu Hao  3
Affiliations

Pan-immune-inflammation value and mortality in the US adult MASLD: a nonlinear NHANES analysis

Qing Zhou et al. BMC Gastroenterol. .

Abstract

Background and aim: Systemic inflammatory markers derived from immune cell counts have been associated with mortality risk in metabolic dysfunction-associated steatotic liver disease (MASLD). However, the clinical relevance of the pan-immune-inflammation value (PIV), a composite index incorporating neutrophil, platelet, monocyte, and lymphocyte counts, in relation to mortality has not been fully elucidated. This study aimed to evaluate the association between PIV and both all-cause and cardiovascular mortality in individuals with MASLD.

Methods: In this population-based cohort study, 15,471 participants with MASLD were identified from the 1999-2018 National Health and Nutrition Examination Survey (NHANES). Baseline demographic characteristics, including age, sex, and ethnicity, were collected. Multivariate Cox proportional hazards models and restricted cubic spline analyses were employed to examine the associations between PIV and mortality outcomes.

Results: In fully adjusted models, log-transformed PIV (LnPIV) was independently associated with higher risks of all-cause (hazard ratio [HR] 1.26; 95% confidence interval [CI], 1.14-1.38) and cardiovascular mortality (HR 1.31; 95% CI, 1.10-1.56). Notably, a U-shaped nonlinear association was observed between PIV and all-cause mortality, while a J-shaped relationship was found for cardiovascular mortality. These associations were more pronounced among individuals with a poverty-income ratio (PIR) < 1, suggesting increased vulnerability in socioeconomically disadvantaged populations.

Conclusion: PIV may be a biomarker associated with increased mortality risk in individuals with MASLD, particularly among those from lower socioeconomic backgrounds. These findings underscore the association between PIV and mortality risk and highlight the need for further prospective validation to evaluate its potential role in risk stratification.

Keywords: MASLD; Metabolic dysfunction-associated steatotic liver disease; Mortality; NHANES; Systemic inflammation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: All protocols were approved by the NCHS Ethics Review Board, and participants have provided written informed consent. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Flowchart of study population selection, NHANES 1999–2018
Fig. 2
Fig. 2
KM survival analysis of PIV and all-cause and CVD-related survival in MASLD populations. A: All-cause; B: CVD-cause
Fig. 3
Fig. 3
RCS analysis of the association of PIV with all-cause and CVD mortality in participants with MASLD. A All-cause mortality; B CVD mortality
Fig. 4
Fig. 4
Stratified analysis of the association of PIV with all-cause mortality in participants with MASLD
Fig. 5
Fig. 5
Stratified analysis of the association of PIV with CVD mortality in participants with MASLD
See this image and copyright information in PMC

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