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. 2025 Jul 22;15(1):26545.
doi: 10.1038/s41598-025-12094-4.

Relationship between aggregate index of systemic inflammation and mortality from CCD and malignant neoplasms in diabetic patients

Zhihui Li #  1 , Hua Li #  1 , Peng Wang #  1 , Wei Xie  2 , Guo Shao #  3 , Hongwei Zhu #  4
Affiliations

Relationship between aggregate index of systemic inflammation and mortality from CCD and malignant neoplasms in diabetic patients

Zhihui Li et al. Sci Rep. .

Abstract

Inflammation has been recognized as a pivotal factor in the pathophysiology of diabetes. The aggregate index of systemic inflammation (AISI) has recently been proposed as a novel biomarker for evaluating inflammatory status and predicting clinical outcomes. However, evidence on the association between AISI and mortality in diabetic patients remains limited. To address this knowledge gap, we aimed to investigate the association between AISI and mortality risk from cardio-cerebrovascular disease (CCD) and malignant neoplasms in diabetic patients. We analyzed data from the National Health and Nutrition Examination Survey (NHANES, 2001-2018). Multivariable-adjusted Cox models revealed strong associations between elevated AISI levels and CCD mortality (HR 1.18, 95% CI 1.11-1.26) as well as malignant neoplasm mortality (HR 1.20, 95% CI 1.10-1.30). Kaplan-Meier analysis showed that higher AISI was associated with lower survival in diabetic patients for both CCD and malignant neoplasms. Restricted cubic spline (RCS) analysis demonstrated an increased risk of mortality from CCD and malignant neoplasms in diabetic patients with elevated AISI levels. Subgroup and sensitivity analyses confirmed the robustness of these findings. In adults with diabetes, elevated AISI levels are strongly associated with an increased risk of mortality from CCD and malignant neoplasms.

Keywords: Aggregate index of systemic inflammation (AISI); Cardio-cerebrovascular disease (CCD) mortality; Diabetes; Malignant neoplasm mortality.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Ethics statement: Studies involving human participants were reviewed and approved by the National Health and Nutrition Examination Survey (NHNES). The patients provided written informed consent to participate in the study.

Figures

Fig. 1
Fig. 1
Flow chart of the sample selection process.
Fig. 2
Fig. 2
RCS curve of AISI with CCD mortality (A) and malignant neoplasm mortality (B) in diabetic patients. Adjusted for age, gender, race, poverty income ratio, serum albumin, smoking status, serum uric acid, red blood cell count, insulin user, oral hypoglycemic agent use, diabetes duration, HBA1C, and AST. The solid and red shadow represents the estimated values and their 95% CIs, respectively. Linear relationships were observed in all Figures.
Fig. 3
Fig. 3
Kaplan–Meier survival curves for CCD mortality and malignant neoplasm mortality in the AISI group.
Fig. 4
Fig. 4
Forest plot of the association between AISI and CCD mortality and malignant neoplasm mortality in diabetic patients.
See this image and copyright information in PMC

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