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. 2025 Jul 8:13:1514016.
doi: 10.3389/fpubh.2025.1514016. eCollection 2025.

Systemic immune-inflammation index and systemic inflammation response index levels are associated with coronary heart disease prevalence in the asthmatic population: a cross-sectional analysis of the NHANES 2011-2018

Xian Wu  1 , Haiyang Zhang  2 , Hanmin Liu  1
Affiliations

Systemic immune-inflammation index and systemic inflammation response index levels are associated with coronary heart disease prevalence in the asthmatic population: a cross-sectional analysis of the NHANES 2011-2018

Xian Wu et al. Front Public Health. .

Abstract

Background: Earlier studies have indicated a positive correlation systemic immune-inflammatory index (SII) and systemic inflammatory response index (SIRI) levels and the development of coronary heart disease (CHD). However, the correlation between SII, SIRI levels and the incidence of CHD in patients with asthma has not been described. The purpose of the study was to research the potential correlation between the levels of SII, SIRI and the incidence of CHD in patients with asthma.

Methods: We conducted a retrospective cross-sectional analysis in which data of individuals from the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018. This study included 39,156 adults. Weighted multivariable regression analysis and subgroup analyses were used to assess the independent and combined associations between CHD prevalence and SII, SIRI levels of asthmatic population.

Results: Totally, 2,321 adults were included in our analysis, with 116 participants experiencing CHD and the remaining 2,205 participants being free of CHD. SII levels did not significantly correlate with any of the participants' baseline characteristics, nor did SIRI levels (r < 0.1). Higher levels of SII were related to increased incidence of CHD, with an OR of 1.462 (95% CI, 1.031-1.893) (p < 0.001). Similarly, SIRI levels had similar results, with OR of 1.268 (95% CI, 1.095-1.441) (p < 0.05). Positive correlations between SII, SIRI levels and the incidence of CHD were observed (p < 0.05). Curve fitting further illustrated a positive correlation between SII, SIRI and the incidence of CHD in participants with asthma. Threshold effect analysis showed that higher levels of SII and SIRI were associated with a higher incidence of CHD, especially when SII and SIRI levels exceeded the thresholds of 411.238 and 1.812. Stratified analyses confirmed that the associations between higher SII and SIRI and increased CHD incidence in most subgroups remained consistent.

Conclusions: The incidence of CHD in asthmatic individuals was positively correlated with elevated SII and SIRI levels among US adults. SII and SIRI serve as recently emerged inflammatory markers for assessing CHD prevalence in the asthmatic population. However, in order to confirm these findings, more rigorous large-scale prospective studies are needed.

Keywords: NHANES; asthma; coronary heart disease; systemic immune-inflammation index; systemic inflammation response index.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Flowchart depicting the exclusion process from the NHANES 2011-2018 study. Starting with 39,156 participants, 15,331 were excluded for being under 18. Non-asthmatic patients accounting for 21,099 were removed, leaving 2,726. Another 233 were excluded for lacking SII or SIRI data, and 172 more for missing CHD data, resulting in a final count of 2,321 participants.
Figure 1
Flowchart of the sample selection from NHANES 2011–2018.
Graphs A and B show the relationship between Coronary Heart Disease (CHD) and systemic inflammation index (SII) and systemic immune-inflammation response index (SIRI), respectively, with increasing values corresponding to higher CHD risk. Graphs C and D show the probability of CHD in different genders for SII and SIRI. In both groups, the risk of CHD is higher in men than in women when the SII and SIRI at lower intervals. However, when the SII and SIRI values are high, the prevalence of CHD in women rises rapidly and exceeds that of men. Solid line 1 represents men, and dotted line 2 represents women.
Figure 2
Smooth curve fitting detected the relationship between SII, SIRI and CHD. (A) The non-linear relationship between SII and the incidence of CHD in participants diagnosed with asthma. (B) Differences in CHD incidence risk between men and women at different SII levels. 1 represents men, and 2 represents women. (C) The non-linear relationship between SIRI and the incidence of CHD in participants diagnosed with asthma. (D) Differences in CHD incidence risk between men and women at different SIRI levels. 1 represents men, and 2 represents women.
Two forest plots labeled A and B compare various health factors against an outcome. Plot A includes comparisons like gender, age, BMI, and smoking status, with p-values indicating statistical significance in categories like age and smoking. Plot B similarly compares these factors but shows different significant results. Each plot shows confidence intervals and odds ratios for each category, with central squares indicating the effect size. Both plots highlight smoking and BMI as significant, but specific interactions differ.
Figure 3
Subgroup analysis of the association between SII and SIRI levels and CHD prevalence in the asthmatic population. (A) Subgroup analysis of the association between SII levels and CHD prevalence. (B) Subgroup analysis of the association between SIRI levels and CHD prevalence.
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