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. 2025 Aug 6:80:100739.
doi: 10.1016/j.clinsp.2025.100739. Online ahead of print.

Association between systemic immune-inflammation index and all-cause and CVD mortality in non-elderly diabetic adults

Bing Hu  1 , Tong Liu  1 , Yanxiang Sun  1 , Jie Sun  1 , Li Feng  1 , Fei Li  2
Affiliations

Association between systemic immune-inflammation index and all-cause and CVD mortality in non-elderly diabetic adults

Bing Hu et al. Clinics (Sao Paulo). .

Abstract

Background: The Systemic Immune-Inflammation Index (SII) is widely studied for its role in evaluating Cardiovascular Disease (CVD) and mortality. However, its association with all-cause and CVD mortality in non-elderly diabetic adults remains unclear. This study aims to explore the relationship between SII and both all-cause and CVD mortality in non-elderly diabetic adults in the United States.

Methods: Cox proportional hazards models and subgroup analyses were used to assess the link between SII and mortality. Restricted Cubic Splines (RCS) examined the nonlinear association between SII and mortality.

Results: Data from 4680 participants in NHANES (2001‒2018) were analyzed. Over an average follow-up of 98.3 months, there were 625 all-cause deaths and 162 CVD-related deaths. Participants were categorized into two SII groups (higher: > 947.625, lower: ≤ 947.625). Multivariable-adjusted models showed that higher SII levels were significantly associated with an increased risk of both CVD mortality (HR = 3.05; 95 % CI 1.85, 5.01) and all-cause mortality (HR = 1.97; 95 % CI 1.50, 2.58). Subgroup analyses confirmed the consistency of these associations. RCS analysis revealed a nonlinear relationship between SII and all-cause mortality, while the association with CVD mortality was linear.

Conclusion: Higher SII levels in non-elderly diabetic adults in the U.S. are linked to an increased risk of both CVD and all-cause mortality.

Keywords: Cardiovascular disease; Diabetes; Mortality; Systemic immune-inflammation index.

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Conflict of interest statement

Declaration of competing interest The authors declare no conflicts of interest.

Figures

Fig 1
Fig. 1
Flowchart for selecting participants from NHANES 2001–2008.
Fig 2
Fig. 2
Weighted Kaplan-Meier plots illustrate SII's association with all-cause mortality and CVD mortality.
Fig 3
Fig. 3
RCS analysis of the association between SII and mortality.
See this image and copyright information in PMC

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