Predicting MACE Through Systemic Inflammation Response Index: NHANES Based Analysis

Abstract

Purpose

Inflammation is widely recognized for its significant association with major adverse cardiovascular events (MACE). Our study aims to evaluate this relationship and predictive efficacy using the Systemic Inflammation Response Index (SIRI).

Method

In our study, we analyzed 9,450 adults aged 18 years and older from NHANES 2017-2018. We evaluated inflammatory status using the Systemic Inflammation Response Index (SIRI) and conducted ROC analysis to determine its predictive ability. Additionally, we employed three logistic regression models to assess the association of SIRI with Major Adverse Cardiovascular Events (MACE). The first model considered SIRI alone, the second model combined SIRI with hs-CRP and ferritin, and the third model included additional factors such as age, gender, race, education, asthma, diabetes, hypertension, and estimated glomerular filtration rate.

Result

ROC analysis was used to determine the SIRI cut-off points for predicting non-fatal myocardial infarction, stroke, angina, and heart failure, yielding values of 1.1195 (AUC=0.639, 95% CI: 0.606-0.672), 1.0594 (AUC=0.583, 95% CI: 0.549-0.616), 0.9882 (AUC=0.524, 95% CI: 0.506-0.543), and 1.1074 (AUC=0.646, 95% CI: 0.607-0.685), respectively. Despite various influencing factors in Model 3, SIRI showed significant associations with each MACE. These events included myocardial infarction (AOR=1.979, 95% CI: 1.537-2.548), stroke (AOR=1.399, 95% CI: 1.093-1.790), angina (AOR=1.979, 95% CI: 1.537-2.548), and heart failure (AOR=2.586, 95% CI: 1.742-3.837).

Conclusion

SIRI shows strong associations with all outcomes but only predicts non-fatal MI and heart failure. Despite this limitation, its cost-effectiveness and accessibility indicate potential as an early screening tool for improving risk assessment and intervention in high-risk individuals.