Systemic immune inflammation index and all-cause mortality in chronic kidney disease: A prospective cohort study

IF 3.1 4区医学 Q3 IMMUNOLOGY

Immunity, Inflammation and Disease Pub Date : 2024-09-10 DOI:10.1002/iid3.1358

Meng Jia, Wenli Yuan, Yinqing Chen, Yi Wang, Li Shang, Shisheng Han

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Abstract

Background

The aim of this study was to investigate the association between systemic immune-inflammation index (SII) and all-cause mortality in individuals with chronic kidney disease (CKD).

Patients and Methods

This prospective cohort study was carried out among 9303 participants with CKD from the National Health and Nutrition Examination Survey cycles spanning 1999 to 2018. The mortality data were ascertained by linking participant records to the National Death Index up to December 31, 2019. Complex sampling-weighted multivariate Cox proportional hazards models were employed to estimate the association between SII level and all-cause mortality, providing hazard ratios (HR) and 95% confidence intervals (CI). A restricted cubic spline analysis was conducted to explore potential nonlinear correlation. Subgroup analyses and sensitivity analyses were also conducted.

Results

During a median follow-up period of 86 months, 3400 (36.54%) all-cause deaths were documented. A distinctive “J”-shaped relationship between SII level and all-cause mortality was discerned among individuals with CKD, with the nadir observed at an SII level of 478.93 within the second quartile. After adjusting for potential covariates, the risk of all-cause mortality escalated by 13% per increment of one standard deviation of SII, once SII exceeded 478.93 (HR = 1.13; 95% CI = 1.08–1.18). An elevated SII was associated with an increased risk of all-cause mortality among patients with CKD (Q4 vs. Q2: HR = 1.23; 95% CI = 1.01–1.48). Subgroup analyses indicated that the correlation between SII and CKD mortality was particularly pronounced among participants over 60 years old and individuals with diabetes. Sensitivity analyses revealed a linear positive association between SII and all-cause mortality after removing the extreme 5% outliers of SII.

Conclusions

A distinctive “J”-shaped relationship between SII level and all-cause mortality was identified among individuals with CKD. Further research is warranted to validate and expand upon these findings.

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慢性肾脏病患者的全身免疫炎症指数与全因死亡率：前瞻性队列研究

背景本研究旨在调查慢性肾脏病（CKD）患者的全身免疫炎症指数（SII）与全因死亡率之间的关系。患者和方法这项前瞻性队列研究的研究对象是 9303 名患有 CKD 的参与者，他们来自 1999 年至 2018 年的美国国家健康与营养调查周期。截至 2019 年 12 月 31 日的死亡率数据是通过将参与者记录与国家死亡指数联系起来确定的。采用复杂抽样加权多变量考克斯比例危险模型来估计SII水平与全因死亡率之间的关系，提供危险比（HR）和95%置信区间（CI）。为探索潜在的非线性相关性，还进行了限制性三次样条分析。此外还进行了分组分析和敏感性分析。结果在中位 86 个月的随访期间，共记录了 3400 例（36.54%）全因死亡病例。在慢性肾脏病患者中，SII水平与全因死亡率之间呈现出明显的 "J "形关系，第二四分位数的SII水平为478.93时为最低点。在对潜在的协变量进行调整后，一旦 SII 超过 478.93，SII 每增加一个标准差，全因死亡风险就会增加 13%（HR = 1.13；95% CI = 1.08-1.18）。SII 升高与慢性肾脏病患者全因死亡风险增加有关（Q4 与 Q2：HR = 1.23；95% CI = 1.01-1.48）。亚组分析表明，SII 与慢性肾脏病死亡率之间的相关性在 60 岁以上的参与者和糖尿病患者中尤为明显。敏感性分析显示，在剔除 SII 的 5%极端离群值后，SII 与全因死亡率呈线性正相关。结论在慢性肾脏病患者中发现，SII 水平与全因死亡率之间存在明显的 "J "形关系。需要进一步研究来验证和扩展这些发现。

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来源期刊

Immunity, Inflammation and Disease Medicine-Immunology and Allergy

CiteScore

3.60

自引率

0.00%

发文量

146

审稿时长

8 weeks

期刊介绍： Immunity, Inflammation and Disease is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research across the broad field of immunology. Immunity, Inflammation and Disease gives rapid consideration to papers in all areas of clinical and basic research. The journal is indexed in Medline and the Science Citation Index Expanded (part of Web of Science), among others. It welcomes original work that enhances the understanding of immunology in areas including: • cellular and molecular immunology • clinical immunology • allergy • immunochemistry • immunogenetics • immune signalling • immune development • imaging • mathematical modelling • autoimmunity • transplantation immunology • cancer immunology