全身免疫炎症水平升高增加慢性肾脏病患者全因及特定病因死亡风险：一项大型多中心纵向研究

Elevated systemic immune inflammation level increases the risk of total and cause-specific mortality among patients with chronic kidney disease: a large multi-center longitudinal study.

作者信息

Lai Wenguang, Xie Yun, Zhao Xiaoli, Xu Xiayan, Yu Sijia, Lu Hongyu, Huang Haozhang, Li Qiang, Xu Jun-Yan, Liu Jin, Chen Shiqun, Liu Yong

机构信息

School of Biology and Biological Engineering, South China University of Technology, Guangzhou, China.

Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.

出版信息

Inflamm Res. 2023 Jan;72(1):149-158. doi: 10.1007/s00011-022-01659-y. Epub 2022 Nov 9.

DOI:10.1007/s00011-022-01659-y

PMID:36352033

Abstract

BACKGROUND

Chronic kidney disease (CKD) is inherently a complex immune-inflammatory condition, and heightened inflammation and immune dysfunction are closely related to an increased risk of death. However, evidence regarding the relationship between immune-inflammatory levels and all-cause, cardiovascular, and cancer mortality among patients with CKD is scarce.

METHODS

Patients with non-dialysis dependent CKD undergoing coronary angiography (CAG) were included from five Chinese tertiary hospitals. Systemic immune inflammation index (SII) was calculated by multiplying peripheral platelet count with neutrophil-to-lymphocyte ratio, and patients were categorized into four groups by SII quartiles. Cox regression models and competing risk Fine and Gray models were used to examining the relationships between SII levels and all-cause, cardiovascular, and cancer mortality.

RESULTS

A total of the 19,327 patients (68.8 ± 10.03 years, female 32.0%) were included in this study. During a median follow-up of 4.5 years, 5,174 deaths occurred, including 2,861 cardiovascular deaths and 375 cancer deaths. Controlling for confounders, all-cause mortality (Q2, Q3, Q4: hazard ratio(HR) [95 CI%] = 1.15 [1.06-1.26], 1.30 [1.19-1.42], 1.48 [1.35-1.62], respectively; p for trend < 0.001) and cardiovascular mortality (Q2, Q3, Q4: HR [95 CI%] = 1.16 [1.03-1.31], 1.40 [1.24-1.58], 1.64 [1.44-1.85], respectively; p for trend < 0.001) increased with higher SII levels, and SII levels was related to cancer mortality comparing last quartile to first quartile of SII (Q2, Q3, Q4: HR [95 CI%] = 1.12 [0.83-1.52], 1.22 [0.90-1.67], 1.50 [1.09-2.08], respectively; p for trend < 0.001).

CONCLUSION

Elevated immune inflammation level on admission was an independent risk factor for all-cause, cardiovascular, and cancer mortality among CKD patients. Further research is needed to validate the predictive value of SII for mortality risk among CKD patients.

摘要

背景

慢性肾脏病（CKD）本质上是一种复杂的免疫炎症性疾病，炎症加剧和免疫功能障碍与死亡风险增加密切相关。然而，关于CKD患者免疫炎症水平与全因、心血管和癌症死亡率之间关系的证据很少。

方法

纳入来自中国五家三级医院接受冠状动脉造影（CAG）的非透析依赖性CKD患者。通过将外周血小板计数与中性粒细胞与淋巴细胞比值相乘来计算全身免疫炎症指数（SII），并根据SII四分位数将患者分为四组。使用Cox回归模型和竞争风险Fine和Gray模型来检验SII水平与全因、心血管和癌症死亡率之间的关系。

结果

本研究共纳入19327例患者（68.8±10.03岁，女性占32.0%）。在中位随访4.5年期间，发生5174例死亡，包括2861例心血管死亡和375例癌症死亡。在控制混杂因素后，全因死亡率（Q2、Q3、Q4：风险比（HR）[95%置信区间]分别为1.15[1.06-1.26]、1.30[1.19-1.42]、1.48[1.35-1.62]；趋势p<0.001）和心血管死亡率（Q2、Q3、Q4：HR[95%置信区间]分别为1.16[1.03-1.31]、1.40[1.24-1.58]、1.64[1.44-1.85]；趋势p<0.001）随着SII水平升高而增加，并且将SII的最后四分位数与第一四分位数比较时，SII水平与癌症死亡率相关（Q2、Q3、Q4：HR[95%置信区间]分别为1.12[0.83-1.52]、1.22[0.90-1.67]、1.50[1.09-2.08]；趋势p<0.001）。