Chen Mengyuan, Wang Shu-An, Yang Jiayao, Bai Jiawang, Gu Jingyue, Luo Haolong, Zhang Xudong, Han Yan, Shao Jihong, Xu Yan, Guo Shuyan, Ren Xiangmei
Department of Nutrition, School of Public Health, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Jiangsu Engineering Research Center of Biological Data Mining and Healthcare Transformation, Xuzhou Medical University, Xuzhou, Jiangsu, China.
Front Nutr. 2024 Aug 27;11:1375053. doi: 10.3389/fnut.2024.1375053. eCollection 2024.
Systemic immune-inflammation index (SII) is associated with increased risk in a wide range of illnesses. However, few studies have explored the associations between SII and the risk of malnutrition. Therefore, this study aimed to investigate the association between SII and malnutrition in a nationwide, multicenter, cross-sectional study involving Chinese hospitalized patients.
From August 2020 to August 2021, a total of 40,379 hospitalized patients met the inclusion and exclusion criteria. Detailed demographic data, diagnoses, as well as physical and laboratory examination results were recorded. The diagnosis of malnutrition was used with two distinct methods: the Malnutrition Screening Tool 2002 (NRS 2002) + Global Leaders Initiative on Malnutrition (GLIM) criteria and the controlling nutritional status (CONUT) score. The risk factors for malnutrition were analyzed using binary logistic regression and multiple logistic regression to obtain odds ratios (OR) and 95% confidence intervals (CI). Restricted cubic spline (RCS), linear spline, and receiver operating characteristic (ROC) analysis were also used.
The prevalence of malnutrition diagnosed by the two methods was 13.4% and 14.9%, respectively. In the NRS 2002 + GLIM diagnostic model, lnSII showed statistical significance between the malnutrition and non-malnutrition group (6.28 ± 0.78 vs. 6.63 ± 0.97, < 0.001). A positive association was observed between higher SII and the risk of malnutrition in both before and after adjustment models compared to the first quartile (Q vs. Q, OR = 1.27, 95%CI: 1.15-1.40; Q vs. Q, OR = 1.83, 95%CI: 1.67-2.00). However, a significant reduction in prevalence was observed when SII was in the second quartile (Q vs. Q, OR < 1), as indicated by a restricted cubic spline with a U trend ( for nonlinear <0.001). According to the CONUT score, the prevalence of individuals with normal nutritional status decreased with increasing SII, while the occurrence of three different degrees of malnutrition generally increased. The Kappa value between the two diagnostic methods was 0.23, and the merged data observed an area under the ROC curve of 0.73 (95%CI: 0.714-0.742).
The U-shaped association between SII and the prevalence of malnutrition was observed. Both lower and higher SII levels (either continuous or categorical variable) were significantly associated with an increased risk of malnutrition.
全身免疫炎症指数（SII）与多种疾病风险增加相关。然而，很少有研究探讨SII与营养不良风险之间的关联。因此，本研究旨在通过一项涉及中国住院患者的全国性、多中心横断面研究，调查SII与营养不良之间的关联。
2020年8月至2021年8月，共有40379例住院患者符合纳入和排除标准。记录详细的人口统计学数据、诊断结果以及体格和实验室检查结果。营养不良的诊断采用两种不同方法：营养不良筛查工具2002（NRS 2002）+全球营养不良领导倡议（GLIM）标准和控制营养状况（CONUT）评分。采用二元逻辑回归和多元逻辑回归分析营养不良的危险因素，以获得比值比（OR）和95%置信区间（CI）。还使用了受限立方样条（RCS）、线性样条和受试者工作特征（ROC）分析。
两种方法诊断的营养不良患病率分别为13.4%和14.9%。在NRS 2002+GLIM诊断模型中，lnSII在营养不良组和非营养不良组之间具有统计学意义（6.28±0.78对6.63±0.97，<0.001）。与第一四分位数相比，在调整前后的模型中，较高的SII与营养不良风险之间均观察到正相关（Q1对Q2，OR=1.27，95%CI：1.15-1.40；Q1对Q4，OR=1.83，95%CI：1.67-2.00）。然而，当SII处于第二四分位数时，患病率显著降低（Q1对Q2，OR<1），如具有U型趋势的受限立方样条所示（非线性P<0.001）。根据CONUT评分，营养状况正常个体的患病率随SII升高而降低，而三种不同程度营养不良的发生率总体上增加。两种诊断方法之间的Kappa值为0.23，合并数据观察到ROC曲线下面积为0.73（95%CI：0.714-0.74）。
观察到SII与营养不良患病率之间呈U型关联。较低和较高的SII水平（连续或分类变量）均与营养不良风险增加显著相关。
