Zheng Zitian, Luo Huanhuan, Xue Qingyun
Department of Orthopedics, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, PR China; Peking University Fifth School of Clinical Medicine, Beijing, PR China.
Department of Nursing, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Science, Beijing, PR China; Graduate School of Peking Union Medical College, Beijing, PR China.
Arch Gerontol Geriatr. 2023 Oct 10;116:105228. doi: 10.1016/j.archger.2023.105228.
Frailty is a state of heightened vulnerability to stress, whether from within the body or external factors. We aim to assess the prognostic value of the Systemic Immune-Inflammation Index (SII) in middle-aged and older frail adults.
We used data from the 2003-2018 National Health and Nutrition Examination Survey (NHANES) linked to the 2019 National Death Index (NDI) to study mortality. Cox proportional hazards model and two-piecewise Cox proportional hazards model were used to elucidate the nonlinear relationship between SII level and mortality.
Our study included 7,446 frail patients (mean age 65.6) with 2,524 deaths (726 from cardiovascular disease and 458 from cancer) over 49,565 person-years. Elevated SII levels were associated with an increased risk of all-cause, cardiovascular disease (CVD)-related and cancer-related mortality, even after adjusting for potential confounders (adjusted HR (95 % CI) = 1.35 (1.25, 1.46), 1.42 (1.22, 1.65) and 1.26 (1.05, 1.51), respectively). Moreover, a U-shaped correlation was discerned between SII levels and the risks of all-cause and cancer-related mortality, with respective thresholds identified at 334.96 and 348.28.
Our findings reveal SII levels positively correlate with frailty, all-cause mortality, CVD-related mortality, and cancer-related mortality in middle-aged and elderly frail individuals in the U.S. The critical thresholds for SII index were 334.96 for all-cause mortality and 348.28 for cancer-related mortality. This study underscores the potential benefits of maintaining a certain low level of SII to effectively mitigate the incidence of frailty and mortality among frail patients.
虚弱是一种对压力（无论是来自身体内部还是外部因素）高度脆弱的状态。我们旨在评估全身免疫炎症指数（SII）在中老年虚弱成年人中的预后价值。
我们使用了2003 - 2018年全国健康与营养检查调查（NHANES）的数据，并将其与2019年全国死亡指数（NDI）相链接以研究死亡率。采用Cox比例风险模型和两段式Cox比例风险模型来阐明SII水平与死亡率之间的非线性关系。
我们的研究纳入了7446名虚弱患者（平均年龄65.6岁），在49565人年的时间里有2524人死亡（726人死于心血管疾病，458人死于癌症）。即使在调整了潜在混杂因素后，SII水平升高仍与全因、心血管疾病（CVD）相关和癌症相关死亡率的风险增加相关（调整后的HR（95%CI）分别为1.35（1.25，1.46）、1.42（1.22，1.65）和1.26（1.05，1.51））。此外，在SII水平与全因和癌症相关死亡率风险之间发现了U型相关性，全因死亡率和癌症相关死亡率的各自阈值分别为334.96和348.28。
我们的研究结果表明，在美国中老年虚弱个体中，SII水平与虚弱、全因死亡率、CVD相关死亡率和癌症相关死亡率呈正相关。SII指数的临界阈值为全因死亡率334.96，癌症相关死亡率348.28。本研究强调了维持一定低水平的SII对有效降低虚弱患者中虚弱和死亡率发生率的潜在益处。
