Long Zhengyi, Du Jingyun, Hu Jie, Xiao Yang, Hou Can
Key Laboratory Diseases Immunology, Department of Metabolism and Endocrinology, National Clinical Research Center for Metabolic Diseases, Ministry of Education, The Second Xiangya Hospital of Central South University, Changsha, Hunan, China.
J Diabetes Investig. 2025 Mar;16(3):510-520. doi: 10.1111/jdi.14383. Epub 2024 Dec 24.
The relationship between the systemic immune-inflammatory index (SII) and the prognosis of cardiovascular disease (CVD) patients with diabetes or prediabetes remains uncertain. This study investigated the association between baseline SII and all-cause and cardiovascular mortality in American adults with CVD and diabetes or prediabetes.
Our survey included 4,060 adults with cardiovascular disease and diabetes or prediabetes from the National Health and Nutrition Examination Survey (1998-2020). Using restricted cubic splines (RCS) based on Cox regression models and a two-piecewise Cox proportional hazards model for both sides of the inflection point, we elucidated the nonlinear relationship between baseline SII and mortality. Mediation analysis was used to explore the indirect impact of SII on mortality through eGFR.
In the median 129 months of follow-up, 620 people died from cardiovascular causes and 1,800 from all causes. In the CVD population with diabetes or prediabetes, SII showed a U-shaped relationship with all-cause mortality. The association between SII and CVD mortality was nonlinear and J-shaped. Stratified and interaction analysis confirmed the stability of the core results. Notably, eGFR partially mediated the association between SII and both all-cause and cardiovascular mortality by 9.4% and 6.9%, respectively.
SII revealed a U-shaped relationship with all-cause mortality (inflection point: lnSII = 6) and a J-shaped association with CVD mortality (inflection point: lnSII = 5.73) in CVD patients with diabetes or prediabetes among American patients. Thus, assessing the SII index may offer valuable insights into risk assessment and prognosis in patients with CVD who are diabetic or prediabetic.
全身免疫炎症指数（SII）与糖尿病或糖尿病前期心血管疾病（CVD）患者预后之间的关系仍不明确。本研究调查了美国患有CVD以及糖尿病或糖尿病前期的成年人中，基线SII与全因死亡率和心血管死亡率之间的关联。
我们的调查纳入了来自国家健康与营养检查调查（1998 - 2020年）的4060名患有心血管疾病以及糖尿病或糖尿病前期的成年人。使用基于Cox回归模型的受限立方样条（RCS）以及针对拐点两侧的两段式Cox比例风险模型，我们阐明了基线SII与死亡率之间的非线性关系。采用中介分析来探究SII通过估算肾小球滤过率（eGFR）对死亡率产生的间接影响。
在中位129个月的随访期内，620人死于心血管原因，1800人死于各种原因。在患有糖尿病或糖尿病前期的CVD人群中，SII与全因死亡率呈U形关系。SII与CVD死亡率之间的关联是非线性的J形。分层和交互分析证实了核心结果的稳定性。值得注意的是，eGFR分别部分介导了SII与全因死亡率和心血管死亡率之间9.4%和6.9%的关联。
在美国患有糖尿病或糖尿病前期的CVD患者中，SII与全因死亡率呈U形关系（拐点：lnSII = 6），与CVD死亡率呈J形关联（拐点：lnSII = 5.73）。因此，评估SII指数可能为患有糖尿病或糖尿病前期的CVD患者的风险评估和预后提供有价值的见解。
