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ORIGINAL RESEARCH article

Front. Endocrinol.
Sec. Clinical Diabetes
Volume 15 - 2024 | doi: 10.3389/fendo.2024.1399832
This article is part of the Research Topic Exploring the New Biomarkers and Clinical Indicators for Diabetes: Insights from Real-World Studies View all 21 articles

Association of systemic immune-inflammatory index with all-cause and cardiocerebrovascular mortality in individuals with diabetic kidney disease: Evidence from NHANES 1999-2018

Provisionally accepted
Manhuai Zhang Manhuai Zhang 1Siyang Ye Siyang Ye 1Jianbo Li Jianbo Li 1Meng Zhang Meng Zhang 1Li Tan Li Tan 1Yiqing Wang Yiqing Wang 1Peichen Xie Peichen Xie 1Huajing Peng Huajing Peng 1Suchun Li Suchun Li 1Sixiu Chen Sixiu Chen 1Qiong Wen Qiong Wen 1Kam Wa Chan Kam Wa Chan 2Sydney C.W. Tang Sydney C.W. Tang 3*Bin Li Bin Li 1,4*Wei Chen Wei Chen 1*
  • 1 Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
  • 2 School of Chinese Medicine, Hong Kong Baptist University, Hong Kong, Hong Kong Region, China
  • 3 Division of Nephrology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, SAR China
  • 4 The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

The final, formatted version of the article will be published soon.

    Background: Emerging evidence suggests a potential role of immune response and inflammation in the pathogenesis of diabetic kidney disease (DKD). The systemic immuneinflammation index (SII) offers a comprehensive measure of inflammation; however, its relationship with the prognosis of DKD patients remains unclear.Methods: Using data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018, this cross-sectional study involved adults diagnosed with DKD. Cox proportional hazards models were utilized to assess the associations between SII and all-cause or cardio-cerebrovascular disease mortality. Additionally, restricted cubic spline, piecewise linear regression, and subgroup analyses were performed.Results: Over a median follow-up duration of 6.16 years, 1338 all-cause deaths were recorded.After adjusting for covariates, elevated SII levels were significantly associated with increased risks of all-cause and cardio-cerebrovascular disease mortality. Specifically, per one-unit increment in natural log-transformed SII (lnSII), there was a 29% increased risk of all-cause mortality (P < 0.001) and a 23% increased risk of cardio-cerebrovascular disease mortality (P = 0.01) in the fully adjusted model. Similar results were observed when SII was analyzed as a categorical variable (quartiles). Moreover, nonlinear association was identified between SII and all-cause mortality (P < 0.001) through restricted cubic spline analysis, with threshold value of 5.82 for lnSII. The robustness of these findings was confirmed in subgroup analyses. Likewise, the statistically significant correlation between SII levels and cardio-cerebrovascular disease mortality persisted in individuals with DKD.Increased SII levels, whether examined as continuous variables or categorized, demonstrate a significant association with elevated risks of all-cause and cardiocerebrovascular disease mortality among DKD patients. These findings imply that maintaining SII within an optimal range could be crucial in reducing mortality risk.

    Keywords: systemic immune-inflammation index, Diabetes Mellitus, Diabetic kidney disease, Population-based Study, NHANES

    Received: 12 Mar 2024; Accepted: 11 Nov 2024.

    Copyright: © 2024 Zhang, Ye, Li, Zhang, Tan, Wang, Xie, Peng, Li, Chen, Wen, Chan, Tang, Li and Chen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Sydney C.W. Tang, Division of Nephrology, Department of Medicine, School of Clinical Medicine, LKS Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, SAR China
    Bin Li, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
    Wei Chen, Department of Nephrology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China

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