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Association of systemic immune-inflammation index and systemic inflammation response index with chronic kidney disease: observational study of 40,937 adults

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Abstract

Background

Chronic kidney disease (CKD) is linked to immunity and inflammation. Systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) are novel measures for gauging an individual’s systemic inflammatory activity. We aim to investigate the potential associations between them.

Methods

This study encompassed a cohort of 40,937 adults from the National Health and Nutrition Examination Survey (NHANES) 1999–2018. SII and SIRI were log2-transformed before conducting regression analysis, considering that these inflammatory markers were right skewed distributed. Weighted logistic regression models assessed the association of log2-SII and log2-SIRI levels with CKD prevalence. Weighted Cox regression models were utilized to estimate the risk of death. Subgroup analyses were performed to further clarify the effects of other covariates on the associations. Sensitivity analyses were performed to assess the robustness of our results.

Results

6986 participants with CKD were recorded, and 2818 patients died during a mean follow-up time of 100 months. After adjusting for all covariates, the highest level of log2-SII increased the CKD incidence (odds ratio [OR]: 1.47, 95% confidence intervals [CI]: 1.32–1.65, P < 0.001), as well as log2-SIRI (OR: 1.79, 95% CI 1.60–2.01, P < 0.001) when compared with the lowest level reference group. The highest level of log2-SII significantly increased all-cause mortality (hazard risk [HR]: 1.29; 95% CI 1.13–1.48, P < 0.001), cardiovascular mortality (HR: 1.61, 95% CI 1.25–2.09, P < 0.001), and hypertension mortality (HR: 1.73, 95% CI 1.23–2.42, P = 0.001) in CKD patients. Additionally, the positive associations were also found between log2-SIRI and all cause (HR: 1.54, 95% CI 1.35–1.76, P < 0.001), cardiovascular (HR: 1.90, 95% CI 1.38–2.60, P < 0.001), and hypertension mortality (HR: 2.15, 95% CI 1.56–2.94, P < 0.001). Subgroup analyses unveiled variations in these effects among different populations.

Conclusion

There existed a substantial association of SII and SIRI levels with CKD prevalence, as well as mortality in patients with CKD in the U.S. population.

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Data availability

The original data used in this study are nationally representative and publicly available, and can be directly obtained through application to NHANES, which is an ongoing periodic survey of a nationally representative sample of the U.S. noninstitutionalized civilian population using a complex multistage whole-population probability sampling strategy. More details about the survey can be found on the publicly available NHANES website.

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Acknowledgements

We thank Dr. Dachuan Guo, National Key Laboratory for Innovation and Transformation of Luobing Theory; The Key Laboratory of Cardiovascular Remodeling and Function Research, Department of Cardiology, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, Qilu Hospital of Shandong University, for his guidance on the NHANES data weighting processing R code as well as methodology, and we thank Ying-Long Peng, Guangdong Provincial People’s Hospital (Guangdong Academy of Medical Sciences), School of Medicine, South China University of Technology, for guidance on this public database clinical study.

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Author notes

  1. Peixian Huang and Yanpei Mai contributed equally.

Authors and Affiliations

  1. School of Medicine, South China University of Technology, Guangzhou, 510006, Guangdong, China

    Peixian Huang, Yanpei Mai, Jun Zhao, Yushan Yi & Yaqing Wen

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Contributions

All authors contributed to the study conception and design. Peixian Huang: conceptualization; methodology; formal analysis; writing—original draft. Yanpei Mai: methodology; formal analysis; writing—original draft; writing—review and editing. Jun Zhao, Yushan Yi: formal analysis; writing—original draft. Yaqing Wen: data curation; writing—original draft.

Corresponding author

Correspondence to Yanpei Mai.

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Conflict of interest

The authors declare that no relationships or activities might bias their work or be perceived as biased.

Ethical approval

The survey protocol for the NHANES was approved by CDC’s National Center for Health Statistics Institutional Research Ethics Review Board.

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Yanpei Mai is tagged as co-first author. Peixian Huang and Yanpei Mai share the first authorship and have equal status.

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Huang, P., Mai, Y., Zhao, J. et al. Association of systemic immune-inflammation index and systemic inflammation response index with chronic kidney disease: observational study of 40,937 adults. Inflamm. Res. 73, 655–667 (2024). https://doi.org/10.1007/s00011-024-01861-0

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