Systemic Immune-inflammation Research Articles

Are IL-17 inhibitors superior to IL-23 inhibitors in reducing systemic inflammation in moderate-to-severe plaque psoriasis? A retrospective cohort study.

IL-17 and IL-23 inhibitors have shown successful results in improving skin lesions in the treatment of moderate-to-severe plaque psoriasis. However, psoriasis is a chronic inflammatory disease characterized by systemic inflammation including joints in addition to skin lesions. Therefore, in this retrospective and observational cohort study, we aimed to evaluate the effect of IL-17 inhibitors (secukinumab and ixekizumab) and IL-23 inhibitors (risankizumab and guselkumab) on systemic inflammation in psoriasis. We included 214 treatment courses with IL-17 inhibitors (n = 116, 54.2%) and IL-23 inhibitors (n = 98, 45.8%) and compared the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (d-NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-monocyte ratio (PMR), systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI) at baseline and Week 16 of treatment. In patients receiving IL-17 inhibitor, NLR, d-NLR, PLR, SII, SIRI, and AISI were significantly decreased at Week 16 (p = 0.003, p = 0.001, p = 0.024, p = 0.001, p = 0.008, and p = 0.002, respectively). There was no significant reduction in systemic inflammatory markers in the anti-IL-23 group. At week 16, the anti-IL-17 group showed a significantly higher mean decrease from the baseline values of NLR, d-NLR, SII, SIRI, and AISI than the anti-IL-23 group (p = 0.021, p = 0.009, p = 0.012, p = 0.028, and p = 0.021, respectively). The PASI75/90/100 scores didn't significantly differ between the IL-17 and IL-23 groups. Achieving PASI90 response at Week 16 in the IL-17 group was associated with the change in AISI (p = 0.037). The PASI75 response at Week 16 in the IL-23 group was associated with the change in NLR, d-NLR, and SII (p = 0.044, p = 0.037, and p = 0.031, respectively). NLR (rho = 0.173, p = 0.014), d-NLR (rho = 0.189, p = 0.007), SII (rho = 0.158, p = 0.024), SIRI (rho = 0.156, p = 0.026), and MLR (rho = 0.165, p = 0.019) showed positive correlations with the baseline PASI, but no correlation was found with the change in systemic inflammatory markers and the change in PASI score. In the treatment of moderate-to-severe psoriasis, IL-17 inhibitors appear to have a greater decreasing effect on systemic inflammatory markers than IL-23 inhibitors. However, more evidence-based data are needed to conclude that IL-17 inhibitors are superior to IL-23 inhibitors in suppressing systemic inflammation in psoriatic disease.

Serial systemic immune inflammation indices: markers of acute migraine events or indicators of persistent inflammatory status?

BackgroundMigraine is the most common complex neurological disorder, affecting over a billion people worldwide. Neurogenic inflammation has long been recognized as a key factor in the pathophysiology of migraine though little research has been directed to investigating whether inflammation is greatest in migraine with aura or without, and whether inflammation is a permanent state in migraine or whether is an event related transitory state. Thus, the primary aim of this single-centre, retrospective study was to explore the potential clinical utility of the Serial Systemic Immune-Inflammatory Indices (SSIIi) as a comparative measure of duration and severity of inflammation derived from routine blood cell counts in migraine patients with aura and no-aura both within an acute inpatient setting and as outpatients. Specifically, we assessed the role of two serial white blood cell counts to calculate the SSIIi using the formula: neutrophil count x platelet count/lymphocyte count) between aura and no-aura migraine patients at time of admission to a tertiary care centre in Melbourne, Australia, and following 24 h post admission versus comparable serial measures in 20 out patients with migraine and ongoing symptoms.Main bodyA retrospective analysis was conducted of medical records using baseline demographics and brain imaging findings from 186 migraine hospitalized in-patients who had at least two sets of white blood cell counts drawn within 24 h following their admission to the emergency department of Western Health a tertiary care center in Melbourne, Australia, over an 18-month period. Patients were categorized as having migraine with aura (MA) (N = 67) or without aura (MO) (N = 119) according to ICHD-3 criteria and compared to 2 serial measures in stable in-community acute migraineur controls (N = 20). A mixed-design ANOVA showed a significant main effect of SSIIi between patients with migraine with aura (MA) and migraine without aura (MO) during acute inpatient presentation, in comparison to a convenience sample of outpatients with migraine (MA and MO).ConclusionSSIIi levels were significantly lower in patients with migraine with aura (MA), compared to MO. MA showed a greater, though non-significant, decrease between the two measurements compared to those with migraine without aura (MO) and outpatient controls, whose SSIIi levels remained consistently higher. The control group displayed similar findings to MO inpatients, suggesting persistent systemic inflammation in a subset of migraine patients regardless of in patient or outpatient of presentation and highlighting the need for future studies to more rigorously evaluate the role of systemic inflammation in migraine pathophysiology, chronicity, and progression though the multiple phases of migraine including the interictal phase.

The relationship between polycystic ovary syndrome phenotypes and systemic immune inflammation indices

The relationship between polycystic ovary syndrome phenotypes and systemic immune inflammation indices

Impact of Multi versus Single Arterial Coronary Bypass Graft Surgery on Postoperative Atrial Fibrillation

The effect of multi-arterial (MA) versus single arterial (SA) coronary bypass graft surgery on postoperative atrial fibrillation (POAF) was not investigated. From May 2017 to May 2024, the patients with CYP2C19*2 or *3 allele receiving coronary artery grafting and post-operational aspirin 100 mg/day and clopidogrel 75mg/day were retrospectively reviewed and assigned into MA or SA group. The primary endpoint was the incidence rate of POAF in first week. The secondary endpoints were POAF burden, platelet aggregation, systemic immune-inflammation (SII) index and heart rate variability (HRV). The study included 58 cases in MA group and 174 cases in SA group. The incidence of POAF was 17% in MA group contrasting with 42% in SA group (hazard ratio: 0.353; 95% confidence interval: 0.218 to 0.569, P=0.0012). A lower POAF burden was observed in MA group than that in SA group (2 h [1, 5] versus 10 h [6, 20], P=0.02). Platelet aggregation (arachidonic acid, 46%±10% vs. 56%±8%, P<0.01; adenosine diphosphate, 58%±17% vs. 75%±13%, P<0.01) and inflammation response index (neutrophil-lymphocyte ratio, 26±4 vs. 28±5, P=0.006; SII index, 5019±771 vs. 5382±1204, P=0.032) was notably lower in MA group than those in SA group at one day after CABG. Holter electrocardiogram showed a higher HRV value in standard deviation of normal-to-normal RR intervals, and decreased low-frequency/high-frequency ratio in MA group. In conclusion, MA was associated with a lower incidence rate of POAF, and paralleled with a lower AF burden, platelet aggregation, inflammation reaction and a higher parasympathetic nerve tone compared with SA regimen.

Immune Cell-Based versus Albumin-Based Ratios as Outcome Predictors in Critically Ill COVID-19 Patients.

The aim of the retrospective, single-center study was to assess the prognostic value of immune cell-based and albumin-based ratios regarding lethal outcome in critically ill COVID-19 patients. We analyzed 612 adult critically ill COVID-19 patients admitted to the intensive care unit (ICU) between April 2020 and November 2022. Blood measurement on admission to the ICU encompassed complete blood count (CBC), IL-6, C-reactive protein (CRP), albumin, lactate, lactate dehydrogenase (LDH), serum bicarbonate, arterial base deficit/excess (BD/E), and D-dimer. All the measured and calculated parameters were compared between survivors and nonsurvivors, with the outcome measure being hospital mortality. Immune cell-based ratios [NLR - Neutrophil-to-Lymphocyte Ratio, MLR - Monocyte-to-Lymphocyte Ratio, PLR - Platelet-to-Lymphocyte Ratio, MPV - Mean Platelet Volume, MPV/PC - Mean Platelet Volume-to-Platelet Count Ratio, Derived (d-)NLR ratio - neutrophil count divided by the result of white blood cell (WBC) count - neutrophil count), N/LP - Neutrophil count x 100/Lymphocyte count x Platelet count, CLR - C-reactive protein (CRP)-to-Lymphocyte Ratio, CPR - CRP-to-Platelet Ratio, LLR - Lactate dehydrogenase (LDH)-to-Lymphocyte Ratio, Systemic Immune Inflammation Index (SII) - platelet x neutrophil/lymphocyte count, Systemic Inflammation Response Index (SIRI) - neutrophil x monocyte/lymphocyte count] were investigated. White blood cell and neutrophil counts were significantly higher, while lymphocyte and platelet counts were significantly lower in nonsurvivors. MPV, MPV/PC, NLR, d-NLR, MLR, N/LP, CRP, LDH, CPR, CLR, LLR, SII, and SIRI values were significantly higher in nonsurvivors. Monocyte count and PLR values did not differ significantly between groups. Albumin-based ratios included CRP-to-Albumin Ratio (CAR), Lactate-to-Albumin Ratio (LAR) and LDH-to-Albumin Ratio (LDH/ALB). All values were significantly higher in nonsurvivors. The only independent predictor of lethal outcomes at ICU admission is the albumin-based LDH/ALB ratio. Most of the other parameters were moderate, although highly significant predictors of mortality in critically ill COVID-19 patients.

The prognostic value of the systemic immune inflammation index in patients with IgA nephropathy

Background Immune and inflammatory factors are considered the basic underlying mechanisms of IgA nephropathy (IgAN). The systemic immune inflammation index (SII) is a new inflammatory biomarker and has been identified as a prognostic indicator for various diseases. However, limited studies have been conducted on the prognostic value of the SII in patients with IgAN, and we aimed to address this gap. Methods A total of 374 patients with IgAN confirmed by renal biopsy performed from 1 January 2015 to 1 April 2019, were retrospectively included. The follow-up period of all patients was at least 12 months after diagnosis, and the endpoint was defined as end-stage kidney disease (ESKD). Patients were further divided into a high-risk group (SII ≥ 456.21) and a low-risk group (SII < 456.21) based on the optimal cutoff value of the SII determined by receiver operating characteristic (ROC) curve analysis. Baseline clinicopathological parameters were compared between the groups, and Cox proportional hazards analyses and Kaplan–Meier analysis were performed to assess renal survival in IgAN patients. Results After a median follow-up period of 32.5 months, a total of 53 patients eventually reached ESKD. Patients in the high-SII group tended to have a lower hemoglobin level (p = 0.032) and eGFR (p < 0.001), a higher serum creatinine level (p = 0.023) and 24-hour total protein level (p = 0.004), more severe tubular atrophy and interstitial fibrosis (p = 0.002) and more crescents (p = 0.030) than did those in the low-SII group. Univariate and multivariate Cox regression analyses demonstrated that an SII ≥456.21 was an independent risk factor for poor renal survival in IgAN patients (HR 3.028; 95% CI 1.486–6.170; p = 0.002). Kaplan–Meier analysis revealed that a high SII was significantly associated with poor renal prognosis (p < 0.001) and consistently exhibited remarkable discriminatory ability across different subgroups in terms of renal survival. Conclusion A high SII was associated with more severe baseline clinical and pathological features, and an SII ≥456.21 was an independent risk factor for progression to ESKD in IgAN patients.

The impact of systemic immune inflammation index and neutrophil/lymphocyte ratio on mortality in patients undergoing surgery for infective endocarditis

Aims: Infective endocarditis (IE) is a severe cardiac pathology associated with high morbidity and mortality. Early identification of disease severity and mortality risk using simple, rapid, and cost-effective tests can significantly improve clinical outcomes. This study aims to provide clinicians with valuable information on the prognostic importance of SIII and NLR in the management of IE patients and to guide potentially more effective perioperative interventions. Methods: This study retrospectively investigates the relationship between the Systemic Immune Inflammation Index (SIII), Neutrophil/Lymphocyte Ratio (NLR), and mortality in patients who underwent surgical treatment for IE between March 2020 and November 2023. A total of 100 patients over the age of 18 were included in the study. Data were collected on various clinical parameters, and statistical analyses were performed using SPSS 26.0. Results: Patients who experienced mortality had significantly higher mean SIII (1953.6 vs. 1352.4, p=0.003) and NLR (8.5 vs. 5.7, p=0.007) values than those who survived. These high indices in the mortality group suggest a stronger inflammatory response and immune dysregulation, making SIII and NLR useful indicators for assessing the prognosis of patients with infective endocarditis. Conclusion: The study underscores the potential of these indices as reliable markers for predicting mortality and disease severity in IE, ultimately aiding in better patient stratification and management.

Role of a new inflammation predictor in predicting recurrence of atrial fibrillation after radiofrequency catheter ablation.

Radiofrequency catheter ablation (RFCA) has become an important strategy for treating atrial fibrillation (AF), and postoperative recurrence represents a significant and actively discussed clinical concern. The recurrence after RFCA is considered closely related to inflammation. Systemic immune inflammation index (SII) is a novel inflammation predictor based on neutrophils, platelets, and lymphocytes, and is considered a biomarker that comprehensively reflects the immune inflammatory status of the body. To explore the predictive effect of the SII on AF recurrence after RFCA and its predictive value in combination with the existing APPLE score for AF recurrence after RFCA in patients with non-valvular AF (NVAF). We retrospectively included 457 patients with NVAF first receiving RFCA and classified them into the recurrent or non-recurrent group. We also investigated the predictive role of SII on AF recurrence following RFCA. Finally, we explored and compared the additional predictive value of the SII after combining with the APPLE score. After 12 months of follow-up, 113 (24.7%) patients experienced recurrence. High SII has been demonstrated to be an independent predictor for postoperative AF recurrence. Receiver operating characteristic and decision curve analysis (DCA), as well as net reclassification improvement (NRI) and integrated discrimination improvement (IDI) results, showed that SII combined with the APPLE score had higher predictive efficiency than using the SII or APPLE score alone. The area under the curve of the combined model (0.662, 95% confidence interval: 0.602-0.722) significantly increased compared with that of the SII and APPLE scores alone (P < 0.001). The combined model resulted in an NRI of 29.6% and 34.1% and IDI of 4.9% and 3.5% in predicting AF recurrence compared with the SII and APPLE scores alone, respectively (all P < 0.001). The SII, APPLE score, and their combination demonstrated greater clinical utility than did the treat-all and treat-none strategies over the 20-80% risk threshold according to the DCA. The SII was a predictor of recurrence after RFCA of AF. Moreover, the SII enhanced the predictability of the APPLE score for post-RFCA AF recurrence, providing valuable insights for physicians to optimise patient selection and develop personalised treatment plans.

INDICES OF SYSTEMIC INFLAMMATION IN VERY LOW BIRTH WEIGHT PRETERM INFANTS WITH SEVERE PERINATAL PATHOLOGY

Hematopoiesis plays a pivotal role in providing compensatory and adaptive mechanisms of the body in response to stressors associated with birth and in facilitating adaptation to new conditions of existence. The evaluation of the complete blood count in newborns is a recommended laboratory test for perinatal pathology, as outlined in standard practice guidelines. The interpretation of results from peripheral blood analysis, with consideration of ratios of indicators and the calculation of systemic inflammation indices, enables not only the assessment of the hematopoietic system but also the determination of specific features of the child's adaptation in the context of preterm birth. Materials and methods. A comprehensive clinical and laboratory examination of the newborns was conducted following standard protocols. Based on the results of the complete blood count, additional ratios were calculated, including the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR). Additionally, the following indices were calculated: systemic immune inflammation index (SII), systemic inflammation response index (SIRI), and platelet, neutrophil, monocyte, and lymphocyte index (PIV). Statistical analysis was performed using STATISTICA software (StatSoft Inc., USA, Version 10). Quantitative indicators with a normal distribution were compared using Student's t-test, and differences were considered statistically significant at p &lt; 0.0001. Results. The severity of the newborns’ condition is accompanied by characteristic changes in complete blood count parameters, including ratios and indices. The results demonstrated specific alterations that suggest the presence of distinct deviations in the indicators when compared to the control group. This indicates a disruption in the activation of erythroid, myeloid, and granulocyte germ cells of hematopoiesis in response to hypoxia during the early neonatal period in extremely preterm infants. The utilization of these indicators provides a degree of insight into the pathophysiological alterations occurring in the children under hypoxic inflammation during preterm birth. Conclusion. Determining the ratio of traditional CBC indicators and systemic inflammation indices is a valuable addition to the traditional assessment of laboratory results in perinatal pathology for preterm infants. Calculating the ratio of complete blood count and systemic inflammation indices in newborns provides an additional criterion for assessing the severity of the condition, helping to predict the progression of perinatal pathology, with consideration of gestational age. An in-depth analysis of complete blood count results facilitates a more objective evaluation of the pathophysiological mechanisms of hypoxic inflammation and their specific characteristics in preterm infants.

Prognostic significance of systemic immune inflammation index in patients with urothelial carcinoma: a systematic review and meta-analysis

ObjectiveThis review assessed the prognostic significance of the systemic immune inflammation index (SII) in patients with urothelial carcinoma.MethodsWe performed a systematic review and cumulative meta-analysis of the primary outcomes according to the PRISMA criteria, and assessed study quality. Seven databases were searched: Embase, PubMed, Cochrane Library, Web of Science, China National Knowledge Infrastructure, Wanfang, and SinoMed, from the creation of each database until October 2024.ResultsThe meta-analysis included 31 studies, including 14,437 patients with urothelial carcinoma. A low SII was significantly associated with better recurrence-free survival (RFS) (HR = 1.37, 95%CI (1.19, 1.56), P &amp;lt; 0.05), cancer-specific survival (CSS) (HR = 1.87, 95%CI (1.50, 2.34), P &amp;lt; 0.05), and overall survival (OS) (HR = 1.42, 95%CI (1.23, 1.64), P &amp;lt; 0.05). In addition, subgroup analysis found that higher SII was associated with poorer prognosis regardless of treatment regimen, tumor type, or SII cutoff, and that high SII was an important prognostic biomarker in the UC population.ConclusionA low SII may be associated with better RFS, CSS, and OS. The SII can be used as a is a potentially noninvasive and promising prognostic indicator for urothelial carcinoma; however, further studies with appropriate designs and larger sample sizes are needed to verify these findings.

Prognostic Role of Neutrophil Percentage-to-Albumin Ratio in Patients with Non-ST-Elevation Myocardial Infarction.

Background and Objectives: This study aimed to investigate whether neutrophil percentage-to-albumin ratio (NPAR) levels on admission have prognostic significance regarding one-year major adverse cardiovascular and cerebrovascular events (MACCEs) in non-ST-elevation myocardial infarction (NSTEMI) patients. Materials and Methods: A total of 464 patients aged 59.2 ± 11.6 years constituted the cohort of this retrospectively designed study. Considering a 1-year follow-up period, the patients were divided into two groups: those with MACCEs and those without. The complete blood count, serum C-reactive protein and serum albumin levels were measured at admission. The NPAR, C-reactive protein/albumin ratio (CAR) and systemic immune-inflammation (SII) index were calculated for all patients, and the associations of these inflammatory-based biomarkers with 1-year MACCEs were evaluated. Results: During the 12-month follow-up period, MACCEs were observed in 75 (16.2%) patients, of which 35 (7.5%) patients died. The patients with MACCEs had higher CRP (p < 0.001), a higher percentage of neutrophils (p < 0.001), lower albumin levels (p < 0.001), a higher CAR (p < 0.001), a higher SII index (p = 0.008) and a higher NPAR (p < 0.001). A high anatomical SxSI score, a high low-density lipoprotein cholesterol level, hypoalbuminemia, high neutrophil counts, a high NPAR level and a high CAR level were independent predictors for one-year MACCEs (all p < 0.05). The NPAR (area under the curve [AUC] = 0.775, p < 0.001) and albumin level (AUC = 0.708, p < 0.001) had better and sufficient discriminatory power and predictive accuracy in determining one-year MACCEs, when compared to the neutrophil (AUC = 0.693, p < 0.001), CAR (AUC = 0.639, p < 0.001) and SII index (AUC = 0.660, p < 0.001), in terms of the receiver operating characteristic curve. The DeLong test revealed that the predictive performance of the NPAR was superior to that of the other inflammatory parameters. In particular, individuals with an NPAR value greater than 17.6 were at greater risk of developing MACCEs (p < 0.001). Conclusions: The NPAR can be used as a newly identified promising inflammatory biomarker to predict one-year MACCEs in NSTEMI patients undergoing revascularization therapy.

Analysis of Risk Factors for Restenosis after Interventional Treatment of Tuberculous Airway Stenosis.

Analysis of risk factors for restenosis after intervention for tuberculous airway stenosis. We retrospectively collected the clinical data of patients diagnosed with tuberculous airway stenosis in the Second Hospital of Lanzhou University and Lanzhou Pulmonary Hospital from January 2021 to June 2023. The patients were divided into the restenosis group and the non-restenosis group according to whether or not restenosis occurred in the airway within 1 year after the intervention, and the differences in the clinical data between the two groups were compared, and the variables with statistically significant differences in the univariate analysis were analyzed by multifactorial binary logistic regression. A total of 154 patients with tuberculous airway stenosis were included in this study, including 64 patients in the stenosis group, with a restenosis rate of 41.6%. The results of univariate analysis showed that the systemic immune inflammation index (SII) level was higher in the restenosis group compared with the non-restenosis group, and the composition of patients with diabetes mellitus, a stenosis length of >3cm, and a positive antacid staining of tracheal secretions was higher (all P<0.05). The composition of microscopic inactivity, antituberculosis treatment prior to intervention, and performing balloon dilatation was lower (all P<0.05). The results of multifactorial binary logistic regression analysis showed that diabetes(OR=5.758, 95%CI: 1.434~23.119), stenosis length (OR=6.349, 95%CI: 2.653~15.197), SII level (OR=1.002, 95%CI: 1.001~1.003), prior to interventional anti-tuberculosis treatment (OR=0.250, 95%CI: 0.084~0.746), and TBTB microscopic classification and staging(OR=0.306, 95%CI: 0.099~0.941) were independent influences on restenosis after interventional treatment for tuberculous airway stenosis. Diabetes, stenosis length>3cm, and high SII were independent risk factors for restenosis after intervention for tuberculous airway stenosis, prior to interventional anti-tuberculosis treatment and microscopic inactivity were independent protective factors.

Differential effects of systemic immune inflammation indices on hepatic steatosis and hepatic fibrosis: evidence from NHANES 1999–2018

BackgroundSeveral studies have demonstrated that systemic immune inflammation index (SII) has a positive relationship with hepatic steatosis. However, it is lack of system evidence for the correlation between SII and hepatic fibrosis. The objective of this study was to evaluate the relationships between SII and hepatic steatosis or hepatic fibrosis.MethodsA cross-sectional analysis was performed from the National Health and Nutrition Examination Survey (NHANES). Fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS) and hepamet fibrosis score (HFS) were the indicators for hepatic fibrosis; fatty liver index (FLI), NAFLD liver fat score (LFS) and Framingham steatosis index (FSI) were the indicators for hepatic steatosis. Pearson’s test, generalized linear model (GLM) and restricted cubic splines (RCS) were used to analyze associations of SII with hepatic fibrosis and hepatic steatosis.ResultsA total of 21,833 participants were enrolled in the study. Pearson’s test and GLM revealed that there were negative relationships between SII and hepatic fibrosis (FIB-4, NFS and HFS), while positive relationships between SII and hepatic steatosis (FLI, LFS and FSI). The corresponding β (95%CI) of SII and hepatic fibrosis were − 0.35(-0.46, -0.24), -0.67(-0.71, -0.63) and − 0.10(-0.12, -0.09), respectively. The corresponding β (95%CI) of SII and hepatic steatosis were 6.12(4.75, 7.50), 0.22(0.12, 0.31) and 0.27(0.20, 0.34), respectively. Statistically significant non-linear association were found in SII with hepatic fibrosis and hepatic steatosis in RCS model (all P < 0.001).ConclusionThere was a negative significant association between SII and hepatic fibrosis, while a positive significant association between SII and hepatic steatosis.

Correlation of systemic immune inflammation and serum uric acid with gout: based on NHANES.

This study aimed to explore the relationship of systemic immune inflammation index (SII) and uric acid with gout using NHANES 2017-2018 data. Data were collected from the 2017-2018 circle of the NHANES database. SII was calculated based on the counts of lymphocytes (LC), neutrophils (NC), and platelets (PC). Data on gout patients were collected from questionnaires. Logistic regression analysis and subgroup analysis were used to explore the relationship between SII and gout. A total of 4517 participants were included in the study, with 273 individuals in the gout group and 4244 in the non-gout group. Logistic regression analysis showed that SII and serum uric acid were higher in the gout group than those in the non-gout group. SII ≥ 511.8 and uric acid ≥ 7.0mg/dL may be positively associated with gout. Further subgroup analysis revealed that the level of SII was positively associated with gout in the female group and the group with eGFR of 60-89.9mL/min/1.73 m2. Serum uric acid was positively associated with gout in the age, hypertension, hyperglycemia, and male groups and the group with eGFR ≥ 60mL/min/1.73 m2. There are positive correlations of SII and serum uric acid with gout. Our study suggests that SII could be a novel, valuable, and feasible inflammatory marker for gout. Key Points • Gout is a joint disease associated with hyperuricemia. The mechanism of the disease involves multiple complex factors, including metabolic disorders and inflammation. • Systemic immune inflammation index (Sll), as an evaluation index of systemic inflammatory responses, can reflect the body's inflammatory changes when the immune system is continuously activated with chronic inflammation of joints and other tissues. • We used the NHANES database to explore the relationship of SII and uric acid with gout, providing a basis for the diagnosis of gout and prognostic assessment of gout patients.

Prognostic value of inflammatory and nutritional indexes among patients with unresectable advanced gastric cancer receiving immune checkpoint inhibitors combined with chemotherapy-a retrospective study.

Recent studies have revealed that inflammatory factors and nutritional status of patients with advanced gastric cancer (AGC) are related to the efficacy of drug therapy and patient prognosis. This study seeks to evaluate the correlation between inflammatory markers, nutritional status, and clinical outcomes of immune checkpoint inhibitor (ICI)-based therapies among inoperable AGC patients. This retrospective study included 88 AGC patients who received ICIs combined with chemotherapy. Inflammatory and nutritional indicators from patients before and after two cycles of treatment were collected. Finally, the correlations between these indicators and the clinical response and survival of AGC patients with ICI treatment were examined. The results revealed that an Eastern Cooperative Oncology Group performance status (ECOG PS) score of 0, neutrophil count to lymphocyte count ratio (NLR) < 2.84, platelet count to lymphocyte count ratio (PLR) < 82.23, lymphocyte count to monocyte count ratio ≥ 2.35, the hemoglobin, albumin, lymphocyte and platelet score (HALP) ≥ 31.17, prognostic nutritional index (PNI) ≥ 46.53, albumin ≥ 41.65, the decreased HALP group and the decreased PNI group were significantly correlated with improved objective response rate. Additionally, an ECOG PS score of 0, NLR < 2.84 and the decreased HALP group was associated with a superior disease control rate. Meanwhile, an ECOG PS score of 0 (progression-free survival (PFS): P = 0.003; overall survival (OS): P = 0.001) and decreased PLR following treatment (PFS: P = 0.011; OS: P = 0.008) were significant independent predictors of PFS and OS. Lastly, a systemic immune inflammation index ≥ 814.8 was also a positive independent predictor of OS among AGC patients. Our study supports the potential of inflammatory and nutritional factors to serve as predictors of the efficacy and prognosis in patients undergoing ICI-based therapies for AGC. However, further investigations are necessary to validate these findings.

Development and Validation of an Explainable Prediction Model for Postoperative Recurrence in Pediatric Chronic Rhinosinusitis.

This study aims to develop an interpretable machine learning (ML) predictive model to assess its efficacy in predicting postoperative recurrence in pediatric chronic rhinosinusitis (CRS). A decision analysis was performed with retrospective clinical data. Recurrent group and nonrecurrent group. This retrospective study included 148 pediatric CRS treated with functional endoscopic sinus surgery from January 2015 to January 2022. We collected demographic characteristics and peripheral blood inflammatory indices, and calculated inflammation indices. Models were trained with 3 ML algorithms and compared their predictive performance using the area under the receiver operating characteristic (AUC) curve. Shapley Additive Explanations and Ceteris Paribus profiles were used for model interpretation. The final model was transformed into a web for interactive visualization. Among the 3 ML models, the Random Forest (RF) model demonstrated the best discriminative ability (AUC = 0.728). After reducing features based on importance and tuning parameters, the final RF model, including 4 features (systemic immune inflammation index (SII), pan-immune-inflammation value (PIV) and percentage of eosinophils (E%) and lymphocytes (L%)), showed good predictive performance in internal validation (AUC = 0.779). Global interpretation of the model suggested that L% and E% substantially contribute to the overall model. Local interpretation revealed a nonlinear relationship between the included features and model predictions. To enhance its clinical utility, the model was converted into a web (https://juice153.shinyapps.io/CRSRecurrencePrediction/). Our ML model demonstrated promising accuracy in predicting postoperative recurrence in pediatric CRS, revealing a complex nonlinear relationship between postoperative recurrence and the features SII, PIV, L%, and E%.

Systemic immune-inflammation index and long-term mortality in patients with hypertension: a cohort study.

The objective of this study was to examine the relationship between systemic inflammation and long-term mortality in patients with hypertension. The study employed a retrospective cohort design. The study population was derived from the National Health and Nutrition Examination Survey (NHANES), and the mortality data for this population was acquired from the National Death Index (NDI) database. Systemic inflammation was quantified by the Systemic Immune Inflammation Index (SII) and the Systemic Inflammatory Response Index (SIRI), which were then categorized into four groups (Q1-Q4, with Q4 representing the highest level of SII or SIRI). Weighted Cox regression models were constructed to investigate the association between mortality and SII and SIRI, with hazard ratios (HRs) subsequently calculated. A total of 7431 participants were included in the analysis. The highest quantile (Q4) of SII was associated with a higher risk of all-cause mortality (hazard ratio 1.36, 95% CI 1.1-1.69, P < 0.001). After adjustment for important covariates, the association remained significant (hazard ratio 1.70, 95% CI 1.27-2.30, P < 0.001). The highest quantile (Q4) of SIRI was also associated with the highest risk of mortality (hazard ratio 2.11, 95% CI 1.64-2.70, P < 0.001), and this association remained significant after adjustment for important covariates (hazard ratio 1.64, 95% CI 0.61-1.22, P = 0.001). Both SII and SIRI scores were found to be associated with mortality rates in patients with hypertension. The findings suggest that these scores may serve as complementary biomarkers to the neutrophil-to-lymphocyte ratio (NLR) for assessing mortality risk in patients with hypertension. Further investigation is warranted to elucidate the underlying mechanisms that underpin this association.

Associations of systemic inflammation and systemic immune inflammation with serum uric acid concentration and hyperuricemia risk: the mediating effect of body mass index

BackgroundWith the development of lifestyle, elevated uric acid and hyperuricemia have become important factors affecting human health, but the biological mechanism and risk factors are still unclear.MethodsA multi-stage, cross-sectional study of 41,136 adults from the NHANES 2003-2018 was conducted. Serum uric acid concentrations, platelet, neutrophil, lymphocyte, and monocyte counts were measured. The systemic inflammation response (SIRI) index and systemic immune-inflammatory (SII) index were calculated to reflect systemic inflammation and systemic immune inflammation. The height and weight data were obtained to assess body mass index (BMI). Generalized linear models were used to examine the relationships of SIRI and SII with uric acid and hyperuricemia risk, as well as the associations of SIRI and SII with BMI, and BMI with uric acid and hyperuricemia risk. Causal mediation effect model was used to assess the mediating effect of BMI in the relationships of SIRI, and SII with uric acid concentration and hyperuricemia risk.ResultsThe prevalence of hyperuricemia in US adults is 19.78%. Positive associations were found in the relationships of SIRI and SII with uric acid level, hyperuricemia risk, and BMI, as well as the relationships of BMI with uric acid and hyperuricemia risk. Causal mediation effect model showed that BMI played an important mediating role in the relationships of SIRI, and SII with uric acid concentration and hyperuricemia risk, with the proportion of mediating effect ranging from 23.0% to 35.9%.ConclusionExposure to higher SIRI and SII is associated with increased uric acid concentration and hyperuricemia risk in adults, and BMI plays an important mediating effect. Reducing systemic inflammation and systemic immune inflammation and proper weight control could be effective ways to reduce hyperuricemia prevalence and related health problems.

Immune inflammation markers and physical fitness during a congested match play period in elite male soccer players

Background/ObjectiveCellular immune markers of inflammation such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR) and systemic immune inflammation index (SII) are frequently used in patient care. The adoption of these markers to elite sports, e.g. soccer could be beneficial when monitoring training and aiming to maximize physical fitness. This study investigated cellular immune inflammation markers and physical fitness in elite male soccer players in relation to changes in training and match exposure during a congested match play period.MethodsFifteen elite male soccer players were evaluated three times (T1, T2, and T3) over 12 weeks (T1–T2: six weeks uncongested period of match play and T2–T3: six weeks congested period of match play). Players performed vertical jump tests (squat jumps [SJ], countermovement jumps [CMJ]), the 20-meter sprint test, and the Yo-Yo intermittent recovery test (YYIRL1) at T1, T2 and T3. Measurements included counts of leucocytes and its subtypes, as well as platelets. Cellular immune inflammation markers (NLR, PLR and SII) were calculatedat T1, T2, and T3. Training session rating of perceived exertion was also recorded on a daily basis.ResultsSignificant increases in leucocyte, neutrophil, eosinophil, basophil and monocyte counts occurred at T3 compared with T2 (0.002 < p < 0.04, -0.56 < ES < -0.40) and T1 (-0.78 < ES < -0.49). Lymphocyte counts were lower at T3 as compared to T2 and T1 (p = 0.038, -0.48 < ES <-0.25), while NLR, PLR and SII were greater at T3 compared to T2 (0.001 < p < 0.015, -1.01 < ES < -0.44) and T1 (-0.99 < ES < -0.21). There was a negative correlation between YYIRL1 performance with NLR (r= -0.56; p = 0.02), PLR (r=-0,44, p = 0.015), and SII (r= -0.63; p = 0.01) after the congested period of match play (i.e., T3). Values for maximal oxygen uptake (VO2max), estimated from the YYIRL1 test, negatively correlated with NLR (r= -0.56; p = 0.02), PLR (r=-0,44, p = 0.015), and SII (p = 0.01; r= -0.63). There was a positive correlation between NLR, and SII with workload parameters. In addition, a clear positive correlation was observed between NLR and SII with competitive loadinstead (r= [0.59–0.64; p˂ 0.001), training load (TL) (r= [0.65–0.68]; p˂ 0.001), session rating of perceived exertion (S-RPE) (r= [0.65–0.68]; p = 0.001), and training volume (r= [0.60–0.61; p = 0.001).ConclusionAn intensive period of congested match play significantly alterated immune cell counts and cellular markers of inflammation (NLR, PLR and SII). Changes in NLR and SII were related to workload parameters, suggesting the usefulness of these markers in regulating training intensity and competitive load. An association between physical fitness (YYIRL1, VO2max) and NLR, PLR and SII suggests that these biomarkers are promising tools to monitor aerobic physical fitness of elite soccer players during congested periods of match play.

High level of systemic immune inflammation index elevates delirium risk among patients in intensive care unit

Evidence regarding the effect of systemic immune-inflammation index on delirium occurrence is limited. This study aimed to investigate the association between SII and delirium in intensive care unit (ICU) patients. Methods: Information was extracted from Medical Information Mart for Intensive Care-IV. Four logistic regression model was established and incorporated with subgroup analysis and restricted cubic spline (RCS). The cutoff value of SII was acquired from receiver operator characteristic curve (ROC), and propensity score matching (PSM) was utilized to attenuate the confounding effect. Survival analysis was utilized to evaluate the relationship between SII and 30-day or 90-day all-cause mortality. Results: Among the 7,518 participants, 1,685 cases of delirium occurred. Individuals in the highest quartile of SII exhibited a heightened delirium risk, with a significant multivariable-adjusted odds ratio (OR) of 3.12(2.24,4.33). Tendency analysis, subgroup analysis and PSM together confirmed the positive relationship. Results of Cox regression displayed the risk of both 30-day and 90-day mortality increased about 50% in the higher-SII group. Conclusion: Higher levels of SII is positively associated with the occurrence of delirium and increased all-cause mortality risk.