Association of systemic immune-inflammation index with all-cause, cardiovascular and cancer mortality in chronic kidney disease: evidence from NHANES
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Objectives We aimed to assess the association between SII levels and risk of all-cause and cause-specific mortality in the CKD population. Methods The dataset was collected from the National Health and Nutritional Examination Surveys (NHANES 1999–2014) and followed for vital status through December 31, 2015. Cox proportional hazard models were performed to evaluate the correlation between various mortalities [all-cause mortality (ACM)/cardiovascular-related mortality (CVM)/cancer-related mortality (CCM)] and SII levels. Besides, we also further performed restricted cubic splines (RCS), two-piecewise linear regression, and subgroup analysis. Results A total of 7035 eligible subjects were included. In this cohort, 3279 death participants were observed, of which 1022 were from cardiovascular causes, 562 from cancer causes, and 1659 from other causes during the long-term follow-up period. After adjusting for possible confounders, the risks for ACM (Q2, Q3, Q4: HR [95 CI%] = 1.05[0.95–1.17], 1.11[1.00-1.23], 1.48[1.34–1.63], P for trend < 0.001) and CVM (Q2, Q3, Q4: HR [95 CI%] = 0.96[0.8–1.16], 1.19[0.99,1.42], 1.27[1.06–1.5], P for trend < 0.001) were an uptrend, along with the increasing SII. In addition, SII levels were also associated with CCM (HR [95 CI%] = 1.13[1.07–1.19]). The RCS analyses demonstrated a J-shaped correlation between log (SII) and various mortalities in adults with CKD, with threshold values of 2.2, 2.66, and 2.6 for log (SII) respectively. Finally, subgroup analyses showed that this association was more pronounced in females, age ≥ 60 years, and body mass index(BMI) > 29.9. Conclusion Increased SII levels were an independent risk factor for ACM, CVM, and CCM in the CKD population. Furthermore, we found a J-shaped curvilinear relationship between log (SII) and various mortalities (ACM/CVM/CCM), with threshold values of 2.2, 2.66, and 2.6, respectively.
