Atherosclerosis is significantly influenced by chronic inflammation and insulin resistance (IR). This study aims to explore the effects of the Systemic Inflammation Response Index (SIRI) and the Triglyceride-Glucose Index (TyG) on the severity of coronary artery stenosis in patients with coronary artery disease (CAD). This study is a retrospective cross-sectional study conducted at a single center, including 1,019 CAD patients. Based on the median Gensini score, patients were divided into low stenosis (Gensini score < 30) and high stenosis (Gensini score ≥ 30) groups. Logistic regression, interaction analysis, receiver operating characteristic (ROC) curve, Spearman correlation analysis, mediation analysis, and sensitivity analysis using Gensini score tertiles were used to explore the relationship between SIRI, TyG, and the severity of coronary artery stenosis. Multivariable logistic regression analysis revealed that SIRI (OR: 1.231, 95% CI: 1.025-1.489, P = 0.006) and TyG (OR: 2.458, 95% CI: 1.737-3.502, P < 0.001) were significantly associated with severe stenosis. Based on the median values of SIRI (0.961) and TyG (8.620), participants were divided into four groups, with the low SIRI + low TyG group as the reference. The OR for the high SIRI + high TyG group was 4.912 (95% CI: 3.185-7.649, P < 0.001). A significant additive interaction between SIRI and TyG was observed, with RERI: 1.947 (95% CI: 0.208-4.103), API: 0.396 (95% CI: 0.042-0.616), and S: 1.991 (95% CI: 1.067-4.430). The inclusion of SIRI and TyG significantly improved predictive performance compared to the traditional risk model, with a Net Reclassification Improvement (NRI) of 0.334 (P < 0.001) and an Integrated Discrimination Improvement (IDI) of 0.036 (P < 0.001). Spearman correlation analysis confirmed significant positive correlations of SIRI (ρ = 0.435, P < 0.001) and TyG (ρ = 0.347, P < 0.001) with the continuous Gensini score. In the mediation analysis, TyG accounted for 46.7% of the association between SIRI and severe stenosis via a significant indirect statistical association, while SIRI accounted for 21.3% of the association between TyG and severe stenosis via a significant indirect statistical association. Sensitivity analysis using Gensini tertiles confirmed that both SIRI (OR: 1.371, 95% CI: 1.181-1.591, P < 0.001) and TyG (OR: 1.491, 95% CI: 1.181-1.883, P < 0.001) remained independently associated with higher stenosis severity. SIRI and TyG are important indicators for predicting the risk of coronary artery stenosis, with an interaction between them, and they exhibit significant indirect statistical associations with each other.
Background/Objectives: ABO/Rh blood groups and systemic inflammation are each linked to cancer biology and prognosis, yet their combined and interactive prognostic value has not been clarified in small-cell lung cancer (SCLC). We investigated the distribution of ABO/Rh blood groups in SCLC, their association with baseline complete blood count (CBC)-derived inflammatory indices, and the prognostic significance of blood group-inflammation interactions for treatment response and survival outcomes. Methods: This retrospective study included 158 patients with SCLC with available ABO/Rh typing and pretreatment CBC data. Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were calculated using standard formulas. Treatment response was assessed according to RECIST v1.1 and categorized as response (CR/PR) versus non-response (SD/PD). Progression-free survival (PFS) and overall survival (OS) were analyzed using Cox regression models incorporating interaction terms. Results: Patients with blood group O exhibited consistently lower baseline inflammatory indices compared with non-O blood groups. Non-O blood group status and higher SIRI independently predicted chemoradiotherapy non-response. Among the evaluated indices, SIRI demonstrated superior diagnostic performance compared with SII, NLR, and PLR. Similarly, non-O blood group status and higher SIRI were independently associated with increased risks of progression and mortality. In joint analyses, compared with blood group O and low SIRI (reference), the highest risk of progression was observed in patients with blood group AB × high SIRI (HR 14.67), followed by blood groups A × high SIRI (HR 10.38) and B × high SIRI (HR 7.95). A similar pattern was observed for mortality, with the highest risk in patients with blood group AB × high SIRI (HR 22.76), followed by blood groups A × high SIRI (HR 13.93) and B × high SIRI (HR 12.41). Conclusions: ABO blood group is associated with distinct inflammatory profiles in SCLC. Elevated SIRI independently predicts treatment non-response and adverse survival, and its prognostic effect varies by blood group, underscoring the role of host biology in modulating systemic inflammation.
To investigate the predictive value of the systemic immune-inflammation index (SIRI) for the timing and prognosis of lung metastases in patients with papillary thyroid carcinoma (PTC) post-surgery and before the first 131I ablation therapy. This retrospective study collected clinical data from 234 outpatients who underwent total or subtotal thyroidectomy followed by their first 131I ablation therapy. Patients were divided into two groups: a lung metastasis group (n=78) and a PTC control group (n=156). The optimal cutoff value for SIRI in the development of lung metastases was determined using receiver operating characteristic (ROC) curves. The 78 patients with lung metastases were further divided into a high SIRI group (n=60) and a low SIRI group (n=18). Statistically significant differences were found between the groups in terms of SIRI, pre-ablation thyroglobulin (Ps-Tg), maximum tumor diameter, and whether the tumor was multifocal (all P<0.05). Patients with higher SIRI values, higher Ps-Tg levels, larger main tumors, and more multiple tumors were more likely to develop lung metastases (all P<0.05). SIRI was effective in diagnosing lung metastases in patients with PTC, with an area under the curve (AUC) of 0.834 and an optimal cutoff value of 0.64. Overall, in all cases, the disease control rate and progression-free survival were significantly higher in the low-SIRI group than in the high-SIRI group (both P<0.05). SIRI prior to the first 131I treatment has good predictive value for the occurrence of postoperative lung metastases and prognosis in PTC patients.
Patients with heart failure (HF) admitted to the intensive care unit (ICU) face poor prognoses, necessitating rapid and accessible prognostic markers. We investigated the association between the systemic inflammatory response index (SIRI)-an inflammatory metric derived from routine blood counts-and 1-year all-cause mortality in critically ill HF patients, evaluating its utility in clinical risk stratification. We conducted a retrospective cohort study using data from the Medical Information Mart for Intensive Care IV database [2008-2019]. We included 11,156 ICU patients with HF, stratifying them into tertiles based on baseline SIRI values. We analyzed the association between SIRI and 1-year all-cause mortality using Kaplan-Meier survival analysis and multivariable Cox proportional hazards regression. Higher SIRI levels were significantly associated with increased 1-year all-cause mortality. After adjusting for potential confounders, an elevated SIRI remained an independent predictor of mortality [hazard ratios (HR) for tertile 3 vs. tertile 1: 1.269, 95% confidence intervals (CI): 1.157-1.391, P<0.001]. A nonlinear relationship was identified, with an SIRI threshold of 17.093. Below this value, each unit increase in SIRI was associated with a 2.3% higher mortality risk (HR: 1.023, 95% CI: 1.016-1.030). Elevated SIRI is an independent predictor of higher 1-year all-cause mortality in ICU patients with HF. These findings support the potential integration of SIRI into risk stratification strategies to enhance clinical management in critical care settings.
Monitoring rheumatoid arthritis (RA) disease activity is crucial for treatment optimization. Hematological indices (SII, SIRI, NLR, PLR, MLR) show promise as systemic inflammation biomarkers. This study assessed their correlation with RA disease activity versus healthy controls. This retrospective cross-sectional study included 204 ACR/EULAR-classified RA patients and 216 age-/sex-matched controls. Complete blood counts enabled calculation of SII (neutrophils × platelets/lymphocytes), SIRI (neutrophils × monocytes/lymphocytes), NLR, PLR, and MLR. Disease activity was measured via DAS-28-ESR. RA patients (96.2% female, age 50.9 ± 12.4 years) demonstrated significantly elevated indices versus controls (94.4% female, age 47.2 ± 11.9 years): SII (722.7 ± 695.2 vs. 563.1 ± 448.9; p = 0.006), SIRI (12.36 ± 9.46 vs. 10.32 ± 5.78; p = 0.009), PLR (12.10 ± 14.40 vs. 9.64 ± 9.67; p = 0.039), MLR (0.21 ± 0.19 vs. 0.17 ± 0.08; p = 0.015). Among RA patients, active disease (DAS-28 > 2.6) exhibited significantly higher SII (780.6 ± 826.1 vs. 614.4 ± 310.4; p = 0.040) than remission. ROC analysis identified SII/SIRI as strong predictors (AUC train/test: 0.946/0.898). Hematological indices were significantly higher in RA patients and associated with disease activity. SII and SIRI demonstrated superior predictive capability for active RA. Key Points • This retrospective cross-sectional study included 204 patients with rheumatoid arthritis and 216 age- and sex-matched healthy controls. • Hematological indices including SII, SIRI, NLR, PLR, and MLR were significantly higher in RA patients compared to controls. • Among these indices, SII and SIRI showed the strongest correlation with disease activity measured by DAS-28. • SII and SIRI demonstrated excellent predictive performance for distinguishing active disease from remission, suggesting their potential as simple and cost-effective biomarkers for clinical monitoring.
Acute appendicitis (AA) is one of the most common clinical conditions for emergency surgery. The diagnosis of acute appendicitis remains challenging for surgeons. Researchers are still looking for a parameter that is less expensive and easily available for diagnosis. The main aim of the study was to determine the diagnostic accuracy of inflammatory biomarkers for AA and the severity of inflammation. A prospective comparative cross-sectional study was conducted among 161 participants (80 with acute appendicitis and 81 non-AA abdominal pain controls) recruited using a consecutive sampling technique. The study was conducted from August 21, 2024 to January 16, 2025. In this study, we have investigated the diagnostic utility of white blood cells (WBC), neutrophil to lymphocyte ratio (NLR), systemic inflammatory index (SII) and systemic inflammation response index (SIRI) for AA. Normality was assessed using the Shapiro-Wilk test and visual inspections. Mean differences for WBC were compared using the Independent sample t-test, while the Mann-Whitney U test was employed for others. ROC curve analysis was done for statistically significant parameters (p value < 0.05 with 95%CI). Post-hoc power analysis was performed using G*Power 3.1.9.7 to ensure study robustness. Males account for 57.76% of participants. The mean age of non-AA and AA group was 26.47 ± 8.53 and 24.34 ± 9.77 years, respectively. The AA group demonstrated significantly higher WBC, NLR, SII and SIRI levels compared to non-AA. Significantly higher WBC, NLR, SII and SIRI levels were observed in complicated AA (CAA) groups relative to simple AA (SAA) groups. The area under the ROC curve (AUC) of WBC, NLR, SII, and SIRI to diagnose AA was 0.814, 0.834, 0.816, and 0.814, respectively. WBC, NLR, SII, and SIRI can predict CAA with AUC of 0.722, 0.781, 0.770, and 0.715, respectively. Inflammatory markers, including WBC, NLR, SII, and SIRI have acceptable diagnostic performance for AA. Additionally, WBC, NLR, SII and SIRI possess potential for differentiating CAA from SAA. It may be better for surgeons to consider the level of NLR, SII and SIRI for the diagnosis of AA and to determine its severity. However, further studies on a larger sample size are recommended to validate their clinical utility.
Aneurysmal subarachnoid hemorrhage (aSAH) is a devastating cerebrovascular disease associated with high rates of mortality and long-term disability. Early risk stratification is essential to guide personalized management. Systemic inflammation plays a key role in secondary brain injury after aSAH. The systemic inflammation response index (SIRI), a novel inflammatory marker combining neutrophil, monocyte, and lymphocyte counts, has shown prognostic value in multiple disorders, but its long-term prognostic role in aSAH remains unclear. This study aimed to investigate the association between admission SIRI and 12-month unfavorable functional outcomes (modified Rankin Scale [mRS] ≥ 3) in patients with aSAH, verify its independent prognostic value, and construct a clinically useful prediction nomogram. A retrospective cohort study was performed including 258 patients with aSAH admitted between January 2021 and December 2024. Patients were divided into a favorable prognosis group (mRS 0-2, n = 158) and an unfavorable prognosis group (mRS ≥ 3, n = 100). Baseline characteristics, imaging indices including modified Fisher scale, laboratory parameters, and treatment data were collected. Multivariate logistic regression with forced entry was used to identify independent prognostic factors. Restricted cubic spline (RCS) analysis was applied to explore the non-linear relationship between SIRI and prognosis. A prediction nomogram was constructed and validated using temporal validation (training cohort n = 170; validation cohort n = 88). Model performance was evaluated using discrimination, calibration, and decision curve analysis. SIRI was significantly higher in the unfavorable prognosis group (p < 0.001). Multivariate analysis confirmed that SIRI (OR = 1.20, 95% CI: 1.08-1.34, p = 0.001), age, hypertension, GCS score ≤ 8, modified Fisher scale, and treatment modality were independent prognostic factors. RCS analysis demonstrated a non-linear relationship (P for nonlinearity = 0.020), with a clear threshold at SIRI = 4.36; the risk of unfavorable outcomes rose steeply above this cutoff. The nomogram showed excellent discrimination (AUC = 0.881 in training; 0.919 in validation) and satisfactory calibration. Decision curve analysis confirmed favorable clinical utility. Admission SIRI is an independent predictor of 12-month unfavorable functional outcomes in patients with aSAH. A threshold value of 4.36 can effectively identify high-risk patients. The SIRI-integrated nomogram provides accurate and individualized prognosis prediction across both training and temporal validation cohorts. This validated tool provides robust evidence to support clinical risk stratification and personalized decision-making.
Pneumatic tourniquet use during total knee arthroplasty (TKA) remains controversial. Although it reduces intraoperative blood loss, tourniquet-induced ischemia-reperfusion may amplify systemic inflammation. Hematologic immune-inflammatory indices such as the Systemic Immune-Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) provide simple and cost-effective measures of systemic inflammation. This study aimed to investigate the independent effect of tourniquet use on early postoperative SII and SIRI following primary TKA. In this retrospective cohort study, 120 patients (60 tourniquet, 60 non-tourniquet) undergoing primary TKA for Kellgren-Lawrence grade IV osteoarthritis were analyzed. Preoperative and 24-hour postoperative complete blood counts were used to calculate SII and SIRI values. Between-group comparisons, within-group time-dependent analyses, correlation testing, and multivariable linear regression modeling were performed to determine independent predictors of percentage increases in SII and SIRI. Effect sizes were reported alongside statistical significance. Baseline demographic characteristics and preoperative SII/SIRI values were comparable between groups. Tourniquet use was associated with significantly lower postoperative hemoglobin decline (2.64 ± 0.99 vs. 3.53 ± 0.75 g/dL, p = 0.001). However, postoperative inflammatory activation was markedly higher in the tourniquet group. Postoperative SII (2387.0 ± 1009.2 vs. 1900.8 ± 928.6, p = 0.003) and SIRI (8.54 ± 2.53 vs. 5.29 ± 2.38, p = 0.001) were significantly elevated. Percentage increases in SII and SIRI were substantially greater in the tourniquet group, with large effect sizes. In multivariable regression analyses, tourniquet use independently predicted both SII increase (β = 91.8, p = 0.001, R²=0.34) and SIRI increase (β = 272.8, p = 0.001, R²=0.35). Tourniquet application during primary TKA is independently associated with a significantly greater early systemic inflammation, despite reduced perioperative hemoglobin loss. These findings suggest that tourniquet use is associated with higher early postoperative systemic inflammatory marker levels beyond local tissue effects. Prospective studies are warranted to determine whether minimizing tourniquet exposure can improve postoperative recovery and clinical outcomes. Level IV, retrospective cohort study.
We investigated whether inflammatory markers would be significant prognostic factors for survival in patients with non-small-cell lung cancer (NSCLC). This was a retrospective cohort study including 748 consecutive Chinese NSCLC patients. The relationships of inflammatory markers with clinicopathologic characteristics and prognosis were analyzed by chi-squared test and Cox regression. Restricted cubic splines (RCS) with 4 knots were used to flexibly model non-linear relationships between markers and overall survival (OS). Survival was estimated using Kaplan-Meier curves. In multivariate analysis, the systemic inflammation response index (SIRI) and albumin-to-globulin ratio (AGR) were independently associated with OS (HR: 1.506, 95% CI: 1.224-1.852; HR: 0.749, 95% CI: 0.608-0.923). RCS showed a non-linear association for SIRI (P for non-linear = 0.004) and a linear association for AGR (P for non-linear = 0.258). We constructed a 3-tier SIRI-AGR score: Score 1 (low risk: SIRI ≤ 0.91 and AGR > 1.19), Score 2 (intermediate: either SIRI > 0.91 or AGR ≤ 1.19, but not both), Score 3 (high risk: SIRI > 0.91 and AGR ≤ 1.19). Patients with Score 3 had significantly shorter OS (HR: 1.974; 95% CI: 1.486-2.622). Time-dependent ROC showed stable predictive performance with AUC ≈ 0.70 throughout follow-up. The SIRI-AGR score is an independent, convenient, and low-cost prognostic factor for NSCLC. It can serve as a useful indicator for risk stratification and clinical decision-making.
Traumatic brain injury (TBI) involves systemic inflammation, oxidative stress, and metabolic disturbances. The systemic inflammation response index (SIRI) and serum uric acid (UA) are both linked to inflammatory and oxidative processes, but their relationship in acute TBI is unclear. To examine the association between SIRI and serum UA in adults with acute TBI, including potential nonlinear patterns and differences by sex and injury severity. This retrospective cross-sectional study included 1,930 adults with CT-confirmed acute TBI admitted between March 2018 and April 2024. Laboratory data were collected within 24 h of admission. SIRI was calculated as neutrophil × monocyte/lymphocyte. Multivariable linear regression, generalized additive models, and piecewise linear regression were used to assess the association between SIRI and UA. Subgroup analyses were conducted by sex and Glasgow Coma Scale (GCS) category. Higher SIRI was independently associated with higher UA levels. In the fully adjusted model, each 1-unit increase in SIRI corresponded to a 0.88 μmol/L increase in UA (β = 0.88, 95% CI: 0.29-1.47). The relationship was approximately linear, and the threshold model did not significantly improve fit. The association was significant in both sexes, stronger in females, and significant only in patients with severe TBI (GCS 3-8). Higher SIRI was associated with increased serum UA in acute TBI, suggesting a link between systemic inflammation and purine metabolism after injury. This relationship may be stronger in females and in severe TBI. Further longitudinal multicenter studies are needed.
Psoriasis is a chronic inflammatory skin disease frequently associated with systemic inflammation. Recently, blood cell-derived markers such as the Systemic Immune Inflammation Index (SII) and Systemic Inflammation Response Index (SIRI) have been proposed as potential biomarkers for disease activity and treatment monitoring. However, their clinical relevance in patients undergoing biological therapy, particularly IL-23 inhibitors, has not been fully explored. To evaluate the utility of SII and SIRI in monitoring disease activity in patients with severe psoriasis treated with guselkumab, risankizumab, or tildrakizumab. This retrospective observational study included 120 patients with moderate-to-severe psoriasis treated with IL-23 inhibitors over 12 months. SII, SIRI, and Psoriasis Area and Severity Index (PASI) were assessed at baseline, six months, and 12 months. Correlations between inflammatory indices and some comorbidities were analyzed. Despite significant PASI improvement across all treatment groups, SII and SIRI values showed inconsistent fluctuations and did not parallel clinical response. While SII decreased slightly in the tildrakizumab group, no consistent trend was observed in guselkumab and risankizumab cohorts. SIRI demonstrated similarly variable behavior. Weak-to-moderate correlations were noted between inflammatory indices and comorbidities such as obesity, diabetes mellitus, and hypertension. SII and SIRI do not reliably reflect treatment response in psoriasis patients receiving IL-23 inhibitors. Their variability and correlation with comorbidities suggest limited value as psoriasis-specific biomarkers. More targeted indicators are needed for accurate monitoring of systemic inflammation in this setting.
To evaluate and compare the prognostic value of multiple nutrition- and inflammation-related indices derived from routine blood tests in patients with metastatic breast cancer, and to identify the most clinically applicable indicators. This retrospective study analyzed data from 163 newly diagnosed breast cancer patients with a single distant metastasis. Seventeen nutrition- and inflammation-related indices were assessed, including ALI, NLR, dNLR, SII, SIRI, PLR, MLR, NMLR, PNI, GLR, AGR, GNRI, mGNRI, TP, PA, TRF, and ALB. Kaplan-Meier survival analysis and Cox regression models were used to evaluate the associations between these indices and overall survival (OS). The predictive performance of each index was assessed using the concordance index (C-index), and the Boruta algorithm was applied to identify key variables. Restricted cubic spline (RCS) regression was performed to explore potential nonlinear relationships between indices and OS, and subgroup analyses were conducted to examine index performance across different clinical characteristics. Multivariate Cox regression analysis identified MLR, SIRI, ALI, AGR, and PA as independent predictors of OS in patients with metastatic breast cancer. Patients with MLR ≥ 0.33 had a 3.94-fold increased risk of death, and those with SIRI ≥ 1.70 had a 3.32-fold increased risk. In contrast, patients with ALI ≥ 53.99, AGR ≥ 1.11, and PA ≥ 181 had 73%, 76%, and 77% reductions in mortality risk, respectively. Inflammation-related indices demonstrated stronger predictive value for short-term (1-year) outcomes, whereas nutrition-related indices were more effective in predicting medium- to long-term (3-5 years) survival. ALI and MLR showed consistent prognostic performance across all clinical subgroups, while SIRI, AGR, and PA exhibited significant interactions in specific subgroups. Nutrition- and inflammation-related indices derived from routine blood tests-particularly MLR, SIRI, ALI, AGR, and PA-serve as effective tools for prognostic assessment in metastatic breast cancer. Among these, ALI and MLR have universal applicability across patient subgroups, offering clinicians valuable guidance for optimizing patient management strategies and improving survival and quality of life.
Renal cell carcinoma (RCC) is a significant urological malignancy with a rising incidence, increasingly linked to metabolic dysregulation and chronic systemic inflammation. While traditional metrics such as body mass index (BMI) are commonly used, they may not fully capture the biological heterogeneity underlying carcinogenesis. This study investigated the associations of the Metabolic Score for Insulin Resistance (METS-IR) and the Systemic Inflammation Response Index (SIRI) with subsequent RCC risk, together with their joint effects and longitudinal trajectory patterns. We conducted a retrospective analysis within the UK Biobank prospective cohort, comprising 410,766 participants aged 37-73 years. METS-IR and SIRI were calculated from baseline blood samples. Incident RCC was ascertained through national cancer registries. Multivariable Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), because the outcome was time to incident RCC with variable follow-up and right censoring. Nonlinear relationships were evaluated using restricted cubic splines, and joint effects were assessed on an additive scale. Dynamic trajectory analysis based on repeat assessment data was treated as exploratory. During a median follow-up of 13.65 years, 1,752 (0.43%) participants developed RCC, with a median time to diagnosis of 8.01 years among cases. Both biomarkers were independently associated with RCC risk. In fully adjusted models, each 1-SD increase in METS-IR was associated with a 26% higher RCC risk (HR: 1.26; 95% CI: 1.12-1.42), showing a linear dose-response pattern. SIRI showed a non-linear association, with risk increasing more sharply beyond an index value of approximately 1.2; participants in the highest quartile had a 57% higher risk (HR: 1.57; 95% CI: 1.35-1.83)than those in the lowest quartile. Participants with concomitantly high METS-IR and high SIRI had the highest risk (HR: 2.40; 95% CI: 2.06-2.79), although additive interaction metrics did not show statistical evidence of interaction. In exploratory trajectory analyses, persistently high METS-IR or SIRI was associated with higher RCC risk, whereas estimates for improved and worsened groups were more imprecise. METS-IR and SIRI were independently associated with RCC risk in this cohort. Their combined assessment may improve risk stratification. The findings further suggest that metabolic and inflammatory trajectory patterns may carry different prognostic information, although these longitudinal results should be interpreted cautiously and not as evidence of causality or risk reversibility.
This study aims to evaluate the associations of complete blood cell count-derived inflammatory markers-including monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune-Inflammation Index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI)-with acute gouty arthritis in males. A cross-sectional study was conducted in 380 males from the Department of Endocrinology and Department of Physical Examination, Central Hospital of Dalian University of Technology, between January 2022 and January 2024. Multivariable logistic regression models were used to investigate the independent associations between six inflammatory markers and acute gouty arthritis. Restricted cubic splines (RCS) were employed to model the dose-response relationships of inflammatory markers with acute gouty arthritis. Subgroup analyses were performed to identify susceptible populations. The diagnostic capabilities of the inflammatory markers were evaluated and compared using receiver operating characteristic (ROC) curves. A total of 380 male participants were included, with a mean age of 54 years. Among them, 108 participants had AGA, giving a prevalence of 28.4%. Significant associations with AGA were observed for monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), Systemic Immune-Inflammation Index (SII), systemic inflammatory response index (SIRI), and aggregate index of systemic inflammation (AISI). Further analysis using RCS revealed nonlinear dose-response relationships between SII and AGA (p-nonlinear = 0.001), as well as between AISI and AGA (p-nonlinear <0.001). Subgroup analysis showed that inflammatory markers (NLR, PLR, SII, SIRI, and AISI) were more effective in assessing AGA onset among men with fatty liver. ROC analysis indicated that when compared with other inflammatory markers (MLR, NLR, PLR, and SIRI), SII and AISI demonstrated superior diagnostic accuracy and discriminatory power in assessing the risk of AGA in men. In men, AGA is closely associated with inflammatory markers. In addition, compared with other inflammatory markers (MLR, NLR, PLR, and SIRI), SII and AISI may serve as more accurate indicators for the diagnosis of AGA.
Acute pancreatitis (AP) is a common gastrointestinal emergency with a significant proportion of patients progressing to severe acute pancreatitis (SAP), which carries substantial morbidity and mortality. A comprehensive search of the literature was performed in PubMed, Scopus, Web of Science, Embase, Cochrane Library, and Google Scholar, covering all records from database inception through February 2026. Eligible studies were those providing quantitative evidence on the association between the Systemic Inflammatory Response Index (SIRI) and the severity of acute pancreatitis (AP) in adult populations. Methodological rigor was evaluated using the Newcastle-Ottawa Scale, and statistical synthesis was conducted with a random-effects approach using RevMan software. A total of nine studies satisfied the inclusion criteria and were incorporated into the meta-analysis. The aggregated results indicated that higher SIRI values were significantly correlated with a greater likelihood of severe acute pancreatitis (odds ratio or OR: 1.99; 95% confidence interval or CI: 1.46-2.72). Furthermore, patients with severe AP exhibited markedly elevated mean SIRI levels compared with those with mild disease (mean difference or MD: 4.30; 95% CI: 0.41-8.19). Substantial heterogeneity was detected among the included studies (I² = 92% for the OR analysis and I² = 89% for the mean difference analysis). Publication bias was not assessed as the number of included studies was less than 10. The findings of this meta-analysis suggest that elevated SIRI at admission is associated with an increased risk of severe acute pancreatitis, with patients presenting with severe disease demonstrating higher SIRI values compared to those with mild pancreatitis. These results are hypothesis-generating and should be interpreted as preliminary evidence rather than definitive proof of clinical utility. Large-scale prospective studies are warranted to establish optimal cut-off values and validate their incremental utility over existing severity scores.
Cardiac injury is a common complication following intracerebral hemorrhage (ICH), contributing to poor prognosis. Systemic inflammation has been proposed as a critical mediator along the brain-heart axis, linking neurological injury to remote cardiac damage. This study aimed to investigate the association between a composite inflammatory indicator and acute cardiac injury following ICH. This single-center retrospective cohort study included patients with ICH admitted within 24 h of symptom onset between 2017 and 2022. Composite inflammatory indices (NLR, PLR, MLR, SII, SIRI, AISI) were derived from admission peripheral blood cell counts. The primary outcome, acute cardiac injury, was defined as a hs-cTnT level >0.014 ng/mL accompanied by at least one electrocardiographic abnormality. Independent associations were evaluated using multivariable logistic regression, with dose-response relationships assessed via trend tests. Mediation analyses were conducted using PROCESS macro (models 4 and 6). Robustness was examined through stratified and sensitivity analyses. Acute cardiac injury occurred in 166 (29.5%) of the 562 patients. The injury group showed significantly elevated levels of MLR, SIRI, and AISI compared to the non-injury group, each of which independently associated with cardiac injury after multivariable adjustment. These inflammatory indices partially mediated the link between lower Glasgow Coma Scale (GCS) scores and cardiac injury. A significant chain mediation pathway was identified: lower GCS → elevated SIRI → increased hs-cTnT → higher 90-day mortality. The findings were robust in stratified and sensitivity analyses. MLR, SIRI, and AISI serve as independent factors of acute cardiac injury after intracerebral hemorrhage and play a significant mediating role in the brain-heart axis.
Diagnosing acute cholecystitis (AC) in patients with end-stage renal disease (ESRD) is challenging because chronic systemic inflammation and immune dysregulation may obscure acute inflammatory responses. Conventional inflammatory markers may therefore have limited diagnostic specificity in this population. This study aimed to evaluate the diagnostic utility of systemic inflammatory indices in ESRD patients undergoing cholecystectomy. This retrospective single-center study included 48 ESRD patients who underwent cholecystectomy either for clinically suspected AC (AC group, n = 31) or prophylactically prior to kidney transplantation (RT group, n = 17). Demographic characteristics and laboratory parameters were obtained from preoperative blood tests. Systemic inflammatory indices, including the neutrophil-to-lymphocyte ratio, systemic immune-inflammation index, systemic inflammation response index (SIRI), and pan-immune-inflammation value (PIV), were calculated. Histopathological findings were used as the reference standard for confirming acute inflammation. Exploratory receiver operating characteristic curve analysis was performed to evaluate diagnostic performance and determine optimal cutoff values. Histopathological examination demonstrated neutrophilic infiltration consistent with acute inflammation in 30% of patients with clinically suspected AC. Compared with the RT group, patients with histopathologically confirmed acute inflammation had significantly higher neutrophil counts and PIV levels and lower serum albumin levels. In receiver operating characteristic analysis comparing histopathologically confirmed acute cases with RT controls, PIV showed the highest diagnostic accuracy (area under the curve [AUC] = 0.771), followed by C-reactive protein (AUC = 0.733) and SIRI (AUC = 0.732). Within the AC cohort, SIRI demonstrated the best discriminatory ability for differentiating acute from chronic inflammatory changes (AUC = 0.732). Optimal cutoff values differed substantially between analyses, with lower thresholds observed when acute cases were compared with RT controls and higher thresholds required within the AC cohort. Composite inflammatory indices, particularly SIRI and PIV, may provide additional information in identifying histopathologically confirmed acute inflammation in ESRD patients. However, given the limited sample size, these findings should be interpreted as exploratory and require validation in larger prospective studies.
This study explored the relationship between the weight-adjusted-waist index (WWI) and cognitive function among older individuals in the United States (US) and assessed whether blood inflammation indexes potentially mediate the association between WWI and cognitive function. The National Health and Nutrition Examination Survey data from 2011 to 2014 were collected. The WWI (waist circumference divided by the square root of bodyweight) was calculated, and cognitive performance was assessed using the Consortium to Establish a Registry for Alzheimer's Disease Word Learning (CERAD-WL) test, Delayed Recall (CERAD-DR) test, Animal Fluency Test (AFT), and Digit Symbol Substitution Test (DSST). Test-specific and global cognition z-scores were created. The evaluated blood inflammation indexes included systemic inflammatory response index (SIRI), systemic immune-inflammation index (SII), and neutrophil to lymphocyte ratio (NLR). Generalized linear regression models and mediation analysis were used to quantify the association. After adjusting for covariates, the results of generalized linear regression analysis showed a significant negative connection between WWI and CERAD-WL (β = -0.47, 95% CI: -0.87, -0.07) and DSST (β = -1.59, 95% CI: -2.45, -0.72) among the 2026 participants. WWI correlated positively with SII, SIRI, and NLR (p < 0.05), whereas SIRI and NLR demonstrated a negative association with CERAD-WL and DSST (p < 0.05). The relationship between WWI and CERAD-WL performance was partially mediated by SIRI/NLR. A negative association was observed between cognitive performance and WWI. The blood inflammation indexes were found to partially mediate the relationship between WWI and cognition. These findings warrant further evaluation in different populations.
To evaluate the predictive value of first and second trimester hematological inflammatory indices-including the novel cumulative inflammatory index (IIC) and mean corpuscular volume-to-lymphocyte ratio (MCVL)-for the subsequent development of gestational diabetes mellitus (GDM). Additionally, the study will assess whether these markers differ between GDM subgroups managed with diet alone versus insulin therapy. This case-control study enrolled 150 pregnant women, with 75 diagnosed with GDM and 75 serving as healthy controls. Hematological inflammatory indices-namely, NLR, MLR, PLR, dNLR, AISI, SII, SIRI, IIC, and MCVL-were calculated from first- and second-trimester complete blood count parameters. First-trimester inflammatory indices (NLR, MLR, PLR, dNLR, AISI, SII, SIRI, IIC, and MCVL) were significantly elevated in the GDM group compared to controls (all p < 0.05). NLR demonstrated the highest discriminative accuracy (AUC 0.782; 95% CI: 0.709-0.855), followed by SIRI (AUC 0.778) and IIC (AUC 0.775). Among GDM patients, 22 (29.3%) required insulin therapy. Insulin-treated patients exhibited significantly higher SIRI_1 than diet-managed patients (p = 0.025), and showed a substantially elevated inflammatory burden across multiple second-trimester indices. First-trimester fasting glucose was positively correlated with several second-trimester inflammatory indices, including AISI_1 (r = 0.351, p = 0.002) and SII_2 (r = 0.342, p = 0.003). First-trimester hematological inflammatory indices, including the novel IIC and MCVL, are associated with subsequent development of GDM. Furthermore, these indices offer moderate predictive accuracy when derived from routine antenatal blood tests. The clinical usefulness of these findings necessitates prospective validation in larger, multicenter cohorts.
Both dietary preferences and systemic inflammation are associated with metabolic syndrome (MetS); however, the role of inflammation in the association between dietary preferences and MetS remains largely unclear. A total of 33,728 participants were included from the Henan Rural Cohort Study (n = 39,259). Food preferences were collected using a questionnaire. Generalized linear models were used to investigate the independent and joint associations of food preferences, specifically for sour or spicy foods, and inflammatory biomarkers [such as systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI), and pan-immune-inflammation value (PIV)] with MetS prevalence. Furthermore, mediation analysis was conducted to explore the extent to which inflammation statistically accounted for the associations between food preferences and MetS. Participants with a mild or moderate-to-heavy preference for sour/spicy foods had a higher risk of developing MetS compared to those who disliked these flavors, as indicated in the final model. Similarly, each unit increase in natural log-transformed SII, SIRI, and PIV values was associated with an increased risk of MetS, with corresponding odds ratios (ORs) of 1.351, 1.280, and 1.419, respectively. Individuals who had high levels of inflammation and mild-to-heavy sour/spicy food preferences exhibited the highest risk of MetS, compared to those with low levels of inflammation and a dislike for sour/spicy foods. Furthermore, the quantified statistical analysis revealed that the associations between food preferences and MetS, explained by inflammatory indicators, ranged from 5.3 to 14.6%. Both sour/spicy food preferences and elevated inflammatory indicators are independently and jointly associated with an increased risk of MetS. Systemic inflammation indices statistically accounted for part of the observed association, suggesting that systemic inflammation is a potential mediator of the link between food preferences and MetS.