Relationship between the systemic immune-inflammation index and the risk of acute coronary syndrome in maintenance hemodialysis patients

doi:10.3877/cma.j.issn.2095-3216.2025.03.006

Abstract

Abstract:

Objective

To investigate the relationship between the systemic immune-inflammation index （SII） and the risk of acute coronary syndrome （ACS） in maintenance hemodialysis patients.

Methods

A retrospective analysis was conducted on patients who underwent maintenance hemodialysis at Beijing Chao-Yang Hospital from January 1，2015 to January 1，2024.They were divided into an ACS group and a non-ACS group.Multivariate logistic regression analysis， receiver operating characteristic （ROC） curve， and the area under the curve were used to explore the relationship between SII and the risk of ACS.

Results

A total of 314 patients with a mean age of 59.31 ±12.82 years were included，among whom 171 patients were males（54.5%） and 143 patients females （45.5%）.There were 70 cases （22.3%） in the ACS group and 244 cases （77.7%） in the non-ACS group.Significant differences were found between the two groups in smoking history， diabetes history， blood pressure， parathyroid hormone， and SII （P ＜0.05）.After adjusting for confounding factors，the multivariate logistic regression analysis showed that SII was significantly associated with ACS in the patients （OR=1.002， 95%CI： 1.001-1.003，P ＜0.001）.Besides， the area under the ROC curve of SII in predicting ACS was 0.783 （95% CI： 0. 723-0. 843， P ＜0.001）.

Conclusion

There was a correlation between SII and ACS in the maintenance hemodialysis patients，suggesting that SII might have certain predictive value.

Key words: Maintenance hemodialysis, Systemic immune-inflammation index, Acute coronary syndrome, Association

Kaiyi Zhu, Qianmei Sun, Lijie Ma. Relationship between the systemic immune-inflammation index and the risk of acute coronary syndrome in maintenance hemodialysis patients[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2025, 14(03): 152-157.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3216.2025.03.006

https://zhsbyjdzzz.cma-cmc.com.cn/EN/Y2025/V14/I03/152

Figures/Tables 5

References 27

［1］	Angkananard T， Anothaisintawee T， McEvoy M， et al.Neutrophil lymphocyte ratio and cardiovascular disease risk： a systematic review and meta-analysis ［J］.Biomed Res Int，2018，2018：2703518.
［2］	Byrne RA， Rossello X，Coughlan JJ，et al.2023 ESC guidelines for the management of acute coronary syndromes ［J］.Eur Heart J，2023，44（38）：3720-3826.
［3］	Rosselli D， Rueda J， Diaz C.Cost-effectiveness of kidney transplantation compared with chronic dialysis in end-stage renal disease ［J］.Saudi J Kidney Dis Transpl，2015，26（4）：733-738.
［4］	Himmelfarb J， Vanholder R， Mehrotra R， et al.The current and future landscape of dialysis ［J］.Nat Rev Nephrol， 2020， 16（10）：573-585.
［5］	Collins AJ，Foley RN，Chavers B，et al.United States renal data system 2011 annual data report：atlas of chronic kidney disease&end-stage renal disease in the United States ［J］.Am J Kidney Dis，2012，59（1 Suppl 1）： e1-e420.
［6］	Yamamoto S， Kon V.Mechanisms of increased cardiovascular disease in chronic renal dysfunction ［J］.Curr Opin Nephrol Hypertens，2009，18：181-188.
［7］	Manea M， Marcu D， Pantea A， et al.Heart failure with preserved ejection fraction and atrial fibrillation： a review ［J］.Rev Chem，2018，69：4180-4184.
［8］	Libby P， Hansson G.From focal lipid storage to systemic inflammation： JACC review topic of the week ［J］.J Am Coll Cardiol，2019，74（12）：1594-1607.
［9］	Crea F， Libby P.Acute coronary syndromes： the way forward from mechanisms to precision treatment ［J］.Circulation，2017，136（12）：1155-1166.
［10］	Libby P， Pasterkamp G， Crea F， et al.Reassessing the mechanisms of acute coronary syndromes ［J］.Circ Res， 2019，124（1）：150-160.
［11］	Hu B， Yang XR， Xu Y， et al.Systemic immune-inflammation index predicts prognosis of patients after curative resection for hepatocellular carcinoma［J］.Clin Cancer Res，2014，20（23）：6212-6222.
［12］	Dziedzic E， Gᶏsior J， Tuzimek A， et al.Investigation of the associations of novel inflammatory biomarkers-systemic inflammatory index （SII） and systemic inflammatory response index （SIRI）-with the severity of coronary artery disease and acute coronary syndrome occurrence ［J］.Int J Mol Sci， 2022，23（17）：9553.
［13］	Jin Z， Wu Q， Chen S， et al.The associations of two novel inflammation indexes， SII and SIRI with the risks for cardiovascular diseases and all-cause mortality： a ten-year follow-up study in 85，154 individuals ［J］.J Inflamm Res，2021，14：131-140.
［14］	Nascimento M， Ferreira L， Alves T， et al.Inflammatory hematological indices， cardiovascular disease and mortality： a narrative review ［J］.Arq Bras Cardiol， 2024， 121 （7）：e20230752.
［15］	O′Gara P， Kushner F， Ascheim D， et al.2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction： a report of the American College of Cardiology foundation/American Heart Association task force on practice guidelines ［J］.J Am Coll Cardiol，2013，61（4）： e78-e140.
［16］	Amsterdam E， Wenger N， Brindis R， et al.2014 AHA/ACC guideline for the management of patients with non-ST-elevation acute coronary syndromes： a report of the American College of Cardiology/American Heart Association task force on practice guidelines ［J］.J Am Coll Cardiol，2014，64（24）：e139-e228.
［17］	Critchley JA， Capewell S.Mortality risk reduction associated with smoking cessation in patients with coronary heart disease： a systematic review ［J］.JAMA，2003，290（1）：86-97.
［18］	Boutaybi M， Aloutmani B， El-Azrak M， et al.Acute coronary syndromes in chronic hemodialysis patients： a series of 34 cases（case series）［J］.Ann Med Surg （Lond）， 2023， 85（8）：3791-3796.
［19］	Medina DJ， Zepeda O， Dominguez M， et al.Endothelial dysfunction， inflammation and coronary artery disease： potential biomarkers and promising therapeutical approaches ［J］.Int J Mol Sci，2021，22（8）：3850.
［20］	Fracassi F，Crea F，Sugiyama T，et al.Healed culprit plaques in patients with acute coronary syndromes ［J］.J Am Coll Cardiol，2019，73（18）：2253-2263.
［21］	Van Avondt K， Maegdefessel L， Soehnlein O.Therapeutic targeting of neutrophil extracellular traps in atherogenic inflammation ［J］.Thromb Haemost，2019，119（4）：542-552.
［22］	Shah AD， Denaxas S， Nicholas O， et al.Neutrophil counts and initial presentation of 12 cardiovascular diseases： a CALIBER cohort study ［J］.J Am Coll Cardiol， 2017， 69（9）： 1160-1169.
［23］	Ghattas A， Griffiths HR， Devitt A， et al.Monocytes in coronary artery disease and atherosclerosis：where are we now？［J］.J Am Coll Cardiol，2013，62（17）：1541-1551.
［24］	Kurtul A，Ornek E.Platelet to lymphocyte ratio in cardiovascular diseases： a systematic review ［J］.Angiology， 2019， 70（9）：802-818.
［25］	Chien KL， Su TC， Hsu HC， et al.Constructing the prediction model for the risk of stroke in a Chinese population： report from a cohort study in Taiwan ［J］.Stroke，2010，41（9）：1858-1864.
［26］	Nikolsky E， Grines CL， Cox DA， et al.Impact of baseline platelet count in patients undergoing primary percutaneous coronary intervention in acute myocardial infarction （from the CADILLAC trial）［J］.Am J Cardiol，2007，99（8）：1055-1061.
［27］	Azab B， Zaher M， Weiserbs KF， et al.Usefulness of neutrophil to lymphocyte ratio in predicting short-and long-term mortality after non-ST-elevation myocardial infarction ［J］.Am J Cardiol，2010，106（4）：470-476.

项目	AIS组(67例)	非AIS组(191例)	t/x²/Z值	P值
性别[男，例(%)]	38(54.3)	133(54.5)	x²=0.001	1.000
年龄(岁)	63.50(51.00,71.00)	59.00(51.00,68.00)	Z=-1.000	0.317
吸烟史[例(%)]	25(10,7)	26(17.1)	x²=25.107	<0.001^b
饮酒史[例(%)]	10(14.3)	22(9.0)	x²=1.650	0.260
脑卒中病史[例(%)]	7(10.0)	33(13.5)	x²=0.608	0.544
高血压病史[例(%)]	59(84.3)	202(82.8)	x²=0.087	0.858
糖尿病病史[例(%)]	40(57.1)	94(38.5)	x²=7.708	0.006^a
高脂血症病史[例(%)]	27(38.6)	64(26.2)	x²=2.953	0.104
服用阿司匹林[例(%)]	12(17.1)	26(10.7)	x²=2.152	0.149
服用氯吡格雷[例(%)]	6(8.6)	8(3.3)	x²=3.577	0.092
服用降脂药物[例(%)]	28(40.0)	71(29.1)	x²=2.995	0.108
收缩压(mmHg)	155.00(140.00,166.00)	144.00(134.00,157.00)	Z=-3.109	0.002^a
舒张压(mmHg)	86.00(79.00,95.00)	81.00(72.00,88.00)	Z=-3.334	0.001^a
平均动脉压(mmHg)	108.76±12.75	102.48±12.58	t=3.669	<0.001^b
透析超滤量(kg)	3.05(2.50,3.50)	2.90(2.50,3.50)	Z=-0.911	0.362

项目	AIS组(67例)	非AIS组(191例)	t/x²/Z值	P值
性别[男，例(%)]	38(54.3)	133(54.5)	x²=0.001	1.000
年龄(岁)	63.50(51.00,71.00)	59.00(51.00,68.00)	Z=-1.000	0.317
吸烟史[例(%)]	25(10,7)	26(17.1)	x²=25.107	<0.001^b
饮酒史[例(%)]	10(14.3)	22(9.0)	x²=1.650	0.260
脑卒中病史[例(%)]	7(10.0)	33(13.5)	x²=0.608	0.544
高血压病史[例(%)]	59(84.3)	202(82.8)	x²=0.087	0.858
糖尿病病史[例(%)]	40(57.1)	94(38.5)	x²=7.708	0.006^a
高脂血症病史[例(%)]	27(38.6)	64(26.2)	x²=2.953	0.104
服用阿司匹林[例(%)]	12(17.1)	26(10.7)	x²=2.152	0.149
服用氯吡格雷[例(%)]	6(8.6)	8(3.3)	x²=3.577	0.092
服用降脂药物[例(%)]	28(40.0)	71(29.1)	x²=2.995	0.108
收缩压(mmHg)	155.00(140.00,166.00)	144.00(134.00,157.00)	Z=-3.109	0.002^a
舒张压(mmHg)	86.00(79.00,95.00)	81.00(72.00,88.00)	Z=-3.334	0.001^a
平均动脉压(mmHg)	108.76±12.75	102.48±12.58	t=3.669	<0.001^b
透析超滤量(kg)	3.05(2.50,3.50)	2.90(2.50,3.50)	Z=-0.911	0.362

项目	ACS组(70例)	非ACS组(244例)	t/x²/Z值	P值
系统免疫炎症指数	833.46(491.20,1017.24)	528.36(383.86,710.61)	Z=-5.209	<0.001^b
血红蛋白(g/L)	114.00(106.00,122.00)	113.00(103.00,121.00)	Z=-0.710	0.478
白蛋白(g/L)	38.02±4.38	37.48±4.66	t=0.582	0.394
总胆固醇(mmol/L)	4.27(3.64,4.80)	4.00(3.35,4.82)	Z=-1.630	0.103
高密度脂蛋白胆固醇(mmol/L)	1.01(0.86,1.30)	1.02(0.85,1.25)	Z=-0.053	0.958
低密度脂蛋白胆固醇(mmol/L)	2.33(1.75,2.79)	2.13(1.73,2.82)	Z=-0.774	0.439
甘油三酯(mmol/L)	1.86(1.37,2.72)	1.63(1.22,2.32)	Z=-1.841	0.066
血尿素氮(mmol/L)	24.62(19.60,30.10)	23.12(19.35,27.80)	Z=-1.225	0.220
血清肌酐(μmol/L)	856.95(678.20,995.80)	856.30(704.50,1034.10)	Z=-0.868	0.646
血尿酸(μmol/L)	396.00(355.61,456.00)	384.66(344.10,444.94)	Z=-1.239	0.215
钙(mmol/L)	2.26±0.30	2.21±0.26	t=1.310	0.385
磷(mmol/L)	1.88(1.55,2.24)	1.85(1.50,2.19)	Z=-0.506	0.613
甲状旁腺素(μg/L)	221.00(140.90,352.00)	289.45(157.80,463.40)	Z=-2.193	0.028^a

项目	ACS组(70例)	非ACS组(244例)	t/x²/Z值	P值
系统免疫炎症指数	833.46(491.20,1017.24)	528.36(383.86,710.61)	Z=-5.209	<0.001^b
血红蛋白(g/L)	114.00(106.00,122.00)	113.00(103.00,121.00)	Z=-0.710	0.478
白蛋白(g/L)	38.02±4.38	37.48±4.66	t=0.582	0.394
总胆固醇(mmol/L)	4.27(3.64,4.80)	4.00(3.35,4.82)	Z=-1.630	0.103
高密度脂蛋白胆固醇(mmol/L)	1.01(0.86,1.30)	1.02(0.85,1.25)	Z=-0.053	0.958
低密度脂蛋白胆固醇(mmol/L)	2.33(1.75,2.79)	2.13(1.73,2.82)	Z=-0.774	0.439
甘油三酯(mmol/L)	1.86(1.37,2.72)	1.63(1.22,2.32)	Z=-1.841	0.066
血尿素氮(mmol/L)	24.62(19.60,30.10)	23.12(19.35,27.80)	Z=-1.225	0.220
血清肌酐(μmol/L)	856.95(678.20,995.80)	856.30(704.50,1034.10)	Z=-0.868	0.646
血尿酸(μmol/L)	396.00(355.61,456.00)	384.66(344.10,444.94)	Z=-1.239	0.215
钙(mmol/L)	2.26±0.30	2.21±0.26	t=1.310	0.385
磷(mmol/L)	1.88(1.55,2.24)	1.85(1.50,2.19)	Z=-0.506	0.613
甲状旁腺素(μg/L)	221.00(140.90,352.00)	289.45(157.80,463.40)	Z=-2.193	0.028^a

项目	B	标准误	瓦尔德	OR(95%CI)	P值
收缩压	0.006	0.012	0.276	1.006(0.983,1.030)	0.599
舒张压	0.031	0.019	2.702	1.032(0.994,1.071)	0.100
吸烟史	1.249	0.373	11.193	3.486(1.677,7.245)	0.001
高血压病史	0.093	0.450	0.043	1.098(0.454,2.652)	0.836
高脂血症病史	1.057	1.586	0.444	2.877(0.129,64.400)	0.505
糖尿病病史	0.657	0.339	3.753	1.929(0.992,3.748)	0.053
服用阿司匹林	0.222	0.462	0.231	1.249(0.505,3.088)	0.631
服用氯吡格雷	0.409	0.690	0.352	1.505(0.389,5.819)	0.553
服用降脂药物	-0.881	1.574	0.313	0.414(0.019,9.065)	0.576
甲状旁腺素	-0.001	0.001	2.759	0.999(0.998,1.000)	0.097
SII	0.002	0.000	19.745	1.002(1.001,1.003)	<0.001

Please choose a citation manager

Content to export