Pan-immune-inflammation value is associated with poor prognosis in patients undergoing peritoneal dialysis

Figures & data

Figure 1. Flow chart of enrolled patients.

Table 1. Baseline characteristics of peritoneal dialysis patients with different Tertiles of pan-immune-inflammation value (PIV).

	Total, n = 2796	Deficiency	Tertile 1, n = 932	Tertile 2, n = 932	Tertile 3, n = 932	p-Value
		n (%)	(<201)	(≥201 and <362)	(≥362)
Age (years)	52.6 ± 14.7	–	49.7 ± 12.5	53.1 ± 13.9	55.0 ± 14.6	<0.001
Gender, n (%)		–				<0.001
Male	1,274 (45.6)		474 (50.8)	431 (46.2)	369 (39.6)
Female	1,522 (54.4)		448 (49.2)	501 (53.8)	563 (60.4)
Diabetes, n (%)	598 (21.4)	–	159 (17.1)	215 (23.1)	224 (24.0)	<0.001
Smoking, n (%)	485 (19.5)	308 (11.0)	169 (20.3)	163 (19.8)	153 (19.8)	0.534
Medications, n (%)
Diuretic	522 (26.1)	274 (9.8)	182 (26.8)	162 (24.1)	178 (27.4)	0.201
β-blocker	246 (12.3)		82 (12.1)	79 (11.7)	85 (13.1)	0.612
Statins	412 (20.6)		127 (18.7)	136 (20.3)	149 (22.9)	0.064
CCB	1,417 (70.8)		487 (71.7)	471 (70.1)	459 (70.6)	0.723
Hypertension, n (%)	2,291(81.9)	–	754 (80.9)	761 (81.6)	776 (83.2)	0.400
Cardiovascular history, n (%)	795 (28.4)	–	238 (25.5)	254 (27.2)	303 (32.5)	<0.001
BMI (kg/m^2)	22.0 ± 3.6	193 (6.9)	22.1 ± 3.4	22.0 ± 3.6	21.9 ± 3.5	0.467
Hemoglobin (g/L)	90.7 ± 14.3	–	91.3 ± 13.7	91.2 ± 14.2	89.9 ± 14.7	0.059
Neutrophil (10^9/L)	4.4 ± 1.6	–	3.3 ± 1.2	4.3 ± 1.1	5.7 ± 1.7	<0.001
Lymphocyte (10^9/L)	1.3 ± 0.7	–	1.4 ± 0.4	1.4 ± 0.6	1.2 ± 0.6	<0.001
Monocyte (10^9/L)	0.5 ± 0.3	–	0.3 ± 0.1	0.5 ± 0.2	0.6 ± 0.3	<0.001
Platelet (10^9/L)	196.5 ± 70.1	–	154.6 ± 54.5	209.1 ± 59.1	236.9 ± 73.4	<0.001
SII	592 (402, 889)	–	342 (258, 456)	594 (476, 771)	1002 (769, 1328)	<0.001
MLR	0.33 (0.24, 0.45)	–	0.24 (0.20, 0.31)	0.36 (0.27, 0.43)	0.48 (0.37, 0.61)	<0.001
ALT (U/L)	20.6 ± 7.1	112 (4.0)	20.6 ± 8.1	20.7 ± 7.0	20.4 ± 7.1	0.673
AST (U/L)	21.4 ± 6.3	112 (4.0)	22.1 ± 7.4	21.8 ± 6.1	21.9 ± 6.7	0.620
CRP (mg/L)	3.2 (1.1, 9.9)	289(10.3)	2.8 (1.1, 7.2)	3.0 (1.1, 9.6)	4.0 (1.3, 11.8)	0.008
Albumin (g/L)	35.9 ± 5.5	–	37.4 ± 5.2	36.0 ± 5.3	33.3 ± 5.4	<0.001
TC (mmol/L)	4.13 ± 1.52	262 (9.4)	4.01 ± 1.20	4.12 ± 1.63	4.16 ± 1.45	0.066
TG (mmol/L)	1.69 ± 0.49	262 (9.4)	1.67 ± 0.40	1.70 ± 0.44	1.69 ± 0.34	0.249
HDL-c (mmol/L)	1.28 ± 0.43	262 (9.4)	1.28 ± 0.31	1.30 ± 0.54	1.26 ± 0.45	0.152
LDL-c (mmol/L)	2.80 ± 0.56	262 (9.4)	2.80 ± 0.82	2.74 ± 0.84	2.83 ± 0.85	0.065
FBG (mmol/L)	5.43 ± 2.38	177 (6.4)	5.32 ± 2.75	5.34 ± 2.92	5.56 ± 3.31	0.161
Creatinine (umol/L)	762 (584, 971)	–	777 (584, 1002)	739 (582.9, 944.6)	746 (589, 975)	0.334
Uric acid (μmol/L)	408.9 ± 105.5	103 (3.6)	412.6 ± 116.4	405.8 ± 109.1	408.4 ± 104.9	0.405
Calcium (mmol/L)	1.94 ± 0.37	49 (1.7)	1.94 ± 0.42	1.95 ± 0.68	1.93 ± 0.25	0.671
Phosphate (mmol/L)	1.82 ± 0.44	52 (1.8)	1.79 ± 0.56	1.82 ± 0.32	1.83 ± 0.53	0.176
iPTH (pg/ml)	212 (115, 398)	167 (5.9)	238 (129.1, 419)	214 (114, 388)	195 (104, 376)	0.095
eGFR (ml/min/1.73m^2)	6.2 (4.4, 8.2)	–	6.8 (4.4, 8.6)	6.4 (4.9, 8.0)	5.9 (4.1, 7.8)	<0.001

Abbreviations: CCB: calcium channel blocker; BMI, body mass index; SII: systemic inflammatory index; MLR: monocyte count/lymphocyte count; ALT: alanine aminotransferase; AST: aspartate aminotransferase; CRP: C-reactive protein; TC: total cholesterol; TG: triglyceride; HDL-c: high-density lipoprotein cholesterol; LDL-c: low-density lipoprotein cholesterol; FBG: fasting blood-glucose; iPTH: intact parathyroid hormone; eGFR: estimated glomerular filtration rate.

Figure 2. Kaplan–Meier curves of all-cause mortality in different pan-immune-inflammation value (PIV) tertiles.

Table 2. Cox regression analysis of pan-immune-inflammation value (PIV) and all-cause mortality.

	Model 1		Model 2		Model 3
	HR (95% CI)	p-value	HR (95% CI)	p-value	HR (95% CI)	p-value
Continuous^a	1.26 (1.14–1.39)	<0.001	1.28 (1.15–1.43)	<0.001	1.17 (1.04–1.31)	0.009
Categories
Tertile 1	Reference		Reference		Reference
Tertile 2	1.51 (1.24–1.80)	<0.001	1.54 (1.24–1.92)	0.005	1.55 (1.25–1.94)	0.017
Tertile 3	1.76 (1.44–2.05)	0.008	1.83 (1.48–2.26)	<0.001	1.77 (1.43–2.19)	<0.001
Trend. Test		<0.001		<0.001		0.004

^aafter log2 processing.

Model 1: no covariates were adjusted.

Model 2: was adjusted for age, gender, smoking, history of medication, history of cardiovascular disease, hypertension and diabetes.

Model 3: was adjusted for Model 2 + clinic factors (body mass index, hemoglobin, albumin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, C-reactive protein, calcium, phosphate, intact parathyroid hormone and estimated glomerular filtration rate).

Figure 3. Cumulative event rates curves of cardiovascular disease mortality in different pan-immune-inflammation value (PIV) tertiles.

Figure 4. Cumulative event rates curves of infection-related mortality in different pan-immune-inflammation value (PIV) tertiles.

Table 3. Association between pan-immune-inflammation value (PIV) and cardiovascular disease (CVD) mortality (Fine–Gray competing risk model).

	Model 1		Model 2		Model 3
	SHR (95% CI)	p-value	SHR (95% CI)	p-value	SHR (95% CI)	p-value
Tertile 1	Reference		Reference		Reference
Tertile 2	1.64 (1.22–2.17)	0.001	1.58 (1.17–2.23)	0.003	1.84 (1.30–2.59)	<0.001
Tertile 3	1.93 (1.44–2.59)	<0.001	1.73 (1.27–2.35)	<0.001	1.99 (1.40–2.83)	<0.001

Model 1: no covariates were adjusted.

Model 2: was adjusted for age, gender, smoking, history of medication, history of cardiovascular diseae, hypertension and diabetes.

Model 3: was adjusted for Model 2 + clinic factors (body mass index, hemoglobin, albumin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, C-reactive protein, calcium, phosphate, intact parathyroid hormone and estimated glomerular filtration rate).

Figure 5. Curve fitting of pan-immune-inflammation value (PIV) and all-cause mortality after adjusted Cox analysis.

Figure 6. Forest plot for subgroup analysis of pan-immune-inflammation value (PIV) and all-cause mortality.

Figure 7. receiver operating characteristic (ROC) curve of pan-immune-inflammation value (PIV) in predicting all-cause mortality.

Table 4. C-statistic, NRI, and IDI of the PIV, SII and MLR in survival prediction.

Variable	C-statistic		delta C-statistics		NRI		IDI
	Estimate (95%CI)	p-value	Estimate (95%CI)	p-value	Estimate (95%CI)	p-value	Estimate (95%CI)	p-value
SII	0.62 (0.54–0.70)	<0.001
MLR	0.60 (0.54–0.67)	<0.001
PIV	0.73 (0.69–0.77)	<0.001	^a0.11 (0.04–0.17)	<0.001	^a0.38 (0.31–0.43)	0.019	^a0.19 (0.15–0.24)	0.004
			^b0.13 (0.06–0.18)	<0.001	^b0.49 (0.40–0.57)	<0.001	^b0.21 (0.16–0.26)	0.008

Abbreviation: NRI: net reclassification index; IDI: integrated discrimination improvement; PIV: pan-immune-inflammation value; SII: systemic inflammatory index; MLR: monocyte count/lymphocyte count.

^a Compared with SII,

^b Compared with MLR.

Data availability statement

The data presented in this study are available on request from the corresponding author (Xiaoran Feng). The data are not publicly available due to ethical and institutional reasons.