The systemic inflammation indexes predict all-cause mortality in peritoneal dialysis patients

Figures & data

Figure 1. Study procedures, including patients’ selection and their outcomes.

Table 1. Demographic characteristics and laboratory data of the study population.

Clinical characteristics	All patients (n = 369)	Survivors (n = 304)	Non-survivors (n = 65)	p Value
Male (n, %)	214 (58.0%)	179 (58.9%)	35 (53.4%)	.455
Age (years)	47 (37, 59)	45 (35, 56)	63 (52, 71)	<.001
BMI (kg/m^2)	22.50 ± 2.99	22.43 ± 3.00	22.82 ± 2.95	.348
MAP (mmHg)	111 (102, 120)	110 (102, 120)	108 (100, 120)	.325
Diabetes mellitus (n, %)	61 (16.5%)	41 (13.5%)	20 (30.8%)	.001
Current smoking (n, %)	56 (15.2%)	41 (13.5%)	15 (23.1%)	.050
CVD history (n, %)	41 (11.1%)	24 (7.9%)	17 (26.2%)	<.001
KF causes				.001
Glomerulonephritis (n, %)	205 (55.6%)	182 (59.9%)	23 (35.4%)
Diabetic nephropathy (n, %)	34 (9.2%)	22 (7.2%)	12 (18.5%)
Hypertension nephropathy (n, %)	36 (9.8%)	26 (8.6%)	10 (15.4%)
Other/unknown (n, %)	94 (25.5%)	74 (24.3%)	20 (30.8%)
White blood count (×10^9/L)	6.07 (4.94, 7.65)	6.06 (4.93, 7.53)	6.27 (4.96, 8.22)	.293
Hemoglobin (g/dL)	8.19 (6.90, 9.30)	8.20 (6.97, 9.30)	8.03 (6.75, 9.19)	.367
Platelet count (×10^9/L)	161 (125, 208)	159 (124, 207)	170 (137, 221)	.098
Neutrophil count (×10^9/L)	4.23 (3.28, 5.52)	4.16 (3.25, 5.47)	4.66 (3.46, 6.63)	.061
Lymphocyte count (×10^9/L)	1.13 (0.83, 1.53)	1.18 (0.85, 1.58)	1.02 (0.73, 1.27)	.014
Monocyte count (×10^9/L)	0.35 (0.25, 0.48)	0.35 (0.25, 0.46)	0.40 (0.25, 0.55)	.138
AISI	205.20 (116.71, 369.63)	193.91 (106.55, 342.85)	263.19 (145.52, 626.60)	.003
SII	568.45 (371.07, 979.65)	540.84 (355.67, 874.13)	772.91 (483.89, 1300.39)	<.001
SIRI	1.2987 (0.8216, 2.0279)	1.2769 (0.7928, 1.8302)	1.6469 (1.0335, 2.9323)	.005
Albumin (g/L)	33.4 (29.8, 36.5)	33.9 (29.8, 36.5)	32.4 (28.9, 35.8)	.128
Globulin (g/L)	25.8 (22.8, 29.0)	25.6 (22.5, 28.7)	27.5 (23.8, 30.4)	.005
BUN (mmol/L)	30.50 ± 10.45	30.74 ± 10.62	29.38 ± 9.65	.343
Serum creatinine (μmol/L)	800.7 (657.1, 975.0)	811.0 (673.3, 990.6)	725.0 (625.2, 873.0)	.023
Uric acid (μmol/L)	496.02 ± 134.80	497.77 ± 138.87	487.80 ± 114.45	.589
RKF (ml/min/1.73m^2)	5.47 (4.30, 6.97)	5.44 (4.31, 6.96)	5.52 (4.10, 7.11)	.856
Corrected calcium (mmol/L)	2.02 (1.79, 2.18)	2.02 (1.80, 2.17)	2.01 (1.72, 2.20)	.583
Phosphate (mmol/L)	1.89 (1.56, 2.34)	1.89 (1.56, 2.35)	1.89 (1.52, 2.16)	.719
iPTH (Pg/mL)	236.6 (110.3, 418.0)	239.8 (110.7, 432.8)	230.3 (98.5, 343.1)	.468
Prealbumin (mg/L)	269 (222, 304)	273 (232, 308)	232 (191, 283)	<.001
CRP (mg/L)	4.9 (3.6, 8.4)	4.6 (3.6, 7.6)	6.4 (3.7, 15.0)	.012
Cholesterol (mmol/L)	4.13 (3.49, 4.85)	4.11 (3.46, 4.81)	4.25 (3.57, 5.15)	.162
Triglyceride (mmol/L)	1.69 (1.18, 2.30)	1.70 (1.19, 2.32)	1.67 (1.12, 2.23)	.772
HDL-C (mmol/L)	0.92 (0.76, 1.12)	0.92 (0.76, 1.12)	0.95 (0.77, 1.14)	.517
LDL-C (mmol/L)	2.07 (1.65, 2.49)	2.05 (1.62, 2.48)	2.10 (1.78, 2.64)	.284
apo-A1 (g/L)	1.13 ± 0.20	1.13 ± 0.20	1.17 ± 0.20	.112
apo-B (g/L)	0.86 (0.70, 1.01)	0.85 (0.70, 1.00)	0.89 (0.75, 1.08)	.201
EF (%)	62 (59, 64)	62 (59, 64)	61 (57, 63)	.071
Follow-up time (months)	32.83 (19.63, 54.23)	32.73 (20.47, 53.93)	34.30 (17.45, 54.80)	.993

Notes: Continuous variables are presented as mean ± standard deviation for normal distribution data or median (interquartile range) for non-normal distribution data. BMI: body mass index; MAP: mean arterial pressure; CVD: cardiovascular disease; BUN: blood urea nitrogen; RKF: residual kidney function; iPTH: intact parathyroid hormone; CRP: C-reactive protein; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; apo-A1: apolipoprotein A1; apo-B: apolipoprotein B; EF: ejection fraction; AISI: aggregate index of systemic inflammation; SII: systemic immune-inflammation index; SIRI: systemic inflammation response index.

Figure 2. ROC curves of the probability of AISI, SII and SIRI in predicting all-cause mortality.

Figure 3. Kaplan–Meier curves for all-cause mortality in peritoneal dialysis patients with different cutoff values of the blood cell count-derived inflammation indexes. (a): AISI; (b): SII; (c): SIRI.

Table 2. Optimal cutoff values and AUC of blood cell count-derived inflammation indexes.

	Cutoff value	AUC (95% CI)	p Value	Sensitivity (%)	Specificity (%)
AISI	>378.59	0.617 (0.541, 0.693)	.003	41.5	79.7
SII	>463.77	0.644 (0.573, 0.715)	<.001	81.5	43.1
SIRI	>2.0903	0.612 (0.535, 0.688)	.004	43.1	80.9

Note: AISI: aggregate index of systemic inflammation; SII: systemic immune-inflammation index; SIRI: systemic inflammation response index.

Table 3. Univariate Cox analysis of all-cause mortality in peritoneal dialysis patients.

Variables	Univariate analysis
	HR (95% CI)	p Value
Gender (female vs. male)	0.773 (0.471, 1.268)	.308
Age (≥60 years old)	4.487 (2.728, 7.379)	<.001
BMI (kg/m^2)	1.078 (0.995, 1.167)	.065
MAP (mmHg)	0.997 (0.982, 1.013)	.735
Hypertension	3.971 (0.546, 28.881)	.173
Diabetes mellitus	3.687 (2.146, 6.335)	<.001
Current smoking	2.132 (1.195, 3.804)	.010
CVD history	3.033 (1.738, 5.292)	<.001
White blood count (×10^9/L)	1.064 (0.961, 1.178)	.230
Hemoglobin (g/dL)	1.040 (1.007, 1.075)	.018
Platelet (×10^9/L)	1.006 (1.003, 1.010)	.001
Neutrophil (×10^9/L)	1.081 (0.975, 1.198)	.138
Lymphocytes (×10^9/L)	0.736 (0.435, 1.245)	.253
Monocyte (×10^9/L)	2.095 (0.623, 7.047)	.232
Albumin (g/L)	0.976 (0.929, 1.026)	.338
Globulin (g/L)	1.056 (1.007, 1.106)	.024
BUN (mmol/L)	0.978 (0.953, 1.004)	.101
Serum creatinine (μmol/L)	0.999 (0.998, 1.000)	.035
Uric acid (μmol/L)	0.999 (0.997, 1.001)	.161
RKF (ml/min/1.73m^2)	1.051 (0.933, 1.183)	.413
Corrected calcium (mmol/L)	1.047 (0.507, 2.161)	.902
Phosphate (mmol/L)	0.892 (0.597, 1.333)	.577
iPTH (Pg/mL)	1.000 (0.999, 1.001)	.537
Prealbumin (mg/L)	0.992 (0.988, 0.996)	<.001
CRP (mg/L)	1.021 (1.008, 1.034)	.002
Cholesterol (mmol/L)	1.274 (1.035, 1.567)	.022
Triglyceride (mmol/L)	1.009 (0.806, 1.263)	.939
HDL-C (mmol/L)	1.439 (0.659, 3.144)	.362
LDL-C (mmol/L)	1.555 (1.156, 2.092)	.004
apo-A1 (g/L)	1.219 (0.309, 4.804)	.777
apo-B (g/L)	3.840 (1.546, 9.541)	.004
EF (%)	0.972 (0.936, 1.010)	.149
AISI > 378.59	2.226 (1.358, 3.649)	.002
SII > 463.77	2.794 (1.490, 5.238)	.001
SIRI > 2.0903	2.070 (1.264, 3.389)	.004

Note: BMI: body mass index; MAP: mean arterial pressure; CVD: cardiovascular disease; BUN: blood urea nitrogen; RKF: residual kidney function; iPTH: intact parathyroid hormone; CRP: C-reactive protein; HDL-C: high-density lipoprotein cholesterol; LDL-C: low-density lipoprotein cholesterol; apo-A1: apolipoprotein A1; apo-B: apolipoprotein B; EF: ejection fraction; AISI: aggregate index of systemic inflammation; SII: systemic immune-inflammation index; SIRI: systemic inflammation response index.

Table 4. Hazard ratios of blood cell count-derived inflammation indexes by multivariate Cox analysis of inflammation indexes.

	Model 1		Model 2		Model 3
	HR (95% CI)	p Value	HR (95% CI)	p Value	HR (95% CI)	p Value
AISI > 378.59	2.330 (1.404, 3.866)	.001	2.494 (1.490, 4.175)	.001	2.508 (1.505, 4.179)	<.001
SII > 463.77	3.320 (1.691, 6.519)	<.001	2.749 (1.448, 5.221)	.002	3.477 (1.785, 6.775)	<.001
SIRI > 2.0903	1.951 (1.184, 3.215)	.009	1.852 (1.100, 3.118)	.020	1.711 (1.012, 2.895)	.045

Notes: Model 1: adjusted for age, diabetes mellitus, CVD history, current smoking; Model 2: adjusted for model 1 + hemoglobin, globulin, creatinine, prealbumin, CRP; Model 3: adjusted for model 2 + cholesterol, LDL-C, apo-B. AISI: aggregate index of systemic inflammation; SII: systemic immune-inflammation index; SIRI: systemic inflammation response index; CRP: C-reactive protein; CVD: cardiovascular disease; LDL-C: low-density lipoprotein cholesterol; apo-B: apolipoprotein B.

Data availability statement

The data used to support the findings of this study are available from the corresponding author upon request.