Prognostic Value of Systemic Inflammatory Response Index for the Prognosis of Diabetic Maintenance Hemodialysis Patients: A Retrospective Observational Study

Figures & data

Figure 1 The flow chart of this study.

Table 1 The Baseline Characteristics of All Patients

Characteristics	SIRI < 2.5 (n=68)	SIRI ≥ 2.5 (n=85)	P value
Age, years old	62.9 ± 10.1	65.4 ± 11.0	0.147
Gender, Male, n (%)	42 (61.8)	43 (50.6)	0.169
BMI, kg/m2	22.7 ± 4.7	22.4 ± 3.8	0.674
Martial status, n (%)			0.653
Married	63 (92.6)	77 (90.6)
Unmarried/others	5 (7.4)	8 (9.4)
Education status			0.914
Primary school or below	31 (45.6)	39 (44.7)
Middle school or above	37 (54.4)	47 (55.3)
Vascular access			0.145
AVF	18 (26.5)	32 (37.6)
TCC	50 (73.5)	53 (62.4)
DM duration, n (%)			0.010
>10 years	26 (38.2)	49 (57.6)
≤ 10 years	42 (61.8)	36 (42.4)
Complications
Hypertension, n (%)	64 (94.1)	74 (87.1)	0.146
CVD, n (%)	20 (29.4)	25 (29.4)	1.000
Cerebrovascular disease, n (%)	9 (13.2)	19 (22.4)	0.149
Laboratory results
Systolic blood pressure, mmHg	144.0 ± 20.2	148.6 ± 23.5	0.201
Diastolic blood pressure, mmHg	82.0 ± 12.3	81.5 ± 11.6	0.194
White blood cells,×109/L	9.2 ± 3.7	7.7 ± 2.8	0.035
Hemoglobin, g/L	90.7 ± 20.5	91.4 ± 23.7	0.837
Red blood cells, ×1012/L	3.2 ± 0.6	3.3 ± 0.8	0.565
MCV, fL	90.3 ± 5.6	89.0 ± 7.8	0.246
MCH, pg	27.9 ± 2.3	27.8 ± 3.2	0.734
MCHC, g/L	310.7 ± 16.6	307.6 ± 38.7	0.537
RDW, %	15.5 ± 5.8	15.9 ± 5.2	0.150
Platelets, ×109/L	200.2 ± 57.5	196.7 ± 34.4	0.781
SIRI	1.5 ± 0.6	6.3 ± 1.8	<0.001
Glucose, mmol/L	8.9 ± 2.6	9.2 ± 3.3	0.781
HbA1c, %	7.1 ± 1.7	7.1 ± 1.5	0.920
Albumin, g/L	37.8 ± 4.7	35.6 ± 5.3	0.008
BUN, mmol/L	23.3 ± 10.4	26.1 ± 9.4	0.080
Creatinine, umol/L	822.2 ± 173.7	831.0 ± 184.1	0.841
eGFR, mL/min	7.6 ± 1.9	5.8 ± 2.0	0.158
Total cholesterol, mmol/L	4.4 ± 1.3	4.3 ± 1.1	0.591
Triglyceride, mmol/L	1.7 ± 0.5	1.8 ± 0.6	0.814
HDL-C, mmol/L	1.2 ± 0.4	1.1 ± 0.4	0.184
LDL-C, mmol/L	2.2 ± 0.9	2.1 ± 0.8	0.673
Serum ferritin, ug/L	217.9 ± 74.2	168.1 ± 61.3	0.209
CRP, mg/L	7.0 ± 2.9	8.5 ± 2.1	0.348
Potassium, mmol/L	4.2 ± 0.8	4.1 ± 0.7	0.442
Sodium, mmol/L	138.0 ± 3.0	137.7 ± 3.1	0.512
Calcium, mmol/L	2.1 ± 0.2	2.1 ± 0.3	0.419
Serum phosphorus, mmol/L	1.5 ± 0.4	2.2 ± 0.5	0.028
Parathyroid Hormone, pg/mL	205.0 ± 81.2	204.0 ± 78.0	0.998
Survival months	26.0 (15.0, 45.0)	23.0 (13.0, 44.0)	0.502
Death, n (%)	7 (10.3)	43 (50.6)	<0.001

Abbreviations: SIRI, systemic inflammatory response index, BMI, body mass index, AVF, arteriovenous fistula, TCC, tunneled central venous catheter, DM, diabetes mellitus, CVD, cardiovascular disease, MCV, mean corpuscular volume, MCH, mean corpuscular hemoglobin, MCHC, mean corpuscular hemoglobin concentration, RDW, red cell distribution width, HbA1c, hemoglobin A1c, BUN, blood urea nitrogen, eGFR, estimated glomerular filtration rate, HDL-C, High-density lipoprotein cholesterol, LDL-C, Low-density lipoprotein cholesterol, CRP, C reactive protein.

Figure 2 X-tile analyses of SIRI to obtain the optimal cutoff value of SIRI. X-tile plots for patients with diabetic MHD are shown on the left panels; the black circles indicate the optimal cutoff values, which are also presented in histograms (middle panels). Kaplan-Meier curves are shown in the right panels.

Figure 3 The waterfall plots and forest plots of the high-SIRI group and low-SIRI group for the prognosis of diabetic MHD patients. The waterfall plot of SIRI for each patient of mortality (A) and the subgroup analysis of the SIRI for the prognosis of individuals with diabetic MHD patients (B).

Figure 4 The SIRI was established to detect the overall mortality of patients with diabetic MHD. All patients were distinguished into high and low risk based on the SIRI (A), the relationship between survival time and prognosis of patients in the two corresponding groups (B), and the heatmap of other markers between the two groups (C). Receiver operating characteristic (ROC) curve analysis of the SIRI for overall mortality (D), Decision curve analysis of the risk score for the overall mortality (E). Kaplan-Meier curves show the overall mortality of groups with different risks (F).

Table 2 Univariate and Multivariate Cox Regression Analysis for All-Cause Mortality

	Univariate		Multivariate
	HR (95% CI)	P	HR (95% CI)	P
SIRI ≥ 2.5	5.26 (2.37–11.71)	<0.001	4.00 (1.77–9.07)	0.001
DM duration
≥ 10 years	2.29 (1.23–4.26)	<0.001	1.69 (1.18–2.64)	0.025
< 10 years	Ref.	–	Ref.	–
MCV	0.95 (0.92–0.99)	0.013	0.97 (0.94–1.01)	0.120
BUN	1.00 (0.97–1.03)	0.874
eGFR	0.89 (0.75–0.94)	<0.001	0.94 (0.89–0.99)	0.038
Albumin	0.92 (0.87–0.97)	0.003	0.93 (0.88–0.96)	0.010
Serum phosphorus	2.05 (1.45–2.89)	<0.001	1.78 (1.26–2.51)	0.001

Abbreviations: SIRI, systemic inflammatory response index, DM, diabetes mellitus, MCV, mean corpuscular volume, BUN, blood urea nitrogen, eGFR, estimated glomerular filtration rate, HR, hazard ratio, 95% CI, 95% confidence index.

Figure 5 Selection of significant factors associated with OS in diabetic MHD patients by LASSO Cox regression model. (A) The selection process of the optimum value of the parameter λ in the Lasso regression model by cross-validation method; (B) the variation characteristics of the coefficient of variables.

Figure 6 The established nomogram for OS in patients with diabetic MHD (A), the 1-year, 3-year, and 5-year calibration curves of the nomogram for OS (B), decision curve analysis of the nomogram for OS (C), and the time-dependent ROC curves for the 1-year, 3-year, and 5-year OS in patients with diabetic MHD (D).