Systemic immune-inflammation index is associated with diabetic kidney disease in Type 2 diabetes mellitus patients: Evidence from NHANES 2011-2018

Abstract

ObjectiveDiabetic kidney disease (DKD) is the most common chronic kidney disease (CKD) and has the highest prevalence of end-stage kidney disease (ESKD) globally, owing mostly to the rise in Type 2 diabetes mellitus (T2DM) correlated with obesity. Current research suggested that the immune response and inflammation may play a role in the pathophysiology of T2DM. The systemic immune-inflammation index (SII) is a novel and integrated inflammatory biomarker that has not yet been linked to DKD. We aimed to identify the potential relationship between SII and DKD.MethodsIn the National Health and Nutrition Examination Survey (NHANES) between 2011 and 2018, the current cross-sectional study was conducted among adults with T2DM. SII was calculated as the platelet count × neutrophil count/lymphocyte count. DKD was diagnosed with impaired glomerular filtration rate (< 60 mL/min/1.73 m2 assessed by using the Chronic Kidney Disease Epidemiology Collaboration algorithm), albuminuria (urine albumin to creatinine ratio ≥ 30 mg/g), or both in T2DM patients. To investigate the independent association between SII and DKD, weighted univariate and multivariable logistic regression analyses and subgroup analyses were performed.ResultsThe study involved 3937 patients in total, of whom 1510 (38.4%) had DKD for the diagnosis. After adjustment for covariates, multivariable logistic regression revealed that a high SII level was associated with increased likelihood of DKD (OR = 1.42, 95% CI: 1.10-1.83, P = 0.01). Subgroup analyses and interaction tests revealed that age, gender, estimated glomerular filtration rate (eGFR), urine albumin-to-creatinine ratio (ACR), body mass index (BMI), hypertension, hyperlipidemia, anti-inflammation therapy (yes or no), metformin use (yes or no), and insulin use (yes or no) had no significant dependence on this positive relationship (all p for interaction >0.05).ConclusionsOur results indicate that the higher SII level is associated with DKD in T2DM patients. The SII could be a cost-effective and straightforward approach to detecting DKD. This needs to be verified in further prospective investigations.

The association between systemic immune-inflammation index and rheumatoid arthritis: evidence from NHANES 1999–2018

“…Increased SII was associated with poor survival in ASCVD patients. Guo et al [ 32 ] found that SII levels in T2DM patients were associated with the development of diabetic kidney disease (DKD). SII may be a cost-effective and simple method to detect DKD.…”

The systemic immune-inflammation index is associated with Type 2 diabetes mellitus patients: Evidence from NHANES 2011-2018

“…A cross-sectional study found that ln-SII at baseline was associated with all causes of death from any cause in the United States ASCVD population in the NHANES group [22]. Increased SII in ASCVD individuals is related to poor survival [23].In addition, higher levels of SII are related to an increased risk of hepatic steatosis[8], peripheral arterial disease [9], isolated coronary artery ectasia [10], urinary albuminuria excretion [5], diabetic kidney disease [11], and diabetic depression [12]. Likewise, T2DM patients were more likely to have elevated SII in our subgroup analysis compared with those who did not have T2DM, Indicating that in ammation may be signi cantly involved in developing T2DM.…”

“…In addition, in ammatory markers, like SII, can also be used in the treatment of complications of T2DM. Guo et al found that T2DM patients had an increased SII in association with diabetic kidney disease [11].…”

“…SII, as a strong predictive factor, has been reported to be superior to conventional risk factors in the prediction of major cardiovascular events for CHD patients after coronary intervention [6].In addition, a statistically signi cant relationship between SII and higher BMI has been shown in earlier cross-sectional studies [7]. Furthermore, higher SII is correlated with an increased risk of liver steatosis [8], peripheral arterial disease [9], isolated coronary artery ectasia [10], urinary albuminuria excretion [5], diabetic kidney disease [11], diabetic depression [12].…”

The value of peripheral blood cell ratios in primary membranous nephropathy

“…Recent studies have found that the ratios of different blood cell components are new in ammatory and immunoreactive markers, such as neutrophil-lymphocyte ratio (NLR), monocyte-lymphocyte ratio (MLR), platelet-lymphocytes ratio (PLR), and systemic immune-in ammation index (SII, calculated by platelet count × neutrophil count/lymphocyte count), which have good predictive value in the outcome of cancer, chronic kidney disease, cardiovascular disease, rheumatic disease, type 2 diabetes, metabolic syndrome, and so on [10][11][12][13][14][15][16][17] . To our knowledge, limited studies have focused on evaluating the involvement of these markers in PMN, as well as their predictive value for treatment and progression in PMN.…”