Associations of complete blood cell count-derived inflammatory biomarkers with asthma and mortality in adults: a population-based study

Correlations between frailty index and inflammatory markers derived from blood cell count in the United States

BACKGROUND

Complete blood cell count (CBC)-derived inflammatory biomarkers are crucial indicators of adverse outcomes and possess predictive value for a wide range of diseases. The objective of this study was to evaluate the links between CBC-derived inflammatory biomarkers and frailty index.

METHODS

Information was gathered from the National Health and Nutrition Examination Survey (NHANES) spanning the years 1999 to 2016. The research investigated the correlation between inflammatory biomarkers derived from CBC, including the neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic inflammatory response index (SIRI), and systemic immune-inflammation index (SII), and Rockwood's frailty index, using logistic regression analyses.

RESULTS

In total, the cross-sectional study involved 13,507 U.S. adults aged 50 and older, with 3,729 individuals (24%) meeting the criteria for frailty. After adjusting for confounding factors, elevated levels of logNLR (odds ratio [OR] 3.45, 95% confidence interval [CI] 2.52-4.73), logMLR (OR 3.58, 95% CI 2.44-5.25), logSIRI (OR 2.77, 95% CI 2.17-3.55), and logSII (OR 1.89, 95% CI 1.44-2.48) were significantly associated with an increased frailty index in the entire study population. We also found that frailty index and inflammatory biomarkers derived from CBC have a non-linear relationship by restricted cubic spline.

CONCLUSIONS

Our findings indicate a correlation between frailty index and NLR, MLR, SIRI, and SII among elderly adults. Considering their wide accessibility in both clinical and laboratory practice, these biomarkers may be recommended as potential indicators for the development of frailty.

Relationship between neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, platelet-to-lymphocyte ratio and osteoporosis in postmenopausal type 2 diabetic patients: A retrospective study

Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR) are newly discovered inflammatory markers in recent years. To explore the relationship between NLR, MLR, PLR, and bone mineral density (BMD), as well as osteoporosis (OP), in postmenopausal patients with type 2 diabetes mellitus (T2DM). 320 postmenopausal patients with T2DM who were admitted to the Department of Endocrinology and Metabolic Diseases of our hospital from January 2022 to January 2024 for treatment were included in this retrospective study. The patients were divided into 3 groups according to the BMD: normal bone mass group (n = 109), osteopenia group (n = 99), and OP group (n = 112). Clinical data and blood laboratory parameters were collected from the patients. The NLR, MLR, and PLR were calculated. Statistically significant differences were found in the comparison of NLR, MLR, and PLR among the 3 groups of patients (P < .001). The OP group had higher NLR, MLR, and PLR than the normal bone mass group and the osteopenia group. NLR, MLR, and PLR were negatively correlated with BMD at the lumbar spine (L1-L4), left femoral neck, and left hip, respectively. Analysis revealed that elevated levels of NLR and PLR were independent risk factors for OP in postmenopausal patients. The results of the receiver operating characteristic curve analysis indicated that the area under the curve (AUC) for NLR was higher than that of PLR. Combined use of NLR and PLR resulting in an improved AUC of 0.904. Neutrophils produce mediators such as interferon-gamma (IFN-γ), interleukin-6 (IL-6), interleukin-1 (IL-1), and receptor activator of nuclear factor kappa-B ligand (RANKL), which increase the number and activity of osteoclasts. Peripheral blood monocytes play a vital role in osteoclastogenesis as osteoclast precursors. The BMD of postmenopausal T2DM patients is negatively correlated with NLR, MLR, and PLR. NLR and PLR can both serve as predictive indicators for the occurrence of OP in postmenopausal T2DM patients.

Systemic immune inflammation index with all-cause and cause-specific mortality: a meta-analysis

IMPORTANCE

Studies have reported an association among systemic immune inflammation index (SII), all-cause and cause-specific mortality, but the results are inconsistent.

OBJECTIVE

To comprehensively explore the association between Systemic Immune Inflammation (SII) and the risk of all-cause mortality, cardiovascular disease (CVD), and cancer mortality.

EVIDENCE REVIEW

A meta-analysis was conducted by reviewing existing literature. The search encompassed prominent databases including PubMed, Embase, Cochrane, and the Web of Science, with the cutoff date set at March 1, 2024. Furthermore, subgroup analyses and dose-response assessments were undertaken to provide a nuanced exploration of mortality risk factors.

FINDINGS

A total of 33 articles were included (427,819 participants). In the study, SII was associated with an increased risk of all-cause mortality (HR = 1.45, 95%CI [1.36,1.54], P < 0.05). SII increased the risk of CVD mortality (HR = 1.44, 95%CI [1.29,1.60], P < 0.05). The Linear independence shows that for every 100 units increase in SII, the risk of all-cause and CVD death increases by 5% and 6%. SII was not associated with a statistically significant risk of cancer death (HR = 1.09, 95%CI [0.96,1.23], P < 0.05).

CONCLUSIONS AND RELEVANCE

Meta-analysis showed that SII was associated with all-cause mortality and CVD mortality. More data and basic research are needed to confirm the association.

Chronic systemic inflammation predicts long-term mortality among patients with fatty liver disease: Data from the National Health and Nutrition Examination Survey 2007-2018

BACKGROUND

Low-grade systemic inflammation (SI) in patients with fatty liver disease (FLD) is an important hallmark of disease onset and progression. This study aims to evaluate the prognostic significance of novel SI markers in FLD.

METHODS

This was a retrospective cohort study. We included adult patients with FLD with complete data and analyzed the association between chronic SI and long-term mortality in patients with FLD. Systemic immune-inflammation index (SII), pan-immune-inflammation value (PIV), and systemic inflammation response index (SIRI) were evaluated based on peripheral blood counts and FLD was determined by the Fatty Liver Index.

RESULTS

A total of 5497 patients with FLD were included in the final analysis. SII and PIV (but not SIRI) were found to be associated with all-cause and cardiovascular mortality in univariate analysis. Multivariate Cox regression analysis and KM analysis demonstrated that SII and PIV were associated with all-cause mortality, with SII showing a nonlinear correlation in RCS. PIV (but not SII) was associated with the cardiovascular-related survival probability over time. Stratified analysis indicated that the positive correlation between SII and PIV and all-cause mortality was not altered by subgroups.

CONCLUSIONS

SII and PIV are strongly and consistently associated with all-cause mortality in patients with FLD, with PIV potentially showing a closer association with cardiovascular mortality.

Association Between Indices of Peripheral Blood Inflammation and Cavitary Pulmonary Tuberculosis

Objective

To explore inflammation markers of C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), and systemic inflammatory response index (SIRI) in the differential diagnosis of cavitary pulmonary tuberculosis (PTB) from non-cavitary PTB.

Methods

This retrospective study included 1233 patients with PTB, 518 patients were diagnosed with cavitary PTB as case group, while 715 patients which diagnosed with non-cavitary PTB were selected as control group. The clinical data of patients was collected and the levels of inflammation indices were measured. Receiver operating characteristic (ROC) curve analysis was used to assess the diagnosis and analysis of selected indices. Logistic regression analysis was performed to evaluate the factors associated with cavitary PTB.

Results

The CRP, NLR, MLR, PLR, SII, and SIRI in the case group were significantly higher than those in the controls (all p<0.001). When cavitary PTB was taken as the endpoint, the optimal diagnostic thresholds of CRP was 35.365 (area under the ROC curve (AUC)=0.601), NLR was 5.740 (AUC=0.595), MLR was 0.525 (AUC=0.577), PLR was 198.255 (AUC=0.602), SII was 1252.045 (AUC=0.628), and SIRI was 2.095 (AUC=0.605), respectively. Logistic regression analysis showed that gender, CRP, PLR, and SIRI were the independent risk factors for cavitary PTB. The sensitivity of the combination of the three indices (CRP+PLR, CRP+SIRI, PLR+SIRI, and CRP+PLR+SIRI) were higher than those of the CRP, PLR, and SIRI.

Conclusion

CRP, PLR, and SIRI levels were associated with an increased likelihood of cavitary PTB. The combined detection of CRP, PLR, and SIRI is promising as a screening marker and may be useful for ruling out PTB with cavitary.

Weight-adjusted waist index is an independent predictor of all-cause and cause-specific mortality in patients with asthma

BACKGROUND

There is a close relationship between obesity and the occurrence of asthma.The weight-adjusted waist index (WWI) is a relatively novel anthropometric parameter that reflects obesity.

OBJECTIVE

We aimed to explore the association between WWI and mortality in the asthma population.

METHODS

We included adult with asthma from NHANES 1999-2018. WWI = Waist circumference (cm)/square root of body weight (kg). Current asthma was determined by the participant's responses in standardized questionnaires. All-cause, cardiovascular disease (CVD), cancer, and respiratory disease mortality information was obtained by prospectively matching these data to the National Death Index. Multivariate-adjusted Cox proportional hazards regression analyses, Kaplan Meier survival analyses, restricted cubic spline (RCS) analyses, stratified analyses, and sensitivity analyses were used to clarify these associations.

RESULTS

A total of 101,316 participants were included in the study, and 3223 were diagnosed with asthma.WWI was independently and positively associated with all-cause and all factor-specific mortality in asthma. In fully adjusted models, each unit increase in WWI was associated with 43 % (hazard ratio [HR] and 95 % confidence interval [CI] = 1.43 [1.25,1.64], p < 0.0001), 58 % (1.58 [1.25, 1.99], p < 0.001), 50 % (1.50 [1.19, 1.90], p < 0.001), and 79 % (1.79 [1.34, 2.39], p < 0.0001) increased all-cause, CVD, cancer, and respiratory disease mortality, respectively. RCS analyses showed largely linear associations between WWI and all mortality risks. Stratified analyses indicated that these associations were influenced by multiple factors, and that age was consistently the effect modifier across all associations.

CONCLUSIONS

WWI is an independent predictor of all-cause, CVD, cancer, and respiratory-related mortality in the adult asthma population. These findings highlight that WWI may have novel prognostic value as a simple and easily accessible obesity parameter in asthma patients.

Association between systemic immune-inflammatory index and systemic inflammatory response index with body mass index in children and adolescents: a population-based study based on the National Health and Nutrition Examination Survey 2017-2020

Background

The Systemic Immune-Inflammatory Index (SII) and Systemic Inflammatory Response Index (SIRI) are novel composite inflammatory markers. Previous studies suggest that obesity in individuals correlates with persistently low levels of chronic inflammation. This study aims to explore the association between SII and SIRI and Body Mass Index (BMI) among children and adolescents.

Methods

A cross-sectional survey was conducted using the National Health and Nutrition Examination Survey (NHANES) dataset from 2 consecutive cycles from 2017-2020. Multivariate linear regression models were employed to examine the linear relationships between BMI and SII and SIRI. Non-linear associations were explored using smooth curve fitting and threshold effect analysis.

Results

A total of 2980 children and adolescents aged 6-19 years were included in this population-based study. In the population description of body mass index categories, we found progressively higher levels of SII and SIRI, notably peaking among obese children (SII mean ± SD: 528.83 ± 285.46; SIRI mean ± SD: 1.12 ± 0.79). Weighted multivariate linear regression confirmed a significant positive association between BMI and both inflammatory indices (P < 0.0001). Subgroup analyses revealed consistent correlations across gender divisions and highlighted a non-linear relationship between BMI and SII.

Conclusions

SII and SIRI are positively associated with BMI in children and adolescents, indicating their potential as markers for assessing systemic inflammation in pediatric obesity. Further large-scale prospective studies are required to substantiate these findings.

Hydrogen Gas Inhalation Alleviates Airway Inflammation and Oxidative Stress on Ovalbumin-Induced Asthmatic BALB/c Mouse Model

Airway inflammatory diseases, such as asthma, are a global public health concern owing to their chronic inflammatory effects on the respiratory mucosa. Molecular hydrogen (H2) has recently been recognized for its antioxidant and anti-inflammatory properties. In this study, we examined the therapeutic potential of H2 in airway inflammation using an ovalbumin (OVA)-induced BALB/c mouse model of allergic asthma. Female BALB/c mice were sensitized and challenged with OVA to induce airway inflammation, and 30 mice were randomly divided into five groups: NT (non-treatment), HTC (3% H2 treatment only), NC (negative control, OVA only), PC (positive control, OVA + intranasal 1 mg/mL salbutamol 50 μL), and HT (H2 treatment, OVA + inhaled 3% H2). Various inflammatory and oxidative stress (OS)-induced markers such as white blood cells (WBCs) and their differential counts, lung histology, cytokine levels such as interleukin (IL)-4, (IL)-5, (IL)-13, interferon-gamma (IFN-γ), tumor necrosis factor-alpha (TNF-α), granulocyte-macrophage colony-stimulating factor (GM-CSF), (IL)-10, reactive oxygen species (ROS), nitric oxide (NO), glutathione peroxidase (GPx), and catalase (CAT), and total immunoglobulin E (IgE) levels were investigated. Our results showed that inhaled H2 significantly reduced inflammatory cell infiltration, OS markers, and pro-inflammatory cytokine expression while upregulating antioxidant enzyme activity. Furthermore, H2 also significantly decreased serum IgE levels, a marker of allergic inflammation. Collectively, our findings suggest that H2 inhalation is a promising treatment option for airway inflammation, offering a novel approach with potential clinical applications.

Association of naples prognostic score and lung health: A population-based study

BACKGROUND

The Naples Prognostic Score (NPS) is a novel indicator of inflammatory and nutritional status, but its relationship to lung health is unknown.

OBJECTIVE

To evaluate the relationship of NPS to lung health problems.

METHODS

A total of 15,600 participants aged 20 years or older with an available assessment of chronic lung diseases were enrolled from the National Health and Nutrition Examination Survey 2007-2012. The NPS was calculated based on serum albumin, total cholesterol, neutrophil-to-lymphocyte ratio, and lymphocyte-to-monocyte ratio. Associations of NPS with chronic lung disease (diagnosed asthma, chronic bronchitis, and emphysema), respiratory symptoms (cough, phlegm production, wheeze, and exertional dyspnea), and spirometric measurements (FEV1, FVC, and obstructive or restrictive spirometry pattern) were evaluated. Kaplan-Meier survival analysis and multiple Cox regressions were used to assess the significance of NPS in relation to all-cause mortality and chronic lower respiratory diseases mortality in participants. Furthermore, to comprehensively assess the association between NSP and chronic lower respiratory diseases mortality, Fine-Gray subdistribution hazards model was performed to analyze non-chronic lower respiratory diseases mortality as a competitive risk.

RESULTS

People with a higher NPS score were associated with greater odds of asthma, chronic bronchitis, respiratory symptoms (including phlegm production, wheeze, and exertional dyspnea), and a greater risk of obstructive and restrictive spirometry. A higher NPS score was significantly associated with decreased FEV1 and FVC in both overall participants and those with lung health problems. Longitudinally, we found that those in the category with highest NPS were at greater risk of all-cause mortality and chronic lower respiratory diseases mortality in those with chronic lung disease, and respiratory symptoms.

CONCLUSIONS

An elevated NPS is associated with a host of adverse pulmonary outcomes. Prospective studies to define NPS as a biomarker for impaired lung health are warranted.

The association between triglyceride-glucose index and its combination with systemic inflammation indicators and all-cause and cardiovascular mortality in the general US population: NHANES 1999-2018

BACKGROUND

The correlation between the triglyceride-glucose (TyG) index and mortality in the general population remains controversial, with inconsistent conclusions emerging from different studies.

OBJECTIVE

This study aims to investigate whether there is an association between the TyG index and mortality in the general population in the United States, and to explore whether a new index combining the TyG index with systemic inflammation indicators can better predict all-cause and cardiovascular mortality risks in the general population than using the TyG index alone.

METHODS

Calculate the systemic inflammation indicators and TyG index for each participant based on their complete blood count, as well as their triglyceride and glucose levels in a fasting state. TyG-inflammation indices were obtained by multiplying the TyG index with systemic inflammation indicators (TyG-NLR, TyG-MLR, TyG-lgPLR, TyG-lgSII, and TyG-SIRI). Based on the weighted Cox proportional hazards model, assess whether the TyG and TyG-Inflammation indices are associated with mortality risk in the general population. Restricted cubic splines (RCS) are used to clarify the dose-response relationship between the TyG and TyG-Inflammation indices and mortality, and to visualize the results. Time-dependent receiver operating characteristic (ROC) curves are used to evaluate the accuracy of the TyG and TyG-Inflammation indices in predicting adverse outcomes.

RESULTS

This study included 17,118 participants. Over a median follow-up period of 125 months, 2595 patients died. The TyG index was not found to be related to mortality after adjusting for potentially confounding factors. However, the TyG-inflammation indices in the highest quartile (Q4), except for TyG-lgPLR, were significantly associated with both all-cause and cardiovascular mortality, compared to those in the lowest quartile (Q1). Among them, TyG-MLR and TyG-lgSII showed the strongest correlations with all-cause mortality and cardiovascular mortality. Specifically, compared to their respective lowest quartiles (Q1), participants in the highest quartile (Q4) of TyG-MLR had a 48% increased risk of all-cause mortality (95% CI: 1.23-1.77, P for trend < 0.0001), while participants in the highest quartile (Q4) of TyG-lgSII had a 92% increased risk of cardiovascular mortality (95% CI: 1.31-2.81, P for trend < 0.001). Time-dependent ROC curve analysis showed that the TyG-MLR had the highest accuracy in predicting long-term mortality outcomes.

CONCLUSIONS

The TyG-Inflammation indices constructed based on TyG and systemic inflammation indicators are closely related to mortality in the general population and can better predict the risk of adverse outcomes. However, no association between TyG and mortality in the general population was found.

Association between the systemic inflammation response index and mortality in the asthma population

Background

As a novel indicator of inflammation, the relationship between the systemic immune-inflammation index (SIRI) and mortality in patients with asthma remains uncertain. Our study aimed to explore the association between SIRI and mortality in asthma patients.

Methods

Data from the National Health and Nutrition Examination Survey (NHANES) for US adults from 2001 to 2018 were included in this study. Then, we divided all patients into three groups based on SIRI tertiles and used multivariable weighted Cox regression analysis, smoothing curve fitting, survival curve analysis, and subgroup analysis to investigate the relationship between SIRI and asthma.

Results

A total of 6,156 participants were included in the study, with each SIRI tertile consisting of 2052 individuals. Asthma patients with higher SIRI levels were older, had a higher level of education, were more likely to be married, and had a higher chance of being smokers. In Cox proportional-hazards models, the highest SIRI group showed higher hazard ratios (HRs) for all-cause mortality in individuals with asthma after adjusting for potential confounders. The restricted cubic spline analysis indicated a non-linear relationship between SIRI and all-cause mortality. The Kaplan-Meier survival curves showed that patients with higher SIRI levels had a higher risk of all-cause mortality. Subgroup analyses revealed SIRI's association with all-cause mortality across various demographics, including age, sex, race, education levels, smoking status, and marital status.

Conclusion

Our study provides evidence for the relationship between SIRI and mortality in asthma patients. SIRI may potentially serve as a predictive tool for evaluating asthma mortality rates.

Elevated inflammatory burden index increases mortality in adults with chronic inflammatory airway diseases: a nationwide cohort study

OBJECTIVE

The objective of this study was to investigate the potential association between the inflammatory burden index (IBI) and the prevalence of chronic inflammatory airway diseases (CIAD), as well as mortality rates among individuals diagnosed with CIAD.

METHODS

Participants were sourced from the National Health and Nutrition Examination Survey (NHANES) conducted between 1999 and 2010. The IBI was calculated using the formula: IBI = C-reactive protein * neutrophils / lymphocytes. CIAD comprised self-reported asthma, chronic bronchitis, and chronic obstructive pulmonary disease (COPD). Mortality outcomes, including all-cause and respiratory disease mortality, were determined through linked data from the National Death Index (NDI) up to December 2019.

RESULTS

A total of 27,495 adults were included. IBI was divided into quartiles, with the lowest quartile as the reference group. After adjusting for confounding variables, a positive correlation was observed between higher IBI and increased prevalence of total CIAD (OR = 1.383 [1.215-1.575]), asthma (OR = 1.267 [1.096-1.465]), chronic bronchitis (OR = 1.568 [1.263-1.946]), and COPD (OR = 1.907 [1.311-2.774]). Over a median follow-up of 12.33 [9.92-16.00] years, there were 1221 deaths from all causes and 220 deaths from respiratory disease among 4499 patients with CIAD. Following multivariate adjustments, the fourth quartile was significantly associated with increased risk of all-cause mortality (HR = 2.227 [1.714-2.893]) and respiratory disease mortality (HR = 2.748 [1.383-5.459]) compared to the first quartile of IBI in CIAD participants. Moreover, variable importance analysis using a random survival forest model demonstrated the significance of IBI in predicting mortality from both all-cause and respiratory diseases.

CONCLUSION

IBI exhibited an association with the prevalence of CIAD, with higher IBI levels correlating with elevated all-cause and respiratory disease mortality among individuals with CIAD.

Association between complete blood count-derived inflammatory markers and the risk of frailty and mortality in middle-aged and older adults

Objective

This study aimed to evaluate the association between six complete blood count (CBC)-derived inflammatory markers [neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), systemic inflammatory response index (SIRI), and pan-immune inflammation value (PIV)] and the risk of frailty and mortality.

Methods

Data were obtained from the National Health and Nutrition Examination Survey (NHANES) 1999-2018. Mortality was identified using the National Death Index until December 31, 2019. Multiple logistic regression analysis was conducted to evaluate the association between six CBC-derived inflammatory markers and frailty. The Cox regression model assessed the association between six CBC-derived inflammatory markers and mortality in frail populations. Restricted cubic spline (RCS) was used to visualize the association of the six CBC-derived inflammatory markers with mortality risk. The predictive value of CBC-derived inflammatory markers for mortality was further assessed using a random survival forest (RSF) approach.

Results

This study analyzed data from a total of 16,705 middle-aged and older participants. Among them, 6,503 participants were frail, with a mortality rate of 41.47%. Multiple logistic regression analysis showed that NLR, MLR, PLR, SII, SIRI, and PIV were positively associated with frailty risk. The Cox regression model revealed that participants in the highest quartile had a significantly increased risk of death compared to those in the lowest quartile: NLR (HR = 1.73, 95% CI:1.54, 1.94), MLR (HR = 1.71, 95% CI:1.51, 1.93), PLR (HR = 1.28, 95%CI: 1.15, 1.43), SII (HR = 1.50, 95%CI:1.34, 1.68), SIRI (HR = 1.88, CI 95%:1.67, 2.12), PIV (HR = 1.55, 95%CI:1.38, 1.73). Random survival forest (RSF) analyses demonstrated that MLR had the highest predictive value for mortality risk middle-aged and older adult frail participants.

Conclusion

The results suggest that CBC-derived inflammatory markers are associated with a higher risk of frailty as well as mortality in the middle and old-aged population of the United States.

The association between the composite dietary antioxidant index and asthma in US children aged 3-18 years: a cross-sectional study from NHANES

The association between composite dietary antioxidant index (CDAI) and asthma remains unclear. Our study aimed to investigate the association of CDAI with asthma in children aged 3-18 years in the United States. Cross-sectional analyses were carried out on 18,118 children aged 3-18 years old. Data was obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2003 and 2020. The Composite Dietary Antioxidant Index (CDAI) was measured by assessing the consumption of six dietary antioxidants (vitamin A, vitamin C, vitamin E, zinc, selenium and carotenoids). The association between CDAI and asthma was explored using multivariate weighted logistic regression, subgroup analyses, and sensitivity analyses. Among the 18,118 participants, 2045 (11.3%) reported a diagnosis of asthma by a healthcare provider. In both the crude and adjusted models, the odds ratios (ORs) for asthma with CDAI were not significant. Specifically, in the fully adjusted model, the OR for T2 was 0.98 (95% CI 0.83, 1.17) and the OR for T3 was 1.00 (95% CI 0.76, 1.31). Subgroup analyses by sex, age and BMI category also showed no significant associations. Sensitivity analyses, including weighted logistic multivariate analyses adjusting for family history of asthma, confirmed the absence of a significant association between CDAI and asthma. Our study showed no significant association between CDAI and asthma in children and adolescents.

The relationship between complete blood cell count-derived inflammatory biomarkers and benign prostatic hyperplasia in middle-aged and elderly individuals in the United States: Evidence from NHANES 2001-2008

BACKGROUND

Benign prostatic hyperplasia (BPH) is a common health disorder of the male genitourinary system with a high prevalence, especially among middle-aged and older adults, which seriously affects men's quality of life. Inflammatory markers derived from complete blood cell count (CBC) have previously been considered a prognostic indicator for various diseases, but little is known about their relationship with BPH. This study evaluated the relationship between complete blood cell count (CBC)-derived inflammatory biomarkers and BPH.

METHODS

Data for this cross-sectional study were gathered from the National Health and Nutrition Examination Survey (NHANES) between 2001 and 2008. Using multiple logistic regressions, the study examined the association between benign prostatic hyperplasia(BPH) and Inflammatory biomarkers derived from blood cell counts such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), Systemic Inflammatory Response Index (SIRI) and Systemic Immunoinflammatory Index (SII).

RESULTS

3,919 participants were included, with a median age of 61.00 (52.00-71.00) years old. Among them, 609 participants had benign prostatic hyperplasia, with a prevalence of 15.54%. Upon accounting for confounding factors, the study revealed a positive correlation between the plurality of BPH PLR and SII. However, MLR, NLR, and SIRI did not significantly correlate with the prevalence of BPH (p>0.05). In contrast to the lowest quartile, higher quartiles of PLR (OR = 1.93[1.38-2.69]) and SII (OR = 1.71[1.22-2.40]) were linked to an elevated risk of BPH. Interaction tests showed that age, body mass index, hypertension, diabetes, smoking, and drinking had no significant effect on this positive correlation (p for interaction>0.05). In addition, we found a roughly linear association between SII, PLR, and BPH using smoothed curve fitting.

CONCLUSIONS

According to our research, high levels of PLR and SII are positively linked with an increased risk of BPH in middle-aged and elderly individuals in the United States. The results compensate for previous studies that still need to be validated with larger prospective cohorts.

Low-grade systemic inflammation links heavy metal exposures to mortality: A multi-metal inflammatory index approach

Certain heavy metals have been correlated to an elevated risk of inflammation-related diseases and mortality. Nevertheless, the intricate relationships between metal exposure, inflammation and mortality remain unknown. We included 3741 adults with measurements of ten urinary heavy metals in the National Health and Nutritional Examination Survey (NHANES) 2005-2010, followed up to December 31, 2019. Low-grade systemic inflammation was evaluated by various markers, including C-reactive protein (CRP) and ratios derived from regular blood tests. We assessed associations between heavy metal and all-cause mortality using multivariate COX regressions. Then we assessed the mediation effect of low-grade systemic inflammation on the associations via Sobel Test. To gauge the systemic inflammatory potential of the multi-metal mixture and its correlation with all-cause mortality, a Metal Mixture Inflammatory Index (MMII) was developed using reduced rank regression (RRR) models. The association between MMII and all-cause mortality was explored via multivariate COX regressions. Cadmium, antimony and uranium displayed positive associations with mortality, with hazard ratios (HR) ranging from 1.18 to 1.46 (all P-FDR < 0.05). Mediation analyses revealed that the associations between specific heavy metals (cadmium and antimony) and mortality risk were slightly mediated by the low-grade systemic inflammation markers, with mediation proportions ranging from 3.11 % to 5.38 % (all P < 0.05). MMII, the weighted sum of 9 heavy metals, significantly predicted platelet-to-lymphocyte ratio (PLR) and CRP (β = 0.10 and 1.16, all P < 0.05), was positively associated with mortality risk (HR 1.28, 95 % CI 1.14 to 1.43). Exposure to heavy metals might increase all-cause mortality, partly mediated by low-grade systemic inflammation. MMII, designed to assess the potential systemic inflammatory effects of exposure to multiple heavy metals, was closely related to the all-cause mortality risk. This study introduces MMII as an approach to evaluating co-exposure and its potential health effects comprehensively.

Association of the systemic immune-inflammation index with all-cause and cardiovascular mortality in individuals with rheumatoid arthritis

The systemic immune-inflammation index (SII), a metric reflecting systemic inflammatory response and immune activation, remains underexplored concerning its correlation with mortality among rheumatoid arthritis (RA) patients. This study aimed to delineate the association between SII and both all-cause and cardiovascular mortality within the cohort of American adults diagnosed with RA, utilizing data from the National Health and Nutrition Examination Survey (NHANES) spanning 1999 to 2018. The investigation extracted data from NHANES cycles between 1999 and 2018, identifying RA patients through questionnaire responses. The SII was computed based on complete blood counts, employing the formula: (platelets × neutrophils) / lymphocytes. The optimal SII cutoff value for significant survival outcomes was determined using maximally selected rank statistics. Multivariable Cox proportional hazards models assessed the relationship between SII levels and mortality (all-cause and cardiovascular) among RA patients, with subgroup analyses examining potential modifications by clinical confounders. Additionally, restricted cubic spline (RCS) analyses were conducted to explore the linearity of the SII-mortality association. The study encompassed 2070 American adults with RA, among whom 287 exhibited a higher SII (≥ 919.75) and 1783 a lower SII (< 919.75). Over a median follow-up duration of 108 months, 602 participants died. After adjustments for demographic, socioeconomic, and lifestyle variables, a higher SII was associated with a 1.48-fold increased risk of all-cause mortality (hazard ratio [HR] = 1.48, 95% confidence interval [CI] 1.21-1.81, P < 0.001) and a 1.51-fold increased risk of cardiovascular mortality (HR = 1.51, 95% CI 1.04-2.18, P = 0.030) compared to a lower SII. Kaplan-Meier analyses corroborated significantly reduced survival rates within the higher SII cohort for both all-cause and cardiovascular mortality (Pall-cause mortality < 0.0001 and Pcardiovascular mortality = 0.0004). RCS analyses confirmed a positive nonlinear relationship between SII and mortality rates. In conclusion, the SII offers a straightforward indicator of the equilibrium between detrimental innate inflammation and beneficial adaptive immunity. Our investigation, utilizing a comprehensive and nationally representative sample, reveals that elevated SII levels independently forecast a greater risk of mortality from all causes, as well as cardiovascular-specific mortality, in individuals suffering from RA. These insights underscore the clinical relevance of the SII as an affordable and readily accessible biomarker. Its incorporation into regular clinical practice could significantly enhance the precision of risk assessment and forecasting for patients with RA, facilitating more tailored and effective management strategies. Specifically, patients with high SII levels could be identified for more stringent cardiovascular risk management, including closer monitoring, lifestyle interventions, and aggressive pharmacological treatments to mitigate their increased risk of mortality.

Association of systemic immune-inflammation index with asthma and asthma-related events: a cross-sectional NHANES-based study

Background

Asthma is associated with persistent airway inflammation, and numerous studies have investigated inflammatory markers causing asthma. However, the systemic immune-inflammation index (SII) is a novel inflammatory marker, with scarce research reporting on the correlation between SII and asthma and asthma-related events.

Objective

The purpose of this study was to assess the relationship between SII and asthma and asthma-related events (including whether asthma is still present, asthma flare-ups in the past year, and asthma duration) using data from the National Health and Nutrition Examination Survey (NHANES).

Methods

The study utilized data from NHANES 2009-2018 with asthma and asthma-related events as dependent variables and SII as an independent variable. Multifactor logistic regression was employed to assess the correlation between the independent and dependent variables. Smoothed curve-fitting and threshold effect analyses were also carried out to determine the presence of non-linear relationships. Subgroup analyses were then performed to identify sensitive populations.

Results

In this study, we analyzed data from 40,664 participants to elucidate the association between SII and asthma and its related events. The study findings indicated a positive correlation between SII and asthma, with a relative risk increase of 0.03% for asthma incidence per one percentage point increase in SII (OR = 1.0003, 95% CI: 1.0002, 1.0004). For individuals still suffering from asthma, higher SII also indicated a positive correlation with ongoing asthma (OR = 1.0004, 95% CI: 1.0001, 1.0006). However, no statistically significant association was observed between SII and asthma exacerbations within the following year (OR = 1.0001, p > 0.05). When considering the duration of asthma, we observed a slight positive correlation with SII (β = 0.0017, 95% CI: 0.0005, 0.0029). Additionally, a significant non-linear relationship between SII and asthma duration emerged at the threshold of 504.3 (β = 0.0031, 95% CI: 0.0014-0.0048, p = 0.0003). Subgroup analysis revealed a stronger correlation between SII and asthma in male patients (OR = 1.0004, 95% CI: 1.0002-1.0006) and individuals aged 60 and above (OR = 1.0005, 95% CI: 1.0003-1.0007). No gender differences were observed for individuals still suffering from asthma. However, the positive correlation between SII and asthma was more pronounced in participants under 20 years old (OR = 1.0004 in Model 3, 95% CI: 1.0002-1.0006). Specific sensitive subgroups for asthma exacerbation recurrence within the past year were not identified. When considering asthma duration, we observed this association to be significant in male individuals (β = 0.0031 in Model 3, 95% CI: 0.0014-0.0049) as well as individuals aged 20 to 39 (β = 0.0023 in Model 3, 95% CI: 0.0005-0.0040).

Conclusion

Our study concludes that SII is positively correlated with the persistence of asthma yet has limited predictive power for asthma recurrence. This highlights SII's potential as a tool for assessing asthma risk and formulating targeted management strategies.

Association of systemic inflammation response index with mortality risk in older patients with hip fracture: a 10-year retrospective cohort study

Objective

With a rapidly aging global population, the assessment of mortality risk following hip fracture in older adults has received increasing attention. Recently, the system inflammation response index (SIRI) has been identified as a novel prognostic marker to reflect both systemic inflammation and immune status. However, it is not yet known whether SIRI is a potential predictor of subsequent death in hip fracture patients. Therefore, this study aimed to investigate the association between SIRI and mortality in older patients with hip fracture.

Methods

A total of 1,206 older hip fracture patients undergoing surgery between January 2013 and December 2022 were consecutively derived from our longitudinal database. Patients were divided into three groups according to SIRI tertiles, calculated as neutrophil × monocyte / lymphocyte. Survival status was obtained from medical records or telephone interviews, and the study outcome was all-cause mortality after hip fracture at the longest follow-up. Multivariate Cox proportional hazard model and restricted cubic spline (RCS) regression model were used to evaluate the association between SIRI and mortality. Moreover, a series of sensitivity analyses were conducted to further validate the robustness of the association.

Results

During a median follow-up of 43.85 months, 337 patients (27.94%) died. After full adjustment, each unit increase in SIRI was significantly associated with a 2.2% increase in overall mortality (95% confidence interval [CI]: 1.001-1.042, p = 0.029). Similarly, compared with the first tertile of SIRI, the second and third tertile showed a 1.335-fold (95% CI: 1.011-1.762, p = 0.042) and 1.447-fold (95% CI, 1.093-1.917, p = 0.010) higher risk of death. Sensitivity analyses confirmed the stability of the association. Moreover, RCS analysis revealed a positive non-linear relationship between SIRI and mortality (P for nonlinearity = 0.021).

Conclusion

High SIRI level at admission was significantly and positively associated with an increased risk of death, suggesting that SIRI may be an independent predictor of mortality in older patients with hip fracture.

Associations of CBC-Derived inflammatory indicators with sarcopenia and mortality in adults: evidence from Nhanes 1999 ∼ 2006

BACKGROUND

It has been proposed that inflammation plays a role in the development of sarcopenia. This study aimed to investigate the links of complete blood cell count (CBC) parameters and CBC-derived inflammatory indicators with sarcopenia and mortality.

METHODS

Data pertaining to sarcopenia were extracted from the 1999-2006 National Health and Nutrition Examination Survey (NHANES), and mortality events were ascertained through the National Death Index up to December 31, 2019. The CBC-derived inflammatory indicators assessed in this study included the neutrophil-to-lymphocyte ratio (NLR), derived neutrophil-to-lymphocyte ratio (dNLR), monocyte-to-lymphocyte ratio (MLR), neutrophil-monocyte to lymphocyte ratio (NMLR), systemic inflammatory response index (SIRI), and systemic immune-inflammation index (SII). The prognostic significance of these CBC-derived inflammatory indicators was evaluated using the random survival forests (RSF) analysis.

RESULTS

The study encompassed a cohort of 12,689 individuals, among whom 1,725 were diagnosed with sarcopenia. Among individuals with sarcopenia, 782 experienced all-cause mortality, and 195 succumbed to cardiovascular causes. Following adjustment for confounding variables, it was observed that elevated levels of NLR, dNLR, NMLR, SIRI, and SII were associated with an increased prevalence of sarcopenia. Among participants with sarcopenia, those in the highest quartile of NLR (HR = 1.336 [1.095-1.631]), dNLR (HR = 1.274 [1.046-1.550]), MLR (HR = 1.619 [1.290-2.032]), NMLR (HR = 1.390 [1.132-1.707]), and SIRI (HR = 1.501 [1.210-1.862]) exhibited an elevated risk of all-cause mortality compared to those in the lowest quartile of these inflammation-derived indicators. These associations were similarly observed in cardiovascular mortality (HR = 1.874 [1.169-3.003] for MLR, HR = 1.838 [1.175-2.878] for SIRI). The RSF analysis indicated that MLR exhibited the highest predictive power for both all-cause and cardiovascular mortality among individuals with sarcopenia.

CONCLUSIONS

Our findings underscore the association between CBC-derived inflammatory indicators and mortality in adults with sarcopenia. Of note, MLR emerged as the most robust predictor of all-cause and cardiovascular mortality in this population.

Positive association between blood ethylene oxide levels and metabolic syndrome: NHANES 2013-2020

Purpose

The exposure of Ethylene oxide (EO) is linked to systemic inflammatory response and various cardiovascular risk factors. Hemoglobin's binding to ethylene oxide (HbEO) was used to measure serum EO level. This research aims to explore the association between metabolic syndrome (MetS) and HbEO, and between HbEO and components of metabolic syndrome.

Method

This research included 1842 participants from 2013 to 2020 in National Health and Nutrition Examination Survey (NHANES) database. Weighted logistic regression models were used to analyze the relationship between HbEO and metabolic syndrome risk, using odds ratio (OR) and 95% confidence interval (CI). The restricted cubic spline plot explores whether there is a dose-response relationship between HbEO and MetS risk. Subgroup analysis was performed to analyze study heterogeneity.

Results

Significant differences were found in gender, educational level, marital status, diabetes status and hypertension among different groups (P < 0.001, P = 0.007, P = 0.003, P < 0.001, P < 0.001, respectively). The serum HbEO level exhibited positive correlation with metabolic syndrome risk in Q2 level (OR=1.64, 1.04~2.48), Q3 level (OR=1.99, 1.29~3.08), and Q4 level (OR=2.89, 1.92~4.34). The dose-response association suggested a possible linear association between serum HbEO and metabolic syndrome risk (P-overall=0.0359, P-non-linear=0.179). L-shaped association was found between HbEO and the risk of MetS in female population, obese population and mid-age and elder population (P-overall<0.001, P-non-linear=0.0024; P-overall=0.0107, P-non-linear=0.0055 P-overall<0.001 P-non-linear=0.0157).

Conclusion

This study indicates a linear correlation between MetS and HbEO, with MetS risk escalating as HbEO levels increase. The prevalence of MetS varies depending on BMI, age and gender, and these factors can also influence MetS prevalence when exposed to EO.

Enhancing Immune Response in Non-Small-Cell Lung Cancer Patients: Impact of the 13-Valent Pneumococcal Conjugate Vaccine

Background: Non-small-cell lung cancer (NSCLC) is one of the most frequently diagnosed diseases among all types of lung cancer. Infectious diseases contribute to morbidity and mortality by delaying appropriate anti-cancer therapy in patients with NSCLC. Methods: The study aimed to evaluate the effectiveness of vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) in 288 newly diagnosed NSCLC patients. The analysis of the post-vaccination response was performed after vaccination by assessing the frequency of plasmablasts via flow cytometry and by assessing the concentration of specific anti-pneumococcal antibodies using enzyme-linked immunosorbent assays. Results: The results of the study showed that NSCLC patients responded to the vaccine with an increase in the frequencies of plasmablasts and antibodies but to a lesser extent than healthy controls. The immune system response to PCV13 vaccination was better in patients with lower-stage NSCLC. We found higher antibody levels after vaccination in NSCLC patients who survived 5 years of follow-up. Conclusions: We hope that our research will contribute to increasing patients' and physicians' awareness of the importance of including PCV13 vaccinations in the standard of oncological care, which will extend the survival time of patients and improve their quality of life.

Systemic immune-inflammatory biomarkers (SII, NLR, PLR and LMR) linked to non-alcoholic fatty liver disease risk

Background

Systemic immune-inflammatory biomarkers including systemic immune inflammation index (SII), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) have been demonstrated to be associated with the risk and severity of various liver diseases. However, studies on their role and clinical significance in metabolic diseases, especially in nonalcoholic fatty liver disease (NAFLD), are limited and results are inconsistent.

Methods

10821 adults aged 20 years or older were enrolled in this cross-sectional study, sourced from six cycles of the National Health and Nutrition Examination Survey (NHANES). Survey-weighted logistic regression was employed to investigate the correlation between systemic immune-inflammatory biomarkers (SII, NLR, PLR, and LMR) and NAFLD risk. Restricted cubic spline regression models and segmented regression models were used to describe nonlinear relationships and threshold effects. Subgroup and sensitivity analyses were also conducted.

Results

After adjusting for all confounding variables, there was a significant positive association observed between ln-transformed SII (OR= 1.46, 95% CI: 1.27-1.69, P <0.001), NLR (OR= 1.25, 95% CI: 1.05-1.49, P =0.015), LMR (OR= 1.39, 95% CI: 1.14-1.69, P = 0.002) with NAFLD. A nonlinear dose-response relationship with an inverted "U"-shaped threshold of 4.64 was observed between ln(PLR) and NAFLD risk. When ln(PLR) was below 4.64, each unit increase in ln(PLR) was associated with a 0.55-fold increase in the risk of NAFLD (OR= 1.55, 95% CI: 1.05-2.31, P <0.05). Conversely, when ln(PLR) exceeded 4.64, each unit increase in ln(PLR) was associated with a 0.40-fold decrease in the risk of NAFLD (OR= 0.60, 95% CI. 0.44-0.81, P <0.05).

Conclusion

ln-transformed SII, NLR, and LMR were linearly associated with NAFLD risk. ln(PLR) showed an inverted "U"-shaped nonlinear dose-response relationship with the risk of NAFLD.

Inflammatory markers are associated with infertility prevalence: a cross-sectional analysis of the NHANES 2013-2020

BACKGROUND

Inflammation exerts a critical role in the pathogenesis of infertility. The relationship between inflammatory parameters from peripheral blood and infertility remains unclear. Aim of this study was to investigate the association between inflammatory markers and infertility among women of reproductive age in the United States.

METHODS

Women aged 20-45 were included from the National Health and Nutrition Examination Survey (NHANES) 2013-2020 for the present cross-sectional study. Data of reproductive status was collected from the Reproductive Health Questionnaire. Six inflammatory markers, systemic immune inflammation index (SII), lymphocyte count (LC), product of platelet and neutrophil count (PPN), platelet-lymphocyte ratio (PLR), neutrophil-lymphocyte ratio (NLR) and lymphocyte-monocyte ratio (LMR) were calculated from complete blood counts in mobile examination center. Survey-weighted multivariable logistic regression was employed to assess the association between inflammatory markers and infertility in four different models, then restricted cubic spline (RCS) plot was used to explore non-linearity association between inflammatory markers and infertility. Subgroup analyses were performed to further clarify effects of other covariates on association between inflammatory markers and infertility.

RESULTS

A total of 3,105 women aged 20-45 was included in the final analysis, with 431 (13.88%) self-reported infertility. A negative association was found between log2-SII, log2-PLR and infertility, with an OR of 0.95 (95% CI: 0.78,1.15; p = 0.60), 0.80 (95% CI:0.60,1.05; p = 0.10), respectively. The results were similar in model 1, model 2, and model 3. Compared with the lowest quartile (Q1), the third quartile (Q3) of log2-SII was negatively correlation with infertility, with an OR (95% CI) of 0.56 (95% CI: 0.37,0.85; p = 0.01) in model 3. Similarly, the third quartile (Q3) of log2-PLR was negatively correlation with infertility, with an OR (95% CI) of 0.61 (95% CI: 0.43,0.88; p = 0.01) in model 3. No significant association was observed between log2-LC, log2-PPN, log2-NLR, log2-LMR and infertility in model 3. A similar U-shaped relationship between log2-SII and infertility was found (p for non-linear < 0.05). The results of subgroup analyses revealed that associations between the third quartile (Q3) of log2-SII, log2-PLR and infertility were nearly consistent.

CONCLUSION

The findings showed that SII and PLR were negatively associated with infertility. Further studies are needed to explore their association better and the underlying mechanisms.

The neutrophil-lymphocyte ratio predicts all-cause and cardiovascular mortality among U.S. adults with rheumatoid arthritis: results from NHANES 1999-2020

Background

The neutrophil-to-lymphocyte ratio (NLR) is recognized as a biomarker for systemic inflammation and immune activation. However, its connection with the mortality risk in individuals with rheumatoid arthritis (RA) is not well understood. This study aimed to investigate the association between NLR and all-cause and cardiovascular mortality risk in U.S. adults with RA.

Methods

Data were gathered from the National Health and Nutrition Examination Survey (NHANES) cycles spanning 1999 to March 2020. We included adults aged ≥20 years. The NLR was computed by dividing the neutrophil count by the lymphocyte count from complete blood counts. The maximally selected rank statistics method helped identify the optimal NLR cutoff value associated with significant survival outcomes. Multivariable logistic regression models were performed to investigate the relationship between the NLR and the all-cause and cardiovascular mortality of RA. Restricted cubic spline (RCS) analyses were utilized to detect whether there were linear or non-linear relationships between NLR and mortality.

Results

In this study, 2002 adults with RA were included, with 339 having a higher NLR (≥3.28) and 1663 having a lower NLR (<3.28). During a median follow-up of 84 months, 79 RA individuals died. Participants with higher NLR had a 2-fold increased risk of all-cause (HR = 2.02, 95% CI: 1.53-2.66) and cardiovascular mortality (HR = 2.48, 95% CI: 1.34-4.57) versus lower NLR, after adjusting for demographics, socioeconomic status, and lifestyle factors. Kaplan-Meier analysis revealed that the survival rate for the higher NLR group was significantly lower than the lower NLR group, in terms of both all-cause and cardiovascular mortality (both P<0.0001). The RCS curve demonstrated a positive linear association between the NLR and all-cause and cardiovascular mortality.

Conclusion

A higher NLR was independently predictive of elevated long-term mortality risk in U.S. adults with RA. The NLR may serve as an inexpensive, widely available prognostic marker in RA.