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Systemic immune inflammatory index and mortality in chronic kidney disease

Yanshuang Ma1,2, Yang Yu3, Zhongdan Jia1

  • 1Department of Hyperbaric Oxygen, First Hospital of Jilin University, Changchun, Jilin, China.

Frontiers in Endocrinology
|September 19, 2025
PubMed

Insights

The systemic immunoinflammatory index (SII) shows a U-shaped relationship with mortality in chronic kidney disease (CKD) patients. Higher SII levels above a certain threshold increase the risk of death from all causes and cardiovascular disease.

Area of Science:

  • Immunology
  • Nephrology
  • Biostatistics

Background:

  • Chronic kidney disease (CKD) is a prevalent condition associated with increased mortality.
  • The relationship between the systemic immunoinflammatory index (SII) and mortality in CKD patients is not well understood.

Purpose of the Study:

  • To investigate the association between the systemic immunoinflammatory index (SII) and mortality in individuals with chronic kidney disease (CKD).
  • To determine if SII can serve as a predictive marker for mortality in CKD patients.

Main Methods:

  • A multivariable Cox regression analysis was performed on a cohort of 46,620 individuals with CKD.
  • Survival data and threshold effects were analyzed to assess the relationship between SII and mortality.
  • Subgroup analyses were conducted to evaluate predictive capabilities in different age groups.

Main Results:

  • A nonlinear, U-shaped correlation was observed between log-transformed SII (SII.log) and all-cause and cardiovascular disease (CVD) mortality.
  • Mortality risk initially decreased with rising SII.log but increased significantly beyond thresholds of 6.06 and 6.25.
  • Higher SII levels were associated with reduced survival, and SII reliably predicted all-cause mortality in CKD patients over 45 years old.

Conclusions:

  • The systemic immunoinflammatory index (SII) is a readily available marker that may predict mortality in CKD patients aged over 45.
  • Further longitudinal research is recommended to confirm the predictive value of SII for all-cause, cardiovascular, and cancer mortality in CKD.
  • The study highlights the potential of SII as a prognostic tool in managing CKD patients.
Abstract

Keywords:
all causes mortalitycancer mortalitycardiovascular diseasechronic kidney diseasesystemic immune-inflammatory index

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