Association Between the Systemic Inflammatory Response Index and Severe Infection in Patients with Diabetic Foot

In this study, we aimed to clarify the association between the Systemic Inflammatory Response Index (SIRI) and the severity of infection in patients with diabetic foot infection (DFI).

A retrospective study was conducted among individuals admitted to The First People's Hospital of Changzhou with DFI from March 2021 to October 2025.Two hundred and forty-two patients with DFI were categorized to a severe infection group (n=110) or a moderate infection group (n=132). The area under the receiver operating characteristic (ROC) curve (AUC) was used to assess the accuracy of association between SIRI and the risk of severe DFI. Multivariate logistic regression analysis and restricted cubic spline (RCS) analysis were employed to characterize the relationship between SIRI and the severity of DFI. Subgroup analyses and interaction analyses were utilized to enhance the reliability of this study. The bootstrap method was utilized to calculate the confidence interval (CI) of AUC. The optimal cutoff value for the ROC curve was determined based on the principle of maximizing the Youden index, and the threshold for the RCS curve was defined at the point where the odds ratio equaled 1.

The ROC curve analysis showed that SIRI was highly associated with the severity of DFI, yielding an AUC of 0.959 (95% CI: 0.932-0.986). For every 1 unit increase in SIRI, the risk of severe DFI increases to 2.26 times the original risk. Furthermore, as SIRI increased, the risk of severe DFI increased in the RCS model. There was a nonlinear association between SIRI and the risk of severe DFI, with an inflection point of SIRI at 3.53 (OR: 0.93, 95% CI: 0.91-0.95). Severe DFI was less likely to occur below this inflection point. Beyond this point, the risk of developing severe DFI increased significantly. When SIRI exceeded 15.96 (OR: 132.23, 95% CI: 42.94-432.18), the increase plateaued.

SIRI is significantly associated with the severity of DFI in diabetes patients, and it is imperative to maintain a low SIRI level in order to prevent the occurrence of severe DFI. The importance of maintaining an appropriate SIRI level should not be overlooked among diabetic foot patients.