Comparative performance of multiple inflammatory indices across different stages of cardiovascular-kidney-metabolism syndrome: A Multi-Cohort Study

Abstract

Background: This study investigated the associations between different inflammatory indices and mortality in CKM patients at various stages, with the goal of identifying the best inflammatory predictors of survival for each stage of CKM.

Patients and methods: Data from 18,700 representative CKM patients in NHANES 1999-2014 and 94,760 CKM patients from the UKB were analysed. The inflammatory index was calculated on the basis of the blood cell count and biochemical indicators. A multivariate Cox proportional hazards model was applied to analyse the associations between inflammatory indices and all-cause mortality stratified by CKM stage.

Results: The advanced lung cancer inflammation index (ALI) has the best predictive performance for early CKM stages (NHANES: stage 2: AUC(t) = 0.600; stage 3: AUC(t) = 0.636; stage 4: AUC(t) = 0.678; UKB: stage 1: AUC(t) = 0.613; stage 3: AUC(t) = 0.666), with higher ALI levels correlated with lower all-cause mortality risk. In contrast, the monocyte‒lymphocyte ratio (MLR), neutrophil‒lymphocyte ratio (NLR), and systemic inflammation response index (SIRI) are correlated with an increased risk of all-cause mortality. The SIRI demonstrates superior predictive performance in the advanced stages of CKM.

Conclusion: This study demonstrated that the ALI was negatively associated with all-cause mortality and exhibited optimal performance and robustness in predicting the prognosis of patients with early-stage CKM, whereas the SIRI showed superior predictive performance in the advanced stages of CKM.

Keywords: All-cause mortality; Cardiovascular-kidney-metabolic syndrome; Inflammatory indices; Prognosis.