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April 28, 2026SHILAP Revista de lepidopterologíaOpen Access

Association between systemic immune-inflammation index(SII) and all-cause and cardiovascular mortality in heart failure patients: a single-center retrospective analysis

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Key result

Elevated systemic immune-inflammation index linked to ~59% higher mortality risk in heart failure.

  • HR 1.59
  • 95% CI 1.03-2.46
  • P=0.036
  • n=1,084

Why the study?

The study aimed to investigate the association between the systemic immune-inflammatory index and mortality in patients with heart failure.

Does an elevated systemic immune-inflammation index (SII) predict increased all-cause and cardiovascular mortality in patients with heart failure?

Population

1,084 patients hospitalized for heart failure

Comparison

Patients categorized by log-transformed systemic immune-inflammatory index

Design

Single-center retrospective cohort study

Follow-up

Until death or July 22, 2025

Authors

JZJunlan ZhangKey Laboratory of Guangdong ProvinceNLNan LyuWenzhou UniversityYZYaping ZhangFirst Hospital of Lanzhou University

Discussion

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Implication

May aid HF risk stratification; leaves open therapeutic targeting of inflammation pending RCTs.

Key Points

  • To investigate the association between the systemic immune-inflammatory index (SII) and all-cause and cardiovascular mortality in patients hospitalized with heart failure.
  • Conducted a single-center retrospective cohort study of 1,084 heart failure patients hospitalized between January 2022 and June 2023, with a mean follow-up of 29.3 months (range: 2 days to 39 months) ending July 22, 2025.
  • Categorized patients into quartiles of log-transformed SII (LnSII) and evaluated primary endpoints of all-cause and cardiovascular mortality using Cox proportional hazards models, restricted cubic splines, and mediation analysis.
  • During follow-up, 142 all-cause deaths (13.1%) and 60 cardiovascular deaths (5.5%) occurred; the highest LnSII quartile (Q4) was significantly associated with increased all-cause mortality compared with Q1 (fully adjusted HR = 1.59, 95% CI: 1.03–2.46), with no statistically significant association observed for cardiovascular mortality.
  • Subgroup analysis revealed a significant interaction with smoking status (P for interaction = 0.023), demonstrating a heightened risk of all-cause mortality among smokers (HR = 2.41, 95% CI: 1.57–3.68).
  • Mediation analyses showed that NT-proBNP and left ventricular ejection fraction mediated 35.8% and 15.0% of the relationship between LnSII and all-cause mortality, respectively.

Study Design

Type

Cohort (n=1,084)

Multicenter

No

Structured PICO

Does an elevated systemic immune-inflammation index (SII) predict increased all-cause and cardiovascular mortality in patients with heart failure?

P
Population
1,084 adults (age 18-90) hospitalized for heart failure (HFmrEF or HFrEF, LVEF ≤ 49% at admission), mean age 62, 78.7% male, in China. Exclusions: malignant tumors, severe infectious diseases, active tuberculosis, autoimmune diseases, pregnancy, severe hepatic or renal insufficiency, in-hospital death, acute myocardial infarction.
I
Intervention
Higher Systemic Immune-Inflammation Index (SII), analyzed as log-transformed SII (LnSII) in the highest quartile (Q4: 6.66-8.78)
C
Comparator
Lower Systemic Immune-Inflammation Index (SII), specifically the lowest quartile (Q1: 2.36-5.84)
O
Outcome
All-cause mortality and cardiovascular mortality at mean 29.3 months follow-uphard clinical

Main Result

Effect estimate: HR 1.59 (95% CI 1.03-2.46)

p-value: p=0.036

Elevated systemic immune-inflammation index (SII) is an independent predictor of all-cause mortality in patients with heart failure, suggesting its potential utility as a prognostic biomarker.

Limitations

  • Retrospective single-center design limits causal inference and generalizability
  • Residual confounding is possible
  • Limited number of cardiovascular deaths reduced statistical power
  • Exclusion of patients who died in-hospital or had acute myocardial infarction may introduce selection bias
  • LVEF and SII were only assessed at baseline without capturing dynamic changes
  • Single-center retrospective design
  • Limited number of cardiovascular deaths (n=60) reducing statistical power
  • Smoking status categorized into two groups, unable to distinguish current/former or quantify exposure
  • Cross-sectional baseline data for mediation analysis cannot establish temporal sequence or rule out reverse causality

Cite This Study

Zhang et al. (2026) conducted a cohort in Heart failure (n=1,084). Systemic immune-inflammation index (SII) highest quartile vs. Lowest quartile of SII was evaluated on All-cause mortality (HR 1.59, 95% CI 1.03-2.46, p=0.036). Elevated systemic immune-inflammation index (highest vs lowest quartile) was independently associated with an increased risk of all-cause mortality (HR 1.59) in patients with heart failure.

synapsesocial.com/papers/69f04d9f727298f751e71f04https://doi.org/10.3389/fcvm.2026.1823641

Topics

Heart failureHFrEF treatment
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Also Consider

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  1. 1Combination of Neutrophil‐to‐Lymphocyte and Platelet‐to‐Lymphocyte Ratios as a Novel Predictor of Cardiac Death in Patients With Acute Decompensated Heart Failure With Preserved Left Ventricular Ejection Fraction: A Multicenter Study2022 · 90 citations
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