Association Between Systemic Immune Inflammation Level and Poor Prognosis Across Different Glucose Metabolism Status in Coronary Artery Disease Patients

Abstract

Background

Blood glucose levels significantly affect the clinical prognosis of patients with coronary artery disease (CAD), and systemic immune inflammation is a common risk factor for both CAD and diabetes. However, the relationship between immune inflammation levels and poor prognosis in patients with CAD with different glucose metabolic statuses remains unclear.

Methods

Between January 2007 and December 2020, we recruited 84,645 patients with CAD. The systemic immune inflammation index (SII) was used to comprehensively reflect the immune and inflammatory levels of patients and was calculated using the following formula: neutrophils × platelets/lymphocytes. The patients were classified into nine groups according to their glucose metabolism status (diabetes mellitus [DM], pre-diabetes mellitus [pre-DM], and normal glucose regulation [NGR]). Cox regression models and competing risk Fine and Gray models were used to investigate the association between SII and clinical outcomes.

Results

During the follow-up period, 12,578 patients died, including 5857 cardiovascular-related and 1251 cancer-related deaths. The risk of all-cause and cause-specific mortality increased with increasing SII tertiles in CAD patients with NGR, pre-DM, and DM. When considering glucose metabolism status, the multivariate cox regression revealed that CAD patients with DM and SII-H levels had the highest risk of all-cause mortality (1.69 [1.56–1.83]), cardiovascular mortality (2.29 [2.02–2.59]), and cancer mortality (1.29 [1.01–1.66]). Moreover, incorporating the SII into traditional risk factor models significantly improved the C-index for predicting all-cause and cardiovascular mortality.

Conclusion

Systemic immune inflammation levels on admission were correlated with a higher risk of all-cause and cause-specific mortality in patients with CAD, particularly in those with DM.

Keywords:

• systemic immune inflammation index
• coronary artery disease
• type 2 diabetes
• prognosis
• mortality

Abbreviations

CAD, Coronary artery disease; DM, Diabetes mellitus; Pre‑DM, Pre-diabetes mellitus; NGR, Normal glucose regulation; SII, Systemic immune inflammation index; CAG, coronary angiography; AMI, acute myocardial infarction; HT, hypertension; CHF, congestive heart failure; CKD, chronic kidney disease; AF, atrial fibrillation; PCI, percutaneous coronary intervention; CABG, Coronary artery bypass grafting; DES, drug metal stent; BES, Bare metal stent; eGFR, estimated glomerular filtration rate; HGB, hemoglobin; LDLC, low-density lipoprotein cholesterol; HDL-C, high-density lipoprotein cholesterol; Prior SCr, Prior serum creatinine; PLT, platelet; NEUT, neutrophil; LYMPH, lymphocyte; SII, systemic immune inflammation index; CCB, calcium channel blocker; ACEI/ARB, angiotensin-converting enzyme inhibitor/angiotensin receptor blocker.

Data Sharing Statement

Data are available from the corresponding author on reasonable request.

Ethics Approval and Informed Consent

This study was approved by the Ethics Committee of Guangdong Provincial People’s Hospital (No.GDREC2019-555H-2). All traceable personal identifiers were removed from the analytical dataset to protect patient privacy. All participating sites received approval from their respective institutional review boards and ethics committees. Our database is not open to the public to protect the privacy of the participants. Because our research included retrospective cases, there was no additional intervention, information on all patients was desensitized, and no informed consent was required. This study was conducted in accordance with the principles of the Declaration of Helsinki.

Acknowledgments

We would like to thank Editage for English language editing.

Author Contributions

All authors have made significant contributions to the reported work, including contributions to the conception, study design, data acquisition, analysis, interpretation, and execution or in all these aspects. They have been involved in drafting, revising, and critically reviewing the manuscript. All authors have provided their final approval for the version to be published; have reached an agreement on the journal to which the article has been submitted; and have committed to being accountable for all aspects of the work.

Disclosure

The authors declare that they have no competing interests in this work.

Additional information

Funding

This research was funded and supported by the Guangdong Provincial Science and Technology Project (2020B1111170011), Guangdong Provincial Science and Technology Project (KJ022021049), and National Science Foundation for Young Scientists of China (grant no.82070360). Key Laboratory of Emergency and Trauma, Ministry of Education (Hainan Medical University) (grant no. KLET-202116). NSFC Incubation Project of Guangdong Provincial People’s Hospital (KY0120220041). The funders had no role in the study design, data collection and analysis, decision to publish, or manuscript preparation.