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Introduction <p>Patients undergoing maintenance hemodialysis (MHD) carry a substantial burden of cardiovascular disease and mortality. Accessible prognostic biomarkers are needed to improve risk stratification. We examined the association between the systemic inflammatory response index (SIRI) and clinical outcomes, and compared SIRI with established inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR), as well as conventional clinical parameters such as C-reactive protein (CRP), white blood cell count, and serum albumin.</p> Methods <p>A retrospective analysis was conducted in a cohort of 221 prevalent hemodialysis patients enrolled at Dongguan Tung Wah Hospital between January and July 2019. Patients were categorized into tertiles based on SIRI for baseline comparison. Associations between SIRI (modeled as a continuous variable) and the risks of cardiovascular events and all-cause mortality were assessed using Cox proportional hazards models, Kaplan–Meier survival curves, and restricted cubic spline analyses.</p> Results <p>During a median follow-up period of 28 months, a total of 30 MHD patients (13.6%) died from any cause, and 47 patients (21.3%) experienced cardiovascular events. Kaplan–Meier analysis revealed that higher SIRI levels were significantly associated with increased cumulative incidence of cardiovascular events and elevated all-cause mortality (both <i>P</i> &lt; 0.001). After multivariable adjustment, higher SIRI values were independently associated with greater risks of cardiovascular events (adjusted hazard ratio [HR] per unit increase, 1.121; 95% confidence interval [CI], 1.041–1.206; <i>P</i> = 0.003) and all-cause mortality (adjusted HR, 1.18; 95% CI, 1.11–1.29; <i>P</i> &lt; 0.001). In receiver operating characteristic analyses, SIRI exhibited the numerically highest AUC among the evaluated biomarkers for predicting cardiovascular events (AUC, 0.677) and all-cause mortality (AUC, 0.794). DeLong’s test showed no statistically significant differences between the AUC of SIRI and those of NLR, MLR, CRP, WBC, or albumin for cardiovascular events (all <i>P</i> &gt; 0.05). For all-cause mortality, SIRI showed no statistically significant differences compared with NLR (<i>P</i> = 0.467), MLR (<i>P</i> = 0.941), and CRP (<i>P</i> = 0.573), but was significantly superior to WBC count (<i>P</i> &lt; 0.001) and albumin (<i>P</i> = 0.012).</p> Conclusion <p>Elevated SIRI is independently associated with adverse outcomes in maintenance hemodialysis patients. In direct comparison with NLR, MLR, CRP, WBC count, and albumin, SIRI demonstrated comparable predictive performance for both cardiovascular events and all-cause mortality.</p>

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Association of systemic inflammatory response index (SIRI) with clinical outcomes in hemodialysis patients: a single-center observational study

  • 期刊论文

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  • 发表日期：

    2026年7月8日

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  • Xiaoyan Su,
  • Jinze Rong,
  • Jianhua Chen,
  • Haowen Zhong,
  • Linqing Chen,
  • Aiqin Cao,
  • Yanshan Liang,
  • Yin Chen,
  • Lianghong Yin,
  • Shaohong Li

摘要

Introduction

Patients undergoing maintenance hemodialysis (MHD) carry a substantial burden of cardiovascular disease and mortality. Accessible prognostic biomarkers are needed to improve risk stratification. We examined the association between the systemic inflammatory response index (SIRI) and clinical outcomes, and compared SIRI with established inflammatory markers, including the neutrophil-to-lymphocyte ratio (NLR) and monocyte-to-lymphocyte ratio (MLR), as well as conventional clinical parameters such as C-reactive protein (CRP), white blood cell count, and serum albumin.

Methods

A retrospective analysis was conducted in a cohort of 221 prevalent hemodialysis patients enrolled at Dongguan Tung Wah Hospital between January and July 2019. Patients were categorized into tertiles based on SIRI for baseline comparison. Associations between SIRI (modeled as a continuous variable) and the risks of cardiovascular events and all-cause mortality were assessed using Cox proportional hazards models, Kaplan–Meier survival curves, and restricted cubic spline analyses.

Results

During a median follow-up period of 28 months, a total of 30 MHD patients (13.6%) died from any cause, and 47 patients (21.3%) experienced cardiovascular events. Kaplan–Meier analysis revealed that higher SIRI levels were significantly associated with increased cumulative incidence of cardiovascular events and elevated all-cause mortality (both P < 0.001). After multivariable adjustment, higher SIRI values were independently associated with greater risks of cardiovascular events (adjusted hazard ratio [HR] per unit increase, 1.121; 95% confidence interval [CI], 1.041–1.206; P = 0.003) and all-cause mortality (adjusted HR, 1.18; 95% CI, 1.11–1.29; P < 0.001). In receiver operating characteristic analyses, SIRI exhibited the numerically highest AUC among the evaluated biomarkers for predicting cardiovascular events (AUC, 0.677) and all-cause mortality (AUC, 0.794). DeLong’s test showed no statistically significant differences between the AUC of SIRI and those of NLR, MLR, CRP, WBC, or albumin for cardiovascular events (all P > 0.05). For all-cause mortality, SIRI showed no statistically significant differences compared with NLR (P = 0.467), MLR (P = 0.941), and CRP (P = 0.573), but was significantly superior to WBC count (P < 0.001) and albumin (P = 0.012).

Conclusion

Elevated SIRI is independently associated with adverse outcomes in maintenance hemodialysis patients. In direct comparison with NLR, MLR, CRP, WBC count, and albumin, SIRI demonstrated comparable predictive performance for both cardiovascular events and all-cause mortality.