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Objective <p>To investigate the association between the systemic immune-inflammation index (SII) and the risk of percutaneous transluminal angioplasty (PTA) intervention in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis via autologous arteriovenous fistula (AVF), and to explore the statistical mediating role of ultrasound-measured brachial artery flow in this association.</p> Methods <p>This retrospective cohort study included ESRD patients who received regular dialysis via AVF at Wuhan Central Hospital from January 2018 to January 2025. The follow-up started from the date of the first completed blood test and AVF ultrasound examination, and ended at either the occurrence of PTA intervention or completion of 6&#xa0;months of follow-up. Cox regression analysis was used to assess the association between SII (as continuous and categorical variables) and the risk of PTA intervention. Subgroup analysis was performed to test the robustness of the association. Restricted cubic spline (RCS) was applied to evaluate non-linear relationships between SII and PTA intervention risk. Time-dependent receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of SII for PTA intervention at 6&#xa0;months, and the optimal cut-off value was determined using the surv_cutpoint function in R. Based on this value, patients were divided into high and low SII groups. Kaplan–Meier survival curves were plotted to compare PTA intervention-free survival between the two groups. Statistical mediation analysis was performed to explore the mediating roles of brachial artery blood flow, resistive index, and stenosis lumen diameter in the association between SII and PTA intervention risk.</p> Results <p>&#xa0;A total of 387 patients were included, and 178 PTA intervention events occurred during follow-up. Multivariable Cox regression analysis revealed a significant positive association between SII and PTA intervention risk: for each 100-unit increase in SII as a continuous variable, the risk of PTA intervention increased by 6% (HR = 1.06, 95% CI 1.03–1.08). When SII was analyzed as a categorical variable (cut-off value SII ≥ 618.18), the high SII group had a significantly higher risk of PTA intervention compared to the low SII group (HR = 1.84, 95% CI 1.32–2.56). RCS analysis indicated no significant non-linear relationship between SII and PTA intervention risk (<i>P</i> &gt; 0.05). Kaplan–Meier analysis showed that patients in the low SII group had a significantly longer PTA intervention-free survival than those in the high SII group (log-rank test, <i>P</i> &lt; 0.0001). Statistical mediation analysis indicated that only brachial artery blood flow partially mediated the association between SII and PTA intervention risk, accounting for 21% of the total effect, with a statistically significant indirect effect (<i>P</i> = 0.038).</p> Conclusion <p>Elevated SII levels were associated with an increased risk of PTA intervention, and this statistical association was partially mediated by brachial artery blood flow.</p>

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The systemic immune-inflammation index and PTA intervention risk in dialysis patients: a mediation analysis of brachial artery flow

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  • 发表日期：

    2026年7月21日

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  • Qian Gao,
  • Li Zhou,
  • Mengying Li,
  • Yin Wang,
  • Xiaomei Huang,
  • Yi Zhang

摘要

Objective

To investigate the association between the systemic immune-inflammation index (SII) and the risk of percutaneous transluminal angioplasty (PTA) intervention in end-stage renal disease (ESRD) patients undergoing maintenance hemodialysis via autologous arteriovenous fistula (AVF), and to explore the statistical mediating role of ultrasound-measured brachial artery flow in this association.

Methods

This retrospective cohort study included ESRD patients who received regular dialysis via AVF at Wuhan Central Hospital from January 2018 to January 2025. The follow-up started from the date of the first completed blood test and AVF ultrasound examination, and ended at either the occurrence of PTA intervention or completion of 6 months of follow-up. Cox regression analysis was used to assess the association between SII (as continuous and categorical variables) and the risk of PTA intervention. Subgroup analysis was performed to test the robustness of the association. Restricted cubic spline (RCS) was applied to evaluate non-linear relationships between SII and PTA intervention risk. Time-dependent receiver operating characteristic (ROC) curve analysis was used to evaluate the predictive performance of SII for PTA intervention at 6 months, and the optimal cut-off value was determined using the surv_cutpoint function in R. Based on this value, patients were divided into high and low SII groups. Kaplan–Meier survival curves were plotted to compare PTA intervention-free survival between the two groups. Statistical mediation analysis was performed to explore the mediating roles of brachial artery blood flow, resistive index, and stenosis lumen diameter in the association between SII and PTA intervention risk.

Results

 A total of 387 patients were included, and 178 PTA intervention events occurred during follow-up. Multivariable Cox regression analysis revealed a significant positive association between SII and PTA intervention risk: for each 100-unit increase in SII as a continuous variable, the risk of PTA intervention increased by 6% (HR = 1.06, 95% CI 1.03–1.08). When SII was analyzed as a categorical variable (cut-off value SII ≥ 618.18), the high SII group had a significantly higher risk of PTA intervention compared to the low SII group (HR = 1.84, 95% CI 1.32–2.56). RCS analysis indicated no significant non-linear relationship between SII and PTA intervention risk (P > 0.05). Kaplan–Meier analysis showed that patients in the low SII group had a significantly longer PTA intervention-free survival than those in the high SII group (log-rank test, P < 0.0001). Statistical mediation analysis indicated that only brachial artery blood flow partially mediated the association between SII and PTA intervention risk, accounting for 21% of the total effect, with a statistically significant indirect effect (P = 0.038).

Conclusion

Elevated SII levels were associated with an increased risk of PTA intervention, and this statistical association was partially mediated by brachial artery blood flow.