Data_Sheet_1_Inflammation index SIRI is associated with increased all-cause and cardiovascular mortality among patients with hypertension.PDF

BackgroundInflammation plays an essential role in the pathogenesis of hypertension. A novel inflammatory biomarker systemic inflammatory response index (SIRI) is related with all-cause and cardiovascular (CVD) mortality, while the role of SIRI in hypertension patients is unclear.
MethodsA total of 21,506 participants with hypertension were recruited in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. SIRI was calculated as the neutrophil count * monocyte count/lymphocyte count. Hypertension was defined according to the examination of blood pressure, prescription, and self-reported physician diagnosis. Survival status was followed through 31 December 2019. The non-linear relationship was assessed using restricted cubic spline analysis. The association of all-cause mortality with SIRI was evaluated using the Kaplan–Meier curve and the weighted Cox regression analysis. The predictive abilities were assessed with Receiver operating curve.
ResultsDuring 189,063 person-years of follow-up, 5,680 (26.41%) death events were documented, including 1,967 (9.15%) CVD related deaths. A J-shaped association was observed between SIRI and all-cause and CVD mortality. The Kaplan–Meier curve indicated the all-cause and CVD mortality risks were higher in high SIRI quartiles compared with lower SIRI quartiles. After adjusting for all covariates, the SIRI was positively associated with the all-mortality risk with HR = 1.19 (1.15, 1.22), and CVD mortality with HR = 1.19 (1.15, 1.24). The result was robust in subgroup analysis and sensitivity analysis.
ConclusionElevated SIRI level is associated with increased all-cause and CVD mortality among patients with hypertension. SIRI is considered as a potential inflammatory biomarker in the clinical practice. Further large-scale cohort studies are required to confirm our findings.

背景：炎症在高血压的发病机制中发挥关键作用。一种新型炎症生物标志物——全身炎症反应指数（systemic inflammatory response index, SIRI）与全因死亡及心血管（cardiovascular, CVD）死亡相关，但SIRI在高血压患者中的作用尚不清楚。

方法：本研究从1999至2018年的美国国家健康与营养检查调查（National Health and Nutrition Examination Survey, NHANES）中纳入21506名高血压参与者。SIRI的计算公式为中性粒细胞计数×单核细胞计数/淋巴细胞计数。高血压的判定依据为血压检测结果、用药处方及自我报告的医师诊断。随访至2019年12月31日以收集参与者的生存状态信息。采用限制性立方样条分析评估SIRI与死亡结局间的非线性关联；通过Kaplan-Meier曲线及加权Cox回归分析评估SIRI与全因死亡的关联；采用受试者工作特征（Receiver Operating Characteristic, ROC）曲线评估SIRI的预测能力。

结果：在189063人年的随访期间，共记录到5680例死亡事件（占比26.41%），其中1967例为心血管疾病相关死亡（占比9.15%）。研究观察到SIRI与全因死亡及心血管疾病死亡呈J形关联。Kaplan-Meier曲线显示，SIRI较高四分位组的全因死亡及心血管疾病死亡风险显著高于SIRI较低四分位组。在校正所有混杂因素后，SIRI与全因死亡风险呈正相关（风险比hazard ratio, HR=1.19，95%置信区间1.15~1.22），与心血管疾病死亡风险亦呈正相关（HR=1.19，95%置信区间1.15~1.24）。亚组分析及敏感性分析均证实该结果稳健可靠。

结论：高血压患者体内升高的SIRI水平与全因死亡及心血管疾病死亡风险增加显著相关。SIRI可作为临床实践中潜在的炎症生物标志物。未来需开展更大规模的队列研究以验证本研究的发现。