Association between systemic inflammatory response index and bone turnover markers in Chinese patients with osteoporotic fractures: a retrospective cross-sectional study.
Frontiers in medicine
Background:The systemic inflammatory response index (SIRI) is a novel composite biomarker of inflammation. However, there is limited information on its use in the context of osteoporotic fractures. Hence, this study aimed to investigate the association between baseline SIRI values and bone turnover markers (BTMs) in Chinese patients diagnosed with osteoporotic fractures (OPFs), to offer a more precise method for assessing bone health and inflammation in clinical settings. Methods:A retrospective cross-sectional study was conducted on 3,558 hospitalized patients with OPFs who required surgery or hospitalization at the First People's Hospital of Kunshan City from January 2017 to July 2022. Baseline measurements of SIRI, β-CTX (beta-C-terminal telopeptide of type I collagen), and P1NP (procollagen type I N-terminal propeptide) were obtained. The analyses were adjusted for variables, including age, sex, body mass index (BMI), and other initial laboratory and clinical findings. Furthermore, multivariable logistic regression, smooth curve fitting, and threshold analysis were also performed. Results:The results revealed a negative correlation between baseline SIRI values and both β-CTX and P1NP levels. After adjusting for covariates in the regression analysis, each unit increase in SIRI was found to be inked to a reduction of 0.04 ( = -0.04; 95% confidence interval [CI], -0.05 to -0.03; with -value <0.001) in β-CTX levels and a decrease of 3.77 ( = 3.77; 95% CI, 5.07 to 2.47; with -value <0.001) in P1NP levels. Furthermore, a curvilinear relationship and threshold effect were also identified. Turning points were identified at SIRI values of 1.41 and 1.63 on the adjusted smooth curve. Conclusion:The results showed a negative correlation between the baseline SIRI value and β-CTX level, as well as the level of P1NP. This suggests a possible link between the systemic inflammatory response and reduced bone metabolism. If these findings are verified, SIRI has the potential to function as a predictive indicator for BTMs. Nevertheless, additional research is necessary to verify these findings.
10.3389/fmed.2024.1404152
Correlation study of multiple inflammatory indices and vertebral compression fracture: A cross-sectional study.
Journal of clinical & translational endocrinology
Background:Vertebral compression fractures (VCFs) are prevalent in patients with osteoporosis and pose significant health risks. Although chronic low-grade inflammation plays a crucial role in the pathogenesis of osteoporosis, the relationship between various inflammatory indices and the occurrence of fractures remains unclear. Objective:This study aims to evaluate the correlation between multiple inflammatory indices, neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammatory index (SII), and systemic inflammatory response index (SIRI), and VCFs, to explore the significance of these indices in clinical application. Methods:Clinical data of 310 patients diagnosed with osteoporosis from November 2020 to June 2023 in the hospital were collected. The general conditions between fracture and non-fracture groups were described. Spearman analysis and binary logistic regression analysis were used to assess the relationship between inflammatory indices and VCFs. Receiver operating characteristic curve was used to evaluate the diagnostic efficacy of these inflammatory indices for VCFs. Results:VCFs were diagnosed in 43.55 % of patients with osteoporosis. NLR(ρ = 0.169, P=0.003), MLR(ρ = 0.293, P<0.001), SII(ρ = 0.126, P=0.027), and SIRI(ρ = 0.273, P<0.001) were positively correlated with the occurrence of VCFs. NLR(OR=1.480, 95 %CI 1.114 ∼ 1.966, P=0.007), MLR(multiplied by 100, OR=1.048, 95 %CI 1.011 ∼ 1.087, P=0.011), and SIRI(OR=3.327, 95 %CI 1.510 ∼ 7.330, P=0.003) were independent risk factors for VCFs, hip bone mineral density (BMD) (OR=0.011, 95 %CI 0.001 ∼ 0.151, P=0.001) was an independent protective factor for VCFs. MLR(AUC 0.671, 95 % CI=0.610 ∼ 0.732, P <0.001) had relatively high clinical diagnostic efficacy. Conclusion:The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), and systemic inflammatory response index (SIRI) are independent risk factors for vertebral compression fractures.
10.1016/j.jcte.2024.100369
Systemic Immune-Inflammation-Based Biomarker and Fragility Fractures in People Living With HIV: A 10-Year Follow-Up Cohort Study in China.
Journal of medical virology
Fragility fractures are a significant concern among people living with HIV(PLWH) due to the combined effects of chronic inflammation, immune dysregulation, and antiretroviral therapy. Traditional biomarkers have limited predictive value for fragility fractures in this population. This study aims to evaluate the systemic immune inflammation-based scores as novel biomarkers for predicting fragility fractures in PLWH in China. We conducted a cohort study of PLWH in the orthopedic department of Beijing Ditan Hospital from January 2011 to September 2023. We monitored fragility fractures and collected data on demographics, clinical characteristics, and laboratory parameters. Multivariate Cox and logistic regression models were used to assess the predictive value of the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) for fragility fractures. Restricted cubic splines (RCS) were employed to explore potential nonlinear relationships, and subgroup analyses were conducted to examine the stability of these associations. During a median follow-up of 5.5 years, our study included 1148 PLWH patients, and 204 patients (17.8%) experienced fragility fractures. After adjusting for all covariates, SII and SIRI were identified as independent risk factors for fragility fractures in PLWH, whereas NLR, PLR, and MLR were not. Patients with higher levels of SII and SIRI had a significantly increased risk of fragility fractures compared to those with lower levels (HR: 1.96, 95% CI: 1.24-3.10, p = 0.004; HR: 1.83, 95% CI: 1.16-2.88, p = 0.009). RCS analysis indicated a stable linear relationship between SIRI and fragility fractures. Furthermore, KM curves demonstrated that patients with higher SII and SIRI scores had a higher likelihood of experiencing fragility fractures. Our research shows that SII and SIRI are promising biomarkers for predicting fragility fractures in PLWH. Clinicians should consider incorporating SIRI into clinical practice to improve fracture risk stratification and guide preventive strategies for this vulnerable population.
10.1002/jmv.70052
Association of systemic inflammatory response index with bone mineral density, osteoporosis, and future fracture risk in elderly hypertensive patients.
Postgraduate medicine
OBJECTIVES:This study sought to investigate the relationship between the systemic inflammatory response index (SIRI) and bone mineral density (BMD), osteoporosis, and future fracture risk in elderly hypertensive patients. METHODS:Elderly hypertensive patients (age ≥60 years) who attended our hospital between January 2021 and December 2023 and completed BMD screening were included in the study. Analyses were performed with multivariate logistic and linear regression. RESULTS:The multiple linear regression indicated that SIRI levels were significantly negatively correlated with lumbar 1 BMD (β = -0.15, 95% CI: -0.24, -0.05), lumbar 2 BMD (β = -0.15, 95% CI: -0.24, -0.05), lumbar 3 BMD (β = -1.35, 95% CI: -0.23, -0.02), lumbar 4 BMD (β = -0.11, 95% CI: -0.30, -0.10), femur neck BMD (β = -0.11, 95% CI: -0.18, -0.05) and Ward's triangle BMD (β = -0.12, 95% CI: -0.20, -0.05) among elderly hypertensive patients, after fully adjusting for confounders. Furthermore, we observed that SIRI was positively associated with future fracture risk in elderly hypertensive patients. Specifically, SIRI was associated with an increased risk of major osteoporotic fractures (β = 0.33) and hip fractures (β = 0.25). The logistic regression analysis indicated that there is an association between the SIRI level and an increased risk of osteoporosis (OR = 1.60, 95% CI = 1.37, 1.87), after fully adjusting for confounders. CONCLUSIONS:Our findings indicate a potential association between SIRI and BMD, osteoporosis, and the risk of future fractures in elderly hypertensive patients. However, further studies are warranted to confirm these findings.
10.1080/00325481.2024.2354158
Systemic inflammatory indices for predicting prognosis of myelofibrosis.
Scientific reports
The impact of inflammatory markers such as systemic immune-inflammation (SII) index and systemic inflammation response index (SIRI) on myelofibrosis (MF) prognosis was evaluated for the first time in this study. Data from 60 patients diagnosed with MF between March 2011 and September 2022 were retrospectively analyzed. In addition to disease-related markers, the impact of SII and SIRI on prognosis was evaluated. In our study, the overall median survival (OS) was 64 months. OS was significantly shorter in patients older than 65 years, with high ferritin and lymphocyte levels, transfusion dependence at diagnosis, platelet count below 100 × 10/L, Hb level below 8 g/dl, and high risk according to the dynamic international prognostic scoring system (DIPSS)-Plus score. When these variables were included in the multivariate Cox regression model, it was found that being older than 65 years, having a high ferritin value, being at high risk according to the DIPSS-plus score and Hb values below 8 increased the risk of death. Platelet-to-lymphocyte ratio (PLR) and SII index were lower in patients with a fatal outcome. No statistically significant relationship was found between SIRI and mortality. The findings of this study showed that low PLR and high ferritin were associated with poor prognosis in MF. Elevated SII and SIRI, evaluated for the first time in patients with myelofibrosis, did not predict prognosis. Since non-inflammatory variables play a role in the pathogenesis of MF, bone marrow indicators and systemic inflammation indicators derived from hematologic parameters may not be accurate.
10.1038/s41598-023-39077-7
Systemic Inflammation Markers Associated with Bone Mineral Density in perimenopausal and Postmenopausal Women.
Journal of inflammation research
Objective:The aim of this research was to determine whether systemic inflammatory indicators, including aggregate index of systemic inflammation (AISI), neutrophils lymphocyte to platelet ratio (NLPR), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI), are related to bone mineral density (BMD) in perimenopausal and postmenopausal women. Methods:One hundred and eighty-one perimenopausal and 390 postmenopausal women were enrolled in this cross-sectional study. Continuous variables by analysis of variance and Kruskal Wallis test for comparing the clinical characteristics. Linear regression analysis was conducted to investigate the associations between inflammatory indicators with BMD. The comparison between the subgroups was performed using the nonparametric test and the -test. Results:AISI, NLPR, SII, and SIRI quartile values were inversely associated with BMD in menopausal women ( = 0.021; = 0.047; < 0.001; < 0.001, respectively). After adjusting for confounding factors, four inflammatory indicators remained significantly associated with BMD (all for trend <0.001). Analysis according to menopausal status demonstrated that AISI, SII, and SIRI were significantly correlated with mean femoral neck BMD in postmenopausal women ( for trend = 0.015, 0.004, and 0.001), but not significantly associated with BMD in perimenopausal women ( for trend = 0.248, 0.054, and 0.352) after adjustment for covariates. Conclusion:The quartile values of AISI, SII, and SIRI were inversely associated with BMD in postmenopausal women, following adjustment for individual variables, hormone profiles and glucolipid metabolism profiles. AISI, SII, and SIRI have potential to be important tools for screening and prevention of bone loss in menopausal women in future clinical practice.
10.2147/JIR.S385220
Association of inflammatory markers with all-cause mortality and cardiovascular mortality in postmenopausal women with osteoporosis or osteopenia.
BMC women's health
BACKGROUND:The objective of the present study was to investigate whether associations exist between inflammatory biomarkers and all-cause mortality and cardiovascular disease (CVD) mortality in women with postmenopausal osteoporosis (PMOP) or osteopenia. METHODS:In this retrospective cohort study, data were obtained from the National Health and Nutrition Examination Survey database from the years 2007 to 2010, 2013 to 2014, and 2017 to 2018. The inflammatory biomarkers including neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), monocyte/lymphocyte ratio (MLR), neutrophil × platelet/lymphocyte (SII), neutrophil × monocyte/lymphocyte (SIRI), and neutrophil × monocyte × platelet/lymphocyte ratio (AISI) were calculated. RESULTS:A total of 2,834 women were included, with a median survival of 113.51 (3.15) months. During follow-up, 602 women died of all-cause mortality and 185 women died of CVD. NLR, MLR, SIRI, and AISI were significantly associated with all-cause mortality in postmenopausal women with osteoporosis or osteopenia. NLR, MLR, SIRI, and AISI were related to CVD mortality in postmenopausal women with osteoporosis or osteopenia (All P < 0.05). Based on the results of the subgroup analysis, AISI, SIRI, and MLR were associated with all-cause mortality and CVD mortality in postmenopausal women with PMOP or osteopenia who had a history of CVD and diabetes. AISI, SII, MLR, and NLR were associated with all-cause mortality and CVD mortality in PMOP or osteopenia women with a body mass index (BMI) > 25 kg/m. PLR was associated with all-cause mortality in PMOP or osteopenia women aged ≥ 65 years. CONCLUSION:Inflammatory biomarkers were correlated with mortality risk in the PMOP or osteopenia population. This finding may be helpful for the prognosis management of PMOP or osteopenia in postmenopausal women.
10.1186/s12905-023-02631-6
Non-diabetic elderly populations: SIRI as a risk factor and PIV as a protective factor against bone abnormalities.
Frontiers in endocrinology
Objective:The prevalence of osteoporosis and its resultant healthcare challenges are escalating, posing significant burdens on public health systems. Studies have introduced immunoinflammatory indices, which are recognized for effectively reflecting the systemic immunoinflammatory status. Despite their potential, the exploration of these indices in the context of osteoporosis remains limited. The study sought to explore the relationship between immune inflammation-related indices and osteoporosis in non-diabetic elderly populations. Methods:The clinical data of 438 non-diabetic elderly subjects were retrospectively analyzed and all statistical analyses were performed using SPSS 27.0. Results:Differences were observed between the osteoporosis group and the normal bone density group in terms of age, neutrophil, lymphocyte, monocyte, hemoglobin, and platelet. A review of prior studies revealed a close association between osteoporosis and chronic inflammation. Immunological indices such as Platelet to Lymphocyte Ratio (PLR), Neutrophil to Lymphocyte Ratio (NLR), Monocyte to Lymphocyte Ratio (MLR), Systemic Immuno-Inflammatory Index (SII), Systemic Inflammatory Response Index (SIRI) and Peripheral Immunity Index (PIV) were calculated. The analysis indicated significant differences in MLR, SII, SIRI and PIV. A multifactorial binary logistic regression model was established, incorporating age, MLR, SII, SIRI, and PIV as variables. The results identified age and SIRI as independent risk factors for bone abnormalities in non-diabetic elderly populations, while PIV served as an independent protective factor. Receiver operating characteristic analysis demonstrated that SIRI and PIV predicted osteoporosis with areas under the curve (AUC) of 0.609 and 0.620, respectively. The diagnostic value was enhanced when combined with age, yielding AUC values of 0.725 for PIV combined with age. PIV combined with age was particularly effective as a biomarker for bone abnormalities in this population. The optimal Youden's index was calculated to be 0.367, corresponding to a sensitivity of 63.8% and a specificity of 72.9%. Conclusions:For non-diabetic elderly populations, SIRI is a risk factor, while PIV serves as a protective factor against bone abnormalities. Combined with previous studies, we suggest that people at high risk of osteoporosis should avoid or minimize the intake of pro-inflammatory dietary patterns. Meanwhile, research from an immune perspective is expected to open new avenues for osteoporosis treatment.
10.3389/fendo.2024.1467683
Osteosarcopenic obesity and its components-osteoporosis, sarcopenia, and obesity-are associated with blood cell count-derived inflammation indices in older Chinese people.
BMC geriatrics
BACKGROUND:The aim of this study was to investigate the associations of osteosarcopenic obesity (OSO) and its components with complete blood cell count-derived inflammation indices. METHODS:In this cross-sectional study, data of 648 participants aged ≥60 years (men/women: 232/416, mean age: 67.21 ± 6.40 years) were collected from January 2018 to December 2020. Areal bone mineral density and body fat percentage were used to define osteopenia/osteoporosis and obesity, respectively. The criteria of the 2019 Asian Working Group for Sarcopenia were used to diagnose sarcopenia. Based on the number of these conditions, participants were divided into four groups: OSO/0, OSO/1, OSO/2, and OSO/3. Logistic regression analysis was conducted to identify associations between blood cell count-derived inflammation indices and the number of disorders with abnormal body composition. RESULTS:Systemic inflammation response index (SIRI), white blood cells, neutrophil-to-lymphocyte ratio (NLR), aggregate inflammation systemic index (AISI), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) showed statistically significant differences among the four groups (P < 0.05). Unlike in the OSO/0 group, in all other groups, AISI, SIRI, PLR, and NLR were significantly associated with increased likelihood of having multiple disorders with abnormal body composition after adjustment for confounders (P < 0.0001 for all). However, LMR showed an inverse correlation with the number of these conditions (P < 0.05). CONCLUSION:Higher SIRI, AISI, NLR, and PLR values and lower LMR values are closely associated with OSO and its individual components-osteoporosis, sarcopenia, and obesity-in older adults, suggesting that the value of these indices in the evaluation of OSO warrants further investigation.
10.1186/s12877-022-03225-x
U-shaped relationship found between fibrinogen-to-albumin ratio and systemic inflammation response index in osteoporotic fracture patients.
Scientific reports
The relationship between the Systemic Inflammatory Response Index (SIRI) and the Fibrinogen-to-albumin ratio (FAR) has not been extensively investigated. The objective of this study was to determine the independent relationship between FAR and SIRI in people with osteoporotic fractures (OPF). A cross-sectional study was conducted using retrospective data from 3431 hospitalized OPF patients. The exposure variable in this study was the baseline FAR, while the outcome variable was the SIRI. Covariates, including age, gender, BMI, and other clinical and laboratory factors, were adjusted. Cross-correlation analysis and linear regression models were applied. The generalized additive model (GAM) investigated non-linear relationships. Adjusted analysis revealed an independent negative association between FAR and SIRI in OPF patients (β = - 0.114, p = 0.00064, 95% CI - 0.180, - 0.049). A substantial U-shaped association between FAR and SIRI was shown using GAM analysis (p < 0.001). FAR and SIRI indicated a negative association for FAR below 6.344% and a positive correlation for FAR over 6.344%. The results of our study revealed a U-shaped relationship between SIRI and FAR. The lowest conceivable FAR for a bone-loose inflammatory disease might be 6.344%, suggesting that this has particular significance for the medical diagnosis and therapy of persons with OPF. Consequently, the term "inflammatory trough" is proposed. These results offer fresh perspectives on controlling inflammation in individuals with OPF and preventing inflammatory osteoporosis.
10.1038/s41598-024-61965-9