The association between systemic immune-inflammation index and chronic obstructive pulmonary disease in adults aged 40 years and above in the United States: a cross-sectional study based on the NHANES 2013-2020

Yifeng Xu; Zhaoqi Yan; Keke Li; Liangji Liu

doi:10.3389/fmed.2023.1270368

The association between systemic immune-inflammation index and chronic obstructive pulmonary disease in adults aged 40 years and above in the United States: a cross-sectional study based on the NHANES 2013-2020

Front Med (Lausanne). 2023 Nov 24:10:1270368. doi: 10.3389/fmed.2023.1270368. eCollection 2023.

Authors

Yifeng Xu¹, Zhaoqi Yan¹, Keke Li¹, Liangji Liu²

Affiliations

¹ School of Clinical Medicine, Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China.
² Department of Respiratory and Critical Care Medicine, Affiliated Hospital of Jiangxi University of Chinese Medicine, Nanchang, Jiangxi, China.

Abstract

Background: Inflammation is the core of Chronic obstructive pulmonary disease (COPD) development. The systemic immune-inflammation index (SII) is a new biomarker of inflammation. However, it is currently unclear what impact SII has on COPD. This study aims to explore the relationship between SII and COPD.

Methods: This study analyzed patients with COPD aged ≥40 years from the National Health and Nutrition Examination Survey (NHANES) in the United States from 2013 to 2020. Restricted Cubic Spline (RCS) models were employed to investigate the association between Systemic immune-inflammation index (SII) and other inflammatory markers with COPD, including Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-to-Lymphocyte Ratio (PLR). Additionally, a multivariable weighted logistic regression model was utilized to assess the relationship between SII, NLR and PLR with COPD. To assess the predictive values of SII, NLR, and PLR for COPD prevalence, receiver operating characteristic (ROC) curve analysis was conducted. The area under the ROC curve (AUC) was used to represent their predictive values.

Results: A total of 10,364 participants were included in the cross-sectional analysis, of whom 863 were diagnosed with COPD. RCS models observed non-linear relationships between SII, NLR, and PLR levels with COPD risk. As covariates were systematically adjusted, it was found that only SII, whether treated as a continuous variable or a categorical variable, consistently remained positively associated with COPD risk. Additionally, SII (AUC = 0.589) slightly outperformed NLR (AUC = 0.581) and PLR (AUC = 0.539) in predicting COPD prevalence. Subgroup analyses revealed that the association between SII and COPD risk was stable, with no evidence of interaction.

Conclusion: SII, as a novel inflammatory biomarker, can be utilized to predict the risk of COPD among adults aged 40 and above in the United States, and it demonstrates superiority compared to NLR and PLR. Furthermore, a non-linear association exists between SII and the increased risk of COPD.

Keywords: NHANES; chronic obstructive pulmonary disease; cross-sectional study; restricted cubic spline; systemic immune-inflammation index.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This work was supported by grants from the Natural Science Foundation of Jiangxi Province (Nos. 20212BAB216061 and 20212BAG70038), Jiangxi Clinical Medical Research Center of Lung Diseases (Gan ke fa she [2019] No. 44), and Jiangxi University of Chinese Medicine Science and Technology Innovation Team Development Program (No. CXTD22011).