ArticleAnnals of medicine2025
Integrated machine learning and population attributable fraction analysis of systemic inflammatory indices for mortality risk prediction in diabetes and prediabetes.
Article in Annals of medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers.
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Who cites it
10 citing papers in PubMed.
- The U-shaped correlation between the systemic immune-inflammation index and all-cause and cardiovascular mortality in hyperlipidemic patients: findings from NHANES 1999-2018.Annals of medicine · 2026Article
- Sex-Specific Associations Between Cadmium Exposure and Mortality Risk in Cardiovascular Disease Patients: A Cohort Study Integrating Molecular Mechanisms of Myocardial Dysfunction.Cardiovascular toxicology · 2026Article
- Enhanced predictive value of post-treatment lymphocyte-based immunoinflammatory biomarkers for cancer therapy-related cardiac dysfunction in anthracycline-treated breast cancer patients.Cardio-oncology (London, England) · 2026Article
- Predictive value of an integrated insulin resistance and lipometabolic score for cardiometabolic multimorbidity in older adults: a UK cohort study.Cardiovascular diabetology · 2026Article
- FT3 Levels and Systemic Inflammation: Evidence From a Population-Based NHANES Analysis.Mediators of inflammation · 2026Article
- Prognostic value of the aggregate index of systemic inflammation and controlling nutritional status score for all-cause mortality in patients undergoing maintenance hemodialysis: a retrospective cohort study.Frontiers in medicine · 2026Article
- Neutrophil-to-lymphocyte ratio as a predictor of post-ablation recurrence in hypertensive patients with paroxysmal atrial fibrillation.International journal of medical sciences · 2026Article
- Application of AI and digital health tools in public health management of T2DM: from mechanism prediction to personalized treatment.Frontiers in public health · 2026Review
- Associations Between Systemic Immunity Inflammation Index, Aggregate Index of Systemic Inflammation, and Hospital Acquired Otitis Media in Children Aged ≤12 years with Bacterial Pneumonia.Infection and drug resistance · 2026Article
- Association Between the Systemic Inflammatory Response Index and Severe Infection in Patients with Diabetic Foot.Diabetes, metabolic syndrome and obesity : targets and therapy · 2026Article
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Authors and funding
13 authors.
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Abstract
backgroundChronic systemic inflammation is a key contributor to cardiometabolic complications in diabetes mellitus (DM) and prediabetes (PreDM). Composite inflammatory indices-including neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), platelet-to-hemoglobin ratio (PHR), and aggregate inflammation systemic index (AISI)-have shown prognostic value for mortality. However, their integrated assessment using machine learning and quantification at the population level remain limited.
methodsIn this retrospective cohort study, 11,304 adults with DM or PreDM from the National Health and Nutrition Examination Survey (NHANES, 2005-2018) were analyzed. The primary outcomes were all-cause and cardiovascular mortality. Associations between inflammatory indices and mortality were evaluated using Cox proportional hazards models. Predictive performance was assessed via Extreme Gradient Boosting (XGBoost), and population attributable fractions (PAFs) estimated the mortality burden related to systemic inflammation.
resultsNLR, MLR, SIRI, SII, and AISI were independently associated with all-cause and cardiovascular mortality. MLR showed the strongest association (HR: 2.948 and 3.717 for all-cause and CVD mortality, respectively). XGBoost identified SIRI, SII, AISI, MLR, and NLR as key predictors, with SIRI ranked highest for cardiovascular mortality. Inclusion of inflammatory indices improved model discrimination and calibration. PAF analysis suggested that 10-20% of mortality reduction could be attributed to improved inflammatory profiles.
conclusionSystemic inflammatory indices are independent predictors of mortality in individuals with DM or PreDM. Their integration into machine learning models enhances risk prediction and may inform population-level strategies for cardiometabolic risk stratification.
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