The association between systemic immune-inflammation index and cardiovascular diseases: An in-depth umbrella review of meta-analyses with GRADE assessment
Background: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. The Systemic Immune-Inflammation Index (SII), an emerging biomarker calculated from platelet, neutrophil, and lymphocyte counts, has gained attention for its potential role in predicting cardiovascular outcomes....
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Elsevier
2025-03-01
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S240584402501117X |
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| author | Kwame Boateng Agyeman Nimra Shafi Rafael Contreras Vishal Parackal Diyana N. Shah Anoop Gurram Narsimha Rao Keetha Daniyal Ameen |
| author_facet | Kwame Boateng Agyeman Nimra Shafi Rafael Contreras Vishal Parackal Diyana N. Shah Anoop Gurram Narsimha Rao Keetha Daniyal Ameen |
| author_sort | Kwame Boateng Agyeman |
| collection | DOAJ |
| description | Background: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. The Systemic Immune-Inflammation Index (SII), an emerging biomarker calculated from platelet, neutrophil, and lymphocyte counts, has gained attention for its potential role in predicting cardiovascular outcomes. However, the clinical utility of SII in cardiovascular risk assessment remains uncertain, and current studies present conflicting findings. This umbrella review aims to synthesize evidence from existing meta-analyses to evaluate the diagnostic and prognostic value of SII in various cardiovascular diseases. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted up to September 2024. The methodological quality of included studies was assessed using the AMSTAR-2 tool. Statistical analysis was performed using random-effects models, and heterogeneity was evaluated with I2 statistics. Publication bias was assessed using funnel plots and Egger's regression tests, with trim-and-fill analysis applied where necessary. Results: The findings indicated a significant association between high SII levels and cardiovascular diseases (Odds Ratio [OR] = 1.67, 95 % Confidence Interval [CI]: 1.06–2.61, P = 0.03). Elevated SII levels were also associated with major adverse cardiovascular events (MACE) in patients with coronary artery disease (OR = 2.36, 95 % CI: 1.52–3.64, P < 0.01). Patients undergoing percutaneous coronary intervention (PCI) with higher SII levels had an elevated risk of MACE (OR = 2.57, 95 % CI: 1.79–3.71, P < 0.01) and non-fatal myocardial infarction (OR = 1.91, 95 % CI: 1.17–3.14, P = 0.02). The overall quality of evidence was rated as very low to low across most outcomes, reflecting concerns about study design, inconsistency, and reporting bias. Conclusions: High SII levels are associated with an increased risk of cardiovascular diseases and major adverse cardiovascular events. However, the substantial heterogeneity and low quality of evidence limit the strength of these conclusions. More high-quality studies are needed to validate the prognostic utility of SII in clinical settings. |
| format | Article |
| id | doaj-art-ba86a08693bf45e996363f2702bd3bbb |
| institution | DOAJ |
| issn | 2405-8440 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
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| series | Heliyon |
| spelling | doaj-art-ba86a08693bf45e996363f2702bd3bbb2025-08-20T03:05:55ZengElsevierHeliyon2405-84402025-03-01115e4273610.1016/j.heliyon.2025.e42736The association between systemic immune-inflammation index and cardiovascular diseases: An in-depth umbrella review of meta-analyses with GRADE assessmentKwame Boateng Agyeman0Nimra Shafi1Rafael Contreras2Vishal Parackal3Diyana N. Shah4Anoop Gurram5Narsimha Rao Keetha6Daniyal Ameen7Division of General Medicine, Department of Medicine, Loma Linda University Health, 11234, Anderson St, Loma Linda, CA, 92354, USA; Corresponding author. Division of General Medicine, Department of Medicine, Loma Linda University Health, 11234 Anderson St, Loma Linda, CA, USA.Department of Medicine, Arnot Ogden Medical Center, 600 Roe Ave, Elmira, NY, 14905, USADepartment of Internal Medicine, Yale New Heaven Health Bridgeport Hospital, 267 Grant St, Bridgeport, CT 06610, USAIndependent Researcher, Mysore, Karnataka, IndiaUniversity of South Florida, Tampa Campus, 4202 E Fowler Ave, Tampa, FL, 33620, USADepartment of Hospital Medicine Cleveland Clinic, 33300 Cleveland Clinic Blvd, Avon, OH, USAOhio Kidney and Hypertension Center, 7255, Old Oak Blvd, Ste C111, Middleburg Hts, OH, USADepartment of Internal Medicine, Yale New Heaven Health Bridgeport Hospital, 267 Grant St, Bridgeport, CT 06610, USABackground: Cardiovascular diseases (CVDs) are the leading cause of mortality worldwide. The Systemic Immune-Inflammation Index (SII), an emerging biomarker calculated from platelet, neutrophil, and lymphocyte counts, has gained attention for its potential role in predicting cardiovascular outcomes. However, the clinical utility of SII in cardiovascular risk assessment remains uncertain, and current studies present conflicting findings. This umbrella review aims to synthesize evidence from existing meta-analyses to evaluate the diagnostic and prognostic value of SII in various cardiovascular diseases. Methods: A comprehensive search of PubMed, Scopus, and Web of Science was conducted up to September 2024. The methodological quality of included studies was assessed using the AMSTAR-2 tool. Statistical analysis was performed using random-effects models, and heterogeneity was evaluated with I2 statistics. Publication bias was assessed using funnel plots and Egger's regression tests, with trim-and-fill analysis applied where necessary. Results: The findings indicated a significant association between high SII levels and cardiovascular diseases (Odds Ratio [OR] = 1.67, 95 % Confidence Interval [CI]: 1.06–2.61, P = 0.03). Elevated SII levels were also associated with major adverse cardiovascular events (MACE) in patients with coronary artery disease (OR = 2.36, 95 % CI: 1.52–3.64, P < 0.01). Patients undergoing percutaneous coronary intervention (PCI) with higher SII levels had an elevated risk of MACE (OR = 2.57, 95 % CI: 1.79–3.71, P < 0.01) and non-fatal myocardial infarction (OR = 1.91, 95 % CI: 1.17–3.14, P = 0.02). The overall quality of evidence was rated as very low to low across most outcomes, reflecting concerns about study design, inconsistency, and reporting bias. Conclusions: High SII levels are associated with an increased risk of cardiovascular diseases and major adverse cardiovascular events. However, the substantial heterogeneity and low quality of evidence limit the strength of these conclusions. More high-quality studies are needed to validate the prognostic utility of SII in clinical settings.http://www.sciencedirect.com/science/article/pii/S240584402501117XBiomarkersCardiovascular diseasesDiagnostic toolsInflammationMeta-analysisPrognosis |
| spellingShingle | Kwame Boateng Agyeman Nimra Shafi Rafael Contreras Vishal Parackal Diyana N. Shah Anoop Gurram Narsimha Rao Keetha Daniyal Ameen The association between systemic immune-inflammation index and cardiovascular diseases: An in-depth umbrella review of meta-analyses with GRADE assessment Heliyon Biomarkers Cardiovascular diseases Diagnostic tools Inflammation Meta-analysis Prognosis |
| title | The association between systemic immune-inflammation index and cardiovascular diseases: An in-depth umbrella review of meta-analyses with GRADE assessment |
| title_full | The association between systemic immune-inflammation index and cardiovascular diseases: An in-depth umbrella review of meta-analyses with GRADE assessment |
| title_fullStr | The association between systemic immune-inflammation index and cardiovascular diseases: An in-depth umbrella review of meta-analyses with GRADE assessment |
| title_full_unstemmed | The association between systemic immune-inflammation index and cardiovascular diseases: An in-depth umbrella review of meta-analyses with GRADE assessment |
| title_short | The association between systemic immune-inflammation index and cardiovascular diseases: An in-depth umbrella review of meta-analyses with GRADE assessment |
| title_sort | association between systemic immune inflammation index and cardiovascular diseases an in depth umbrella review of meta analyses with grade assessment |
| topic | Biomarkers Cardiovascular diseases Diagnostic tools Inflammation Meta-analysis Prognosis |
| url | http://www.sciencedirect.com/science/article/pii/S240584402501117X |
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