Original Articles Open access

Systemic Immune-Inflammation Index as an independent predictor of in-hospital morbidity in diabetic patients with ST-elevation myocardial infarction

Authors

Published
31 July 2026
Section
Original Articles
DOI
10.4081/itjm.2026.2563

Abstract

Diabetic patients presenting with ST-elevation myocardial infarction (STEMI) are particularly vulnerable to unfavorable in-hospital outcomes. We examined the prognostic value of the systemic immune-inflammation index (SII) for predicting in-hospital morbidity in a prospective cohort of 108 diabetic patients with STEMI; patients were classified by clinical outcome into morbid (n=57) and non-morbid (n=51) groups. Demographic characteristics, clinical findings, laboratory results, and angiographic data were recorded. In-hospital morbidity occurred in 52.8% of patients. Multivariate logistic regression identified prior myocardial infarction [p=0.038, odds ratio (OR)=3.34, 95% confidence interval (CI): 1.07-11.01], three-vessel disease (p=0.019, OR=3.81, 95% CI: 1.26-19.51), and SII (p=0.022, OR=3.16, 95% CI: 1.12-14.5) as independent predictors of morbidity. SII demonstrated good discriminatory ability for predicting morbidity with an area under the receiver operating characteristic curve of 0.718 (95% CI: 0.662-0.844, p<0.001); at a cut-off >604.75, the sensitivity was 77% and specificity 63%. These findings suggest that SII is a useful and readily available inflammatory marker for predicting in-hospital morbidity among diabetic patients with STEMI.

Keywords

References

  1. Chen S, Chen Y, Liu B, et al. Does diabetes mellitus increase the short- and long-term mortality in patients with critical acute myocardial infarction? Front Endocrinol 2021;12:797049. DOI: https://doi.org/10.3389/fendo.2021.797049
  2. Mohammedi MKM, Altaweel RB, Gburi AKKA. Exploring the role of non-HDL cholesterol in acute coronary syndrome: a case-control study. Pak Heart J 2024;57:13-7. DOI: https://doi.org/10.47144/phj.v57i1.2600
  3. Yoon GS, Park HC, Choi JH, et al. Association between on-admission neutrophil-to-lymphocyte ratio and mechanical complications and mortality in patients with STEMI. J Korean Med Sci 2021;36:e131. DOI: https://doi.org/10.3346/jkms.2021.36.e131
  4. Babes EE, Radu AF, Cretu NA, et al. Risk stratification in acute coronary syndromes: The systemic immune-inflammation index as prognostic marker. Med Sci 2025;13:116. DOI: https://doi.org/10.3390/medsci13030116
  5. Bruno M, Bizzarri N, Teodorico E, et al. The potential role of systemic inflammatory markers in predicting recurrence in early-stage cervical cancer. Eur J Surg Oncol 2024;50:107311. DOI: https://doi.org/10.1016/j.ejso.2023.107311
  6. Wenpei G, Yuan L, Liangbo L, et al. Predictive value of preoperative inflammatory indexes for postoperative early recurrence of hepatitis B-related hepatocellular carcinoma. Front Oncol 2023;13:1142168. DOI: https://doi.org/10.3389/fonc.2023.1142168
  7. Urbanowicz T, Michalak M, Al-Imam A, et al. The significance of systemic immune-inflammatory index for mortality prediction in diabetic patients treated with off-pump coronary artery bypass surgery. Diagnostics 2022;12:634. DOI: https://doi.org/10.3390/diagnostics12030634
  8. Zhang W, Jia H, Zhao X, et al. Predictive value of cumulative SII for MACE in STEMI patients after PCI. Medicine 2025;104:e41983. DOI: https://doi.org/10.1097/MD.0000000000041983
  9. Orhan AL, Saylik F, Cicek V, et al. Evaluating the systemic immune-inflammation index for in-hospital and long-term mortality in elderly non-ST-elevation myocardial infarction patients. Aging Clin Exp Res 2022;34:1687-95. DOI: https://doi.org/10.1007/s40520-022-02103-1
  10. Li Q, Ma X, Shao Q, et al. Prognostic impact of multiple lymphocytebased inflammatory indices in acute coronary syndrome patients. Front Cardiovasc Med 2022;9:811790. DOI: https://doi.org/10.3389/fcvm.2022.811790
  11. Zhao Y, Zhao S, Shi Y, et al. The Predictive Value of the Systemic Immune-Inflammation Index for Cardiovascular Events in Chronic Total Occlusion Patients Who Prior Coronary Artery Bypass Grafting. J Inflamm Res 2024;17:8611-23. DOI: https://doi.org/10.2147/JIR.S486692
  12. Ye Z, Hu T, Wang J, et al. Systemic immune-inflammation index as a potential biomarker of cardiovascular diseases: a systematic review and meta-analysis. Front Cardiovasc Med 2022;9:933913. DOI: https://doi.org/10.3389/fcvm.2022.933913
  13. Esenboga K, Kurtul A, Yamantürk YY, et al. Systemic immune-inflammation index predicts no-reflow phenomenon after primary percutaneous coronary intervention. Acta Cardiol. 2022;77:59-65. DOI: https://doi.org/10.1080/00015385.2021.1884786
  14. Tosu AR, Kalyoncuoglu M, Biter H, et al. Prognostic value of systemic immune-inflammation index for major adverse cardiac events and mortality in severe aortic stenosis patients after TAVI. Medicina 2021;57:588. DOI: https://doi.org/10.3390/medicina57060588
  15. Bian X, He J, Zhang R, et al. The combined effect of systemic immune-inflammation index and type 2 diabetes mellitus on the prognosis of patients undergoing percutaneous coronary intervention: a large-scale cohort study. J Inflamm Res 2023;16:6415-29. DOI: https://doi.org/10.2147/JIR.S445479
  16. Anzai A, Ko S, Fukuda K. Immune and inflammatory networks in myocardial infarction: current research and its potential implications for the clinic. Int J Mol Sci 2022;23:5214. DOI: https://doi.org/10.3390/ijms23095214
  17. Mauler M, Herr N, Schoenichen C, et al. Platelet serotonin aggravates myocardial ischemia/reperfusion injury via neutrophil degranulation. Circulation 2019;139:918-31. DOI: https://doi.org/10.1161/CIRCULATIONAHA.118.033942
  18. Zhao WM, Tao SM, Liu GL. Neutrophil-to-lymphocyte ratio in relation to the risk of all-cause mortality and cardiovascular events in patients with chronic kidney disease: a systematic review and meta-analysis. Ren Fail 2020;42:1059-66. DOI: https://doi.org/10.1080/0886022X.2020.1832521
  19. Broijersen A, Hamsten A, Eriksson M, et al. Platelet activity in vivo in hyperlipoproteinemia – importance of combined hyperlipidemia. Thromb Haemost 1998;79:268-75. DOI: https://doi.org/10.1055/s-0037-1615005
  20. Totani L, Evangelista V. Platelet-leukocyte interactions in cardiovascular disease and beyond. Arterioscler Thromb Vasc Biol 2010;30:2357-61. DOI: https://doi.org/10.1161/ATVBAHA.110.207480
  21. Su G, Zhang Y, Xiao R, et al. Systemic immune-inflammation index as a promising predictor of mortality in patients with acute coronary syndrome: a real-world study. J Int Med Res 2021;49:3000605211016274. DOI: https://doi.org/10.1177/03000605211016274
  22. Liu Y, Liu J, Liu L, et al. Association of systemic inflammatory response index and pan-immune-inflammation-value with long-term adverse cardiovascular events in st-segment elevation myocardial infarction patients after primary percutaneous coronary intervention. J Inflamm Res 2023;16:3437-54. DOI: https://doi.org/10.2147/JIR.S421491
  23. Wei X, Zhang Z, Wei J, Luo C. Association of systemic immune inflammation index and system inflammation response index with clinical risk of acute myocardial infarction. Front Cardiovasc Med 2023;10:1248655. DOI: https://doi.org/10.3389/fcvm.2023.1248655
  24. Luo J, Qin X, Zhang X, et al. Prognostic implications of systemic immune-inflammation index in myocardial infarction patients with and without diabetes: insights from the NOAFCAMI-SH registry. Cardiovasc Diabetol 2024;23:41. DOI: https://doi.org/10.1186/s12933-024-02129-x

Metrics

Citations and online attention from Dimensions, Altmetric and PlumX.

PlumX Metrics

License

Copyright (c) 2026 the Author(s)

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.