Systemic inflammatory response index and In-hospital mortality in diabetic heart failure patients: evidence from MIMIC-IV.

OBJECTIVE

Systemic inflammation is critically involved in the pathogenesis and progression of diabetes mellitus (DM) and heart failure (HF). Although the Systemic Inflammatory Response Index (SIRI) has shown prognostic significance in cardiovascular diseases, its relationship with in-hospital mortality in patients concurrently suffering from DM and HF has not yet been established.

METHODS

Clinical data for 4,410 critically ill patients diagnosed with DM and HF were obtained from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The patients were divided into four groups according to the quartiles of log2-transformed SIRI. The associations between SIRI and in-hospital mortality were assessed utilizing Kaplan-Meier survival analysis, restricted cubic splines (RCS), and multivariable Cox proportional hazards models.

RESULTS

Elevated SIRI levels were significantly correlated with clinical instability, characterized by increased heart and respiratory rates and decreased blood pressure, as well as higher in-hospital mortality rates. Kaplan-Meier analysis demonstrated poorer survival outcomes associated with higher SIRI levels. RCS analysis revealed nonlinear associations between log2(SIRI) and both 30-day and 90-day mortality. Following multivariable adjustment, the highest SIRI quartile (Q4) emerged as an independent predictor of increased in-hospital mortality, 30-day in-hospital mortality, and 90-day in-hospital mortality, p < 0.001.

CONCLUSION

SIRI independently predicts in-hospital mortality for critically ill patients with DM and HF by using neutrophil, lymphocyte, and monocyte counts to offer a comprehensive inflammatory profile. This aids in risk assessment and clinical decision-making.