Association between systemic immune-inflammation index(SII) and all-cause and cardiovascular mortality in heart failure patients: a single-center retrospective analysis

Association between systemic immune-inflammation index(SII) and all-cause and cardiovascular mortality in heart failure patients: a single-center retrospective analysis | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Association between systemic immune-inflammation index(SII) and all-cause and cardiovascular mortality in heart failure patients: a single-center retrospective analysis junlan Zhang, Nan Lyu, Yaping Zhang, Pan Chen, Qianyu Ma, Nana Hu, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8708839/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to investigate the association between the systemic immune-inflammatory index (SII) and mortality in patients with heart failure (HF). Methods We conducted a retrospective cohort study of 1,084 HF patients. In this retrospective cohort study, we enrolled patients hospitalized for heart failure between January 2022 and June 2023. Follow-up was conducted via telephone and outpatient visits until death or July 22, 2025, with all-cause and cardiovascular mortality as primary endpoints. Patients were categorized by log-transformed SII (LnSII). Cox models assessed associations between LnSII and mortality, while restricted cubic splines evaluated nonlinearity. Subgroup, mediation (NT-proBNP, LVEF), and sensitivity analyses were performed. Results A higher LnSII was significantly associated with an increased risk of all-cause mortality (adjusted HR = 1.66, 95% CI: 1.08–2.55), but not with cardiovascular mortality. Subgroup analysis revealed a significant interaction with smoking status (P for interaction = 0.023), showing a stronger association between LnSII and all-cause mortality among smokers (HR = 2.41, 95% CI: 1.57–3.68). Mediation analysis indicated that NT-proBNP and LVEF mediated 35.8% and 15.0% of this association, respectively. Conclusion Elevated SII is independently associated with an increased risk of all-cause mortality in HF patients, particularly among smokers, and may serve as a useful prognostic biomarker. heart failure systemic immune-inflammatory index (SII) inflammation All-cause Mortality Cardiovascular Mortality Full Text Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8708839","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588711462,"identity":"ccb86dda-ec2e-4a04-a20d-03ea73898611","order_by":0,"name":"junlan Zhang","email":"","orcid":"","institution":"First Hospital of Lanzhou University","correspondingAuthor":false,"prefix":"","firstName":"junlan","middleName":"","lastName":"Zhang","suffix":""},{"id":588711463,"identity":"077e271e-b383-434f-8968-d60c6cc1f9fe","order_by":1,"name":"Nan Lyu","email":"","orcid":"","institution":"Wenzhou 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heart failure patients: a single-center retrospective analysis","fulltext":[],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":false,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":true,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":true,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"heart failure, systemic immune-inflammatory index (SII), inflammation, All-cause Mortality, Cardiovascular Mortality","lastPublishedDoi":"10.21203/rs.3.rs-8708839/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8708839/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e \u003cp\u003eThis study aimed to investigate the association between the systemic immune-inflammatory index (SII) and mortality in patients with heart failure (HF).\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eWe conducted a retrospective cohort study of 1,084 HF patients. In this retrospective cohort study, we enrolled patients hospitalized for heart failure between January 2022 and June 2023. Follow-up was conducted via telephone and outpatient visits until death or July 22, 2025, with all-cause and cardiovascular mortality as primary endpoints. Patients were categorized by log-transformed SII (LnSII). Cox models assessed associations between LnSII and mortality, while restricted cubic splines evaluated nonlinearity. Subgroup, mediation (NT-proBNP, LVEF), and sensitivity analyses were performed.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eA higher LnSII was significantly associated with an increased risk of all-cause mortality (adjusted HR\u0026thinsp;=\u0026thinsp;1.66, 95% CI: 1.08\u0026ndash;2.55), but not with cardiovascular mortality. Subgroup analysis revealed a significant interaction with smoking status (P for interaction\u0026thinsp;=\u0026thinsp;0.023), showing a stronger association between LnSII and all-cause mortality among smokers (HR\u0026thinsp;=\u0026thinsp;2.41, 95% CI: 1.57\u0026ndash;3.68). Mediation analysis indicated that NT-proBNP and LVEF mediated 35.8% and 15.0% of this association, respectively.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eElevated SII is independently associated with an increased risk of all-cause mortality in HF patients, particularly among smokers, and may serve as a useful prognostic biomarker.\u003c/p\u003e","manuscriptTitle":"Association between systemic immune-inflammation index(SII) and all-cause and cardiovascular mortality in heart failure patients: a single-center retrospective analysis","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 15:44:18","doi":"10.21203/rs.3.rs-8708839/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"ddbd6b0b-0b40-41d8-ad1c-d5f5a97cc94c","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2026-03-04T09:55:47+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 15:44:18","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8708839","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8708839","identity":"rs-8708839","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}