The Positive Association Between RCII and Endometriosis and Its Integration into a Clinical Predictive Model: A Cross-Sectional Study

Wu H, F Shan, Ye M, Zhou H, Jiao Roger J., Zhong Gu Z, Wu Y
In: International Journal of Women's Health, Vol Volume 18, Iss Issue 1, Pp 1-13 (2026) · 2026 · W7120862282
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This cross-sectional analysis of NHANES data demonstrates a significant positive association between the Remnant Cholesterol Inflammatory Index and endometriosis risk, supporting its integration into a clinical predictive nomogram.

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This cross-sectional study analyzed data from the 1999–2006 NHANES database to evaluate the association between the Remnant Cholesterol Inflammatory Index (RCII) and endometriosis. Logistic regression and restricted cubic spline models revealed a significant positive linear relationship, where each standard deviation increase in lnRCII corresponded to a 25% higher risk of endometriosis after adjusting for confounders. The researchers constructed a nomogram using LASSO-selected variables to demonstrate the potential utility of RCII as a clinical predictive tool for this condition. This paper is centrally about endometriosis — specifically investigating a novel inflammatory-metabolic biomarker for risk prediction.

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Abstract

Haochan Wu,1,* Fangfang Shan,1,* Mengmeng Ye,1 Hui Zhou,1,2 Jie Jiao,3 Zhaoxia Zhong,4 Yibo Wu1,2 1Human Reproductive Medicine Center, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China; 2Human Genetic and Reproduction Center, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China; 3Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China; 4Department of Obstetrics and Gynecology, Donghai People’s Hospital, Donghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yibo Wu, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China, Email [email protected] Zhaoxia Zhong, Department of Obstetrics and Gynecology, Donghai People’s Hospital, 299Fuguo Road, Donghai, Donghai, People’s Republic of China, Email [email protected]: Studies indicate that endometriosis (EMs) is associated with inflammation and metabolic abnormalities. The Remnant Cholesterol Inflammatory Index (RCII) concurrently reflects both inflammatory and metabolic status. However, the relationship between RCII and EMs remains unclear. Therefore, this study aims to investigate the association between RCII and EMs and explore the potential of RCII as a risk predictor for EMs.Methods: Making use of information from the 1999– 2006 NHANES database, we investigated the connection between natural logarithm-transformed RCII (lnRCII) and EMs employing logistic regression analysis, restricted cubic spline (RCS) models, and subgroup analysis approaches. Finally, a nomogram was constructed based on feature variables selected via LASSO regression to enhance the interpretability of the predictive model.Results: After adjusting for potential confounding factors, lnRCII demonstrated a substantial positive correlation with the risk of EMs. For each 1-standard-deviation increase in lnRCII, the EMs’ risk increased by 25% (fully adjusted model OR = 1.250, 95% CI: 1.266– 1.461, P = 0.006). Furthermore, a linear relationship between lnRCII and EMS was observed via RCS analysis. According to subgroup analysis, the relationship between lnRCII and EMS has a consistent association across the majority of the population. (P for interaction > 0.05).Conclusion: In the US population, RCII was substantially linked to a higher risk of EMs, suggesting that the lipid metabolism-inflammation axis may represent a potential target for intervention in the prevention or treatment of EMs.Keywords: remnant cholesterol inflammatory index, endometriosis, cross-sectional study, NHANES
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International Journal of Women's Health (Jan 2026) The Positive Association Between RCII and Endometriosis and Its Integration into a Clinical Predictive Model: A Cross-Sectional Study Abstract Haochan Wu,1,* Fangfang Shan,1,* Mengmeng Ye,1 Hui Zhou,1,2 Jie Jiao,3 Zhaoxia Zhong,4 Yibo Wu1,2 1Human Reproductive Medicine Center, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China; 2Human Genetic and Reproduction Center, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China; 3Department of Obstetrics and Gynecology, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China; 4Department of Obstetrics and Gynecology, Donghai People’s Hospital, Donghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Yibo Wu, Affiliated Hospital of Jiangnan University, Wuxi, People’s Republic of China, Email [email protected] Zhaoxia Zhong, Department of Obstetrics and Gynecology, Donghai People’s Hospital, 299Fuguo Road, Donghai, Donghai, People’s Republic of China, Email [email protected]: Studies indicate that endometriosis (EMs) is associated with inflammation and metabolic abnormalities. The Remnant Cholesterol Inflammatory Index (RCII) concurrently reflects both inflammatory and metabolic status. However, the relationship between RCII and EMs remains unclear. Therefore, this study aims to investigate the association between RCII and EMs and explore the potential of RCII as a risk predictor for EMs.Methods: Making use of information from the 1999– 2006 NHANES database, we investigated the connection between natural logarithm-transformed RCII (lnRCII) and EMs employing logistic regression analysis, restricted cubic spline (RCS) models, and subgroup analysis approaches. Finally, a nomogram was constructed based on feature variables selected via LASSO regression to enhance the interpretability of the predictive model.Results: After adjusting for potential confounding factors, lnRCII demonstrated a substantial positive correlation with the risk of EMs. For each 1-standard-deviation increase in lnRCII, the EMs’ risk increased by 25% (fully adjusted model OR = 1.250, 95% CI: 1.266– 1.461, P = 0.006). Furthermore, a linear relationship between lnRCII and EMS was observed via RCS analysis. According to subgroup analysis, the relationship between lnRCII and EMS has a consistent association across the majority of the population. (P for interaction > 0.05).Conclusion: In the US population, RCII was substantially linked to a higher risk of EMs, suggesting that the lipid metabolism-inflammation axis may represent a potential target for intervention in the prevention or treatment of EMs.Keywords: remnant cholesterol inflammatory index, endometriosis, cross-sectional study, NHANES

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