Evaluation of systemic immune-inflammation index in young patients with coronary artery disease: association with glycaemic status

Rishitha Bygari; Shibi Mary Thomas; Balakeshwa Ramaiah

doi:10.18203/2319-2003.ijbcp20263788

Authors

Rishitha Bygari Doctor of Pharmacy, Karnataka College of Pharmacy, Rajiv Gandhi University of health sciences, Bangalore, Karnataka, India
Shibi Mary Thomas Department of Pharmacy Practice, Karnataka College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India
Balakeshwa Ramaiah Department of Pharmacy Practice, Karnataka College of Pharmacy, Rajiv Gandhi University of Health Sciences, Bangalore, Karnataka, India

DOI:

https://doi.org/10.18203/2319-2003.ijbcp20263788

Keywords:

Coronary artery disease, Glycaemic status, Systemic immune-inflammation index, Type 2 diabetes mellitus, Young adults

Abstract

Background: Coronary artery disease (CAD) in young adults is an important health concern, particularly in India. The Systemic Immune-Inflammation Index (SII) is a composite inflammatory marker derived from platelet, neutrophil and lymphocyte counts. However, limited information is available regarding its relationship with glycaemic status in young patients with CAD. To assess the association of Systemic Immune-Inflammation Index (SII) with glycaemic status and evaluate cardiovascular risk factors, comorbidities, clinical, laboratory, biochemical and angiographic characteristics in young patients with coronary artery disease.

Methods: A prospective observational study was conducted among 80 patients aged 18–45 years with CAD admitted to the Coronary Care Unit of Bangalore Baptist Hospital, Bangalore, during 2025. Demographic, clinical, laboratory, echocardiographic and angiographic data were collected. SII was calculated as platelet count × neutrophil count / lymphocyte count. Patients were grouped according to SII level and glycaemic status and the groups were compared using appropriate statistical tests.

Results: The mean age was 38.6±3.6 years, with males accounting for 87.5% of participants. Smoking (53.8%), diabetes (43.8%) and hypertension (36.3%) were the most common cardiovascular risk factors. The mean SII was 1049±881. Significant differences between the SII and glycaemic groups were observed for age (p=0.039), dyslipidaemia (p=0.006), HbA1c (p<0.00001), platelet count (p=0.0003), neutrophil count (p<0.00001) and lymphocyte count (p<0.00001). Angiographic disease extent did not differ significantly between the groups (p=0.379).

Conclusions: SII showed significant differences according to glycaemic status, particularly in relation to HbA1c and its cellular components. SII may provide additional information regarding systemic inflammation in young patients with CAD.

References

Pandya T, Suranagi MJ, Subramanyam K, Srinivasa KH. Study of young Indians with ST elevation myocardial infarction: risk factors, clinical presentation, angiographic profile and short-term prognosis. Int J Contemp Med Surg Radiol. 2020;5(4):D7-D13.

Singh M, Kumar R, Kansal V, Singhal A, Kapoor A, Singh G. Young onset coronary artery disease in India: a descriptive observational study. Clin Epidemiol Glob Health. 2024;101851.

Kumar AS, Sinha N. Cardiovascular disease in India: a 360-degree overview. J Clin Prev Cardiol. 2019;8(2):33-38.

Danaei G, Singh GM, Paciorek CJ, Lin JK, Cowan MJ, Finucane MM, et al. The global cardiovascular risk transition: associations of four metabolic risk factors with macroeconomic variables in 1980 and 2008. Circulation. 2013;127(14):1493-502.

Abela GS, Aziz K. The role of cholesterol crystals in plaque rupture leading to acute myocardial infarction and stroke. In: Abela GS, Nidorf SM, editors. Cholesterol Crystals in Atherosclerosis and Other Related Diseases. Cham: Springer Nature. 2023:161-85.

Gupta R, Guptha S, Sharma KK, Gupta A, Deedwania P. Regional variations in cardiovascular risk factors in India: India Heart Watch. World J Cardiol. 2012;4(4):112-20.

Sharma M, Ganguly NK. Premature coronary artery disease in Indians and its associated risk factors. Vasc Health Risk Manag. 2005;1(3):217-25.

Agrawal A, Lamichhane P, Eghbali M, Xavier R, Cook DE, Elsherbiny RM, et al. Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review. J Int Med Res. 2023;51(8):307806.

Prakash B, Jaiswal A, Shah MM. Demographic and angiographic profile of young patients aged 40 years and less undergoing coronary angiography in a tier II city of Eastern India. J Family Med Prim Care. 2020;9(10):5183-7.

Suri P, Arora A, Kinra K, Arora V. Risk factors and angiographic profile in young individuals with acute ST-elevation myocardial infarction (STEMI). Indian J Clin Cardiol. 2023;4:242-7.

Sinha SK, Krishna V, Thakur R, Kumar A, Mishra V, Jha MJ, et al. Acute myocardial infarction in very young adults: a clinical presentation, risk factors, hospital outcome index and their angiographic characteristics in North India-AMIYA Study. ARYA Atheroscler. 2017;13(2):79-87.

Shukla AN, Nisal S, Patil S, Patil N, Bhandarkar P, Chauhan V, et al. Cardiovascular risk factors in young patients of coronary artery disease: a hospital-based study from Western India. Glob Heart. 2019;14(3):257-63.

Karakayalı M, Karakayalı Ö, Gür M. The systemic immune-inflammation index and relationship with INOCA [ischemia with non-obstructive coronary arteries] in patients undergoing coronary angiography. Arq Bras Cardiol. 2024;121(2):e20230540.

Demirci Samedov B, Melekoğlu A, Kahveci U, Altınbilek E. Evaluation of the prognostic value ofsystemic inflammation indexes in patients diagnosed with acute coronary syndrome in the emergency department. Signa Vitae. 2025;21(6):74-85.

Özkan U, Gürdoğan M, Öztürk C, Demir M, Akkuş ÖF, Yılmaz E, et al. Systemic Immune-Inflammation Index: a novel predictor of coronary thrombus burden in patients with non-ST acute coronary syndrome. Medicina. 2022;58(2):143.

Huang J, Zhang Q, Wang R, Ji H, Chen Y, Quan X, et al. Systemic immune-inflammatory index predicts clinical outcomes for elderly patients with acute myocardial infarction receiving percutaneous coronary intervention. 2020;3:49367.

Bian X, He J, Zhang R, Yuan S, Dou K. 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;16:6415-6429.

Yan Y, Lu H, Zheng Y, Lin S. Association between Systemic Immune Inflammation Index and diabetes mellitus in the NHANES 2003-2018 population. J Endocr Soc. 2024;8(8):bvae124.

Zhao Z, Zhang X, Sun T, Huang X, Ma M, Yang S, et al. Prognostic value of systemic immune-inflammation index in CAD patients: systematic review and meta-analyses. Eur J Clin Invest. 2024;54(2):e14100.

Zhang C, Li M, Liu L, Deng L, Xie Y, Zhong Y, et al. Systemic immune-inflammation index as a novel predictor of major adverse cardiovascular events in patients undergoing percutaneous coronary intervention: a meta-analysis of cohort studies. BMC Cardiovasc Disord. 2024;24:189.

Barure R, Shanthaiah DM, Atluri S, Channabasappa S, Kolla G, Reddy SLS, et al. High prevalence of additional cardiovascular risk factors in Eastern-Indian young adults with type 2 diabetes mellitus. Indian J Endocr Metab. 2022;26(4):372-5.

Xu R, Jiang L. Association of systemic immune-inflammation index with type 2 diabetes mellitus and its prognostic significance: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2025;16:1572089.

Dong Y, Tang M, Xu Y, Peng Q. Predictive value of systemic immune-inflammation index in patients with diabetes mellitus: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2025;16:1617814.