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已发表论文
系统性免疫炎症指数与 HIV 相关隐球菌性脑膜炎患者 24 周结局之间的关联：一项前瞻性多中心队列研究的二次分析
Authors Zhao T, Wang X, Song Y, Harypursat V , Chen Y
Received 6 August 2025
Accepted for publication 15 November 2025
Published 3 December 2025 Volume 2025:18 Pages 16991—17003
DOI https://doi.org/10.2147/JIR.S555540
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Adam Bachstetter
Ting Zhao,1,2,* Xiaohong Wang,1,* Yuxia Song,3 Vijay Harypursat,2,4 Yaokai Chen2,4
1Department of Pharmacology, Chongqing Public Health Medical Center, Chongqing, People’s Republic of China; 2Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, People’s Republic of China; 3Department of Infectious Diseases, The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China; 4Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yaokai Chen, Department of Infectious Diseases; Clinical Research Center, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, People’s Republic of China, Tel +86 23 65231256, Fax +86 23 65481658, Email yaokaichen@hotmail.com
Objective: The systemic immune-inflammation index (SII) represents a promising yet underexplored biomarker in HIV-associated cryptococcal meningitis (HCM). The study aimed to assess the association between SII levels before and during treatment, and 24-week outcomes in HCM patients, as well as its potential for predicting mortality.
Methods: This was a secondary analysis of a prospective multicenter study involving HIV patients with newly diagnosed cryptococcal meningitis (CM). SII was measured at baseline, and at weeks 2 and 4 following initiation of induction antifungal therapy. Correlations between baseline SII levels and clinicopathological factors were analyzed. We also investigated the relationship that baseline and on-treatment SII levels may have on patient cumulative mortality.
Results: In total, 21.8% (54/248) of HCM patients succumbed within the 24-week follow-up period. Baseline SII levels were significantly higher in HCM patients compared to those with HIV without CM (p< 0.0001). In patients with HCM, SII levels during treatment were significantly higher in non-survivors than in survivors. Furthermore, a negative correlation was observed between SII levels and CD4+ T-cell counts in HCM patients (r=− 0.245, p< 0.001). After adjusting for potential confounders, elevated SII levels at weeks 2 and 4 remained independently associated with a 2.5-fold and 5.5-fold increased risk of mortality, respectively [adjusted hazard ratio (95% CI): 2.51 (1.09— 5.76), p=0.03; 5.47 (2.38— 12.6), p< 0.001, respectively]. Moreover, the combination of SII levels at weeks 2 and 4, as well as their integration with impaired consciousness (IC) status, effectively predicted poor outcomes within 24 weeks.
Conclusion: Elevated SII levels during treatment are independently associated with increased 24-week mortality in HCM patients, suggesting the potential of SII as an effective prognostic biomarker. The integration of the SII into IC indicators for risk stratification further improves prognostic accuracy.
Keywords: HIV, cryptococcal meningitis, systemic immune-inflammation index, biomarkers, prognostic analysis
1Department of Pharmacology, Chongqing Public Health Medical Center, Chongqing, People’s Republic of China; 2Clinical Research Center, Chongqing Public Health Medical Center, Chongqing, People’s Republic of China; 3Department of Infectious Diseases, The Sixth People’s Hospital of Xinjiang Uygur Autonomous Region, Urumqi, People’s Republic of China; 4Department of Infectious Diseases, Chongqing Public Health Medical Center, Chongqing, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Yaokai Chen, Department of Infectious Diseases; Clinical Research Center, Chongqing Public Health Medical Center, 109 Baoyu Road, Shapingba District, Chongqing, 400036, People’s Republic of China, Tel +86 23 65231256, Fax +86 23 65481658, Email yaokaichen@hotmail.com
Objective: The systemic immune-inflammation index (SII) represents a promising yet underexplored biomarker in HIV-associated cryptococcal meningitis (HCM). The study aimed to assess the association between SII levels before and during treatment, and 24-week outcomes in HCM patients, as well as its potential for predicting mortality.
Methods: This was a secondary analysis of a prospective multicenter study involving HIV patients with newly diagnosed cryptococcal meningitis (CM). SII was measured at baseline, and at weeks 2 and 4 following initiation of induction antifungal therapy. Correlations between baseline SII levels and clinicopathological factors were analyzed. We also investigated the relationship that baseline and on-treatment SII levels may have on patient cumulative mortality.
Results: In total, 21.8% (54/248) of HCM patients succumbed within the 24-week follow-up period. Baseline SII levels were significantly higher in HCM patients compared to those with HIV without CM (p< 0.0001). In patients with HCM, SII levels during treatment were significantly higher in non-survivors than in survivors. Furthermore, a negative correlation was observed between SII levels and CD4+ T-cell counts in HCM patients (r=− 0.245, p< 0.001). After adjusting for potential confounders, elevated SII levels at weeks 2 and 4 remained independently associated with a 2.5-fold and 5.5-fold increased risk of mortality, respectively [adjusted hazard ratio (95% CI): 2.51 (1.09— 5.76), p=0.03; 5.47 (2.38— 12.6), p< 0.001, respectively]. Moreover, the combination of SII levels at weeks 2 and 4, as well as their integration with impaired consciousness (IC) status, effectively predicted poor outcomes within 24 weeks.
Conclusion: Elevated SII levels during treatment are independently associated with increased 24-week mortality in HCM patients, suggesting the potential of SII as an effective prognostic biomarker. The integration of the SII into IC indicators for risk stratification further improves prognostic accuracy.
Keywords: HIV, cryptococcal meningitis, systemic immune-inflammation index, biomarkers, prognostic analysis