# Exploring the combined impact of hepatitis B antibody status and systemic immune-inflammation index on mortality risk: A population-based study

## TL;DR

This study examines how the immune-inflammation index and hepatitis B antibody status together affect mortality risk in a large population.

## Contribution

The study is the first to explore the combined impact of SII and HBsAb status on mortality in a population-based setting.

## Key findings

- Higher systemic immune-inflammation index (SII) is linked to increased all-cause and cardiovascular mortality.
- HBV surface antibody's protective effect on mortality diminishes after adjusting for confounders.
- The combined effect of SII and HBsAb remains significant, suggesting a complex interaction in HBV infection.

## Abstract

Chronic hepatitis B virus (HBV) infection is a significant global health issue, leading to liver-related morbidity and mortality. The systemic immune-inflammation index (SII), a marker of systemic inflammation and immune response, may predict disease outcomes. However, its role in HBV infection and its relationship with HBV surface antibody (HBsAb) status is not well understood. This study investigates the association between SII, HBsAb status, and their combined effects on all-cause and cardiovascular disease (CVD) mortality.

We analyzed data from 43,539 participants in the National Health and Nutrition Examination Survey (NHANES), categorizing them into four groups based on SII and HBsAb status: high/low SII with HBsAb-negative/positive. Mortality outcomes were assessed using Cox proportional hazards models adjusted for age, sex, race/ethnicity, BMI, and comorbidities.

In the analysis of 43,539 participants, the fully adjusted model revealed that SII was significantly associated with both all-cause mortality (HR = 1.138, p < 0.001) and cardiovascular disease mortality (HR = 1.402, p < 0.0001), indicating that higher SII independently increases the risk of both outcomes. While the crude model showed a protective effect of HBV surface antibody on all-cause mortality (HR = 0.491, p < 0.0001) and cardiovascular disease mortality (HR = 0.478, p < 0.0001), this effect diminished after full adjustment. Additionally, the combined effect of SII and HBV surface antibody on both mortality outcomes remained significant in the fully adjusted model (HR = 1.402, p < 0.0001).

Higher SII is independently associated with increased risks of all-cause and cardiovascular disease mortality. The protective effect of HBV surface antibody on mortality diminished after adjustment for confounders. The combined effect of SII and HBV surface antibody on mortality highlights the complex interaction between inflammation and immune response in chronic HBV infection. SII may serve as a useful predictor of long-term health risks in HBV-infected individuals.