Systemic inflammatory indices mediate the association between hyperuricemia and left ventricular hypertrophy: evidence from a single-center retrospective cross-sectional study

TL;DR

This study shows that systemic inflammation, measured by SII and SIRI, links high uric acid levels to heart damage in patients.

Contribution

The study identifies SII and SIRI as mediators between hyperuricemia and left ventricular hypertrophy.

Findings

Elevated SII and SIRI are independently associated with left ventricular hypertrophy in hyperuricemic patients.

Systemic inflammation partially mediates the relationship between serum urate and cardiac remodeling.

A nonlinear 'J-shaped' association was found for lnSII with a threshold at 5.99.

Abstract

Hyperuricemia (HUA) is associated with left ventricular hypertrophy (LVH), a reversible marker of cardiac injury. Systemic inflammation drives ventricular remodeling, and the systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI) may reflect this process. This study investigated their associations with LVH in patients with HUA.

We analyzed 3, 632 patients with HUA hospitalized between 2014 and 2024, excluding those with prior hypertension, diabetes, or advanced chronic kidney disease. Baseline demographic, biochemical, and echocardiographic data were collected. LVH was defined by sex-specific left ventricular mass index thresholds. SII and SIRI were calculated, log-transformed, and analyzed by k-means clustering. Associations with LVH were assessed using logistic regression, restricted cubic spline (RCS), and threshold effect models. Mediation analysis evaluated their role between serum urate and LVH.

Among all patients, 452 (12.5%) had LVH. Compared with non-LVH patients, those with LVH were older, more often female, and exhibited higher systolic blood pressure, serum urate, glucose, SII, and SIRI, and lower eGFR and LVEF (all p < 0.05). Elevated SII, SIRI, and high inflammatory patterns were independently associated with LVH (all p < 0.01). RCS revealed a nonlinear “J-shaped” association for lnSII with a threshold at 5.99, while lnSIRI showed a linear dose–response. Mediation analysis indicated systemic inflammation partially mediated the urate–LVH relationship (11.9% for lnSII, 29.9% for lnSIRI).

In HUA patients, SII and SIRI are positively correlated with LVH and partially mediate the relationship between urate and cardiac remodeling, emphasizing the role of systemic inflammation in hyperuricemia related cardiovascular diseases.

Conceptual overview of the association between systemic inflammation and left ventricular hypertrophy (LVH) in patients with hyperuricemia (HUA).Diagram illustrating the relationship between serum urate, inflammation (SII/SIRI), and left ventricular hypertrophy (LVH). It features a central heart graphic and is divided into three sections: Background, Methods, and Results. The Background outlines the hypothesis linking serum urate and inflammation to LVH. The Methods describe a study of 3,632 hyperuricemic patients analyzed through blood counts and echocardiography. Logistic regression and mediation analysis were used. The Results section provides odds ratios (OR) for SII-SIRI pattern, SII, and SIRI levels in relation to LVH, with visualizations of the relationships from regression analyses.

Conceptual overview of the association between systemic inflammation and left ventricular hypertrophy (LVH) in patients with hyperuricemia (HUA).

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