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Journal of Peking University (Health Sciences) ›› 2025, Vol. 57 ›› Issue (6): 1067-1073. doi: 10.19723/j.issn.1671-167X.2025.06.008

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Role of the SII and SIRI in risk prediction, disease activity assessment, and prog-nostic evaluation of Behçet disease uveitis

Yajing GAO1,2,3, Zhengfang LI1,3, Mengsi MA1,2,3, Lijun WU1,3,*()   

  1. 1. Department of Rheumatology and Immunology, People's Hospital of Xinjiang Uygur Autonomous Region, Uygur 830000, China
    2. Xinjiang Medical University, Uygur 830000, China
    3. Xinjiang Clinical Research Center for Rheumatoid Arthritis, Uygur 830000, China
  • Received:2025-08-12 Online:2025-12-18 Published:2025-10-30
  • Contact: Lijun WU
  • Supported by:
    the Key Research and Development Project of Xinjiang Uygur Autonomous Region(2022B03002-1)

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Abstract:

Objective: To evaluate the association of systemic immune-inflammation index (SII) and systemic inflammatory response index (SIRI) with Behçet disease uveitis (BU), and to assess their predictive value for inflammatory activity and clinical prognosis in BU patients. Methods: There were 194 patients diagnosed with Behçet disease (BD) and 122 healthy controls. The BD patients were classified into two subgroups based on disease activity: An active phase cohort (n=90) and a stable phase cohort (n=104). Furthermore, the patients were categorized according to the presence or absence of uveitis into two cohorts: BU (n=49) and non-BU (n=145). Among the BU cohort, 26 patients were in the active inflammatory stage, while 23 patients were in the quiescent inflammatory stage. SII and SIRI were calculated using routine blood parameters, including platelet, neutrophil, lymphocyte, and monocyte counts. Spearman correlation analysis was performed to assess the associations of SII and SIRI with BU onset, inflammatory activity, and inflammatory markers. Receiver operating characteristic (ROC) curve analysis was conducted to determine the optimal thresholds and predictive accuracy of SII and SIRI for BU onset and inflammatory activity. Results: SII and SIRI levels were significantly elevated in BD patients with ocular and vascular manifestations compared to those with stable disease (P < 0.05). No significant differences were observed in SII or SIRI levels among the patients with other clinical manifestations of BD. In the patients with BU, both SII and SIRI were significantly higher than in the non-BU and healthy control the groups (P < 0.001). Moreover, SII and SIRI levels were higher during the active inflamma-tory stage than in the inactive stage of BU (P=0.004). Spearman correlation analysis revealed that SII was positively associated with BD disease activity (ρ=0.303, P < 0.001), BU onset (ρ=0.442, P < 0.001), inflammatory activity (ρ=0.392, P=0.005), C-reactive protein (CRP, ρ=0.272, P < 0.001), and erythrocyte sedimentation rate (ESR, ρ=0.285, P < 0.001). SIRI was only positively correlated with BU onset (ρ=0.301, P=0.006). Logistic regression analysis demonstrated that eleva-ted SII was an independent risk factor for BU onset (OR=1.003, 95% CI: 1.001-1.004, P < 0.001). ROC curve analysis indicated that the optimal thresholds for SII were 711.800 [area under curve (AUC)=0.752] for predicting BU onset, 1 622.300 (AUC=0.741) for predicting inflammatory activity, and 1 634.200 (AUC=0.726) for predicting poor prognosis. The corresponding thresholds for SIRI were 1.260 (AUC=0.709), 1.390 (AUC=0.704), and 2.790 (AUC=0.678), respectively. Kaplan-Meier analysis indicated that elevated SII independently predicted adverse prognostic events (HR=3.440, 95%CI: 1.040-11.410, P=0.043). Conclusion: SII and SIRI may serve as potential clinical indicators for predicting inflammatory activity and prognosis in BD patients with uveitis. SII, in particular, demonstrates superior predictive performance for BU onset and disease activity, providing a basis for early identification of high-risk patients and clinical decision-making.

Key words: Behçet disease uveitis, Systemic immune inflammation index, Systemic inflammatory response index, Prognostic assessment

CLC Number: 

  • R593.22

Table 1

Baseline clinical characteristics of patients with BD"

Items BD (n=194)
Age/years 37.5 (30, 48)
BD disease course/years 5 (1, 10)
WBC/ (×109/L) 6.83 (5.05, 8.45)
RBC/ (×1012/L) 4.54 (4.16, 4.99)
PLT/ (×109/L) 245 (211.25, 308.00)
NEUT/ (×109/L) 4.05 (2.81, 5.58)
LYMPH/ (×109/L) 1.84 (1.38, 2.35)
MONO/ (×109/L) 0.46 (0.34, 0.63)
CRP/ (mg/L) 2.55 (1.20, 8.54)
ESR/ (mm/h) 17 (10, 30)
SII 510.55 (337.16, 849.29)
SIRI 0.98 (0.59, 1.79)

Table 2

Comparison of inflammatory markers between active and stable BD patients"

Items Active BD (n=90) Stable BD (n=104) P value
WBC/ (×109/L) 7.57 (5.54, 9.75) 6.45 (4.93, 7.76) 0.002
PLT/ (×109/L) 251.50 (213.00, 325.25) 241.00 (210.00, 293.75) 0.269
NEUT/ (×109/L) 4.98 (3.17, 6.65) 3.58 (2.66, 4.73) < 0.001
LYMPH/ (×109/L) 1.74 (1.28, 2.39) 1.92 (1.53, 2.42) 0.078
MONO/ (×109/L) 0.51 (0.37, 0.66) 0.45 (0.33, 0.62) 0.193
CRP/ (mg/L) 4.08 (1.30, 18.46) 2.50 (1.20, 5.25) 0.017
ESR/ (mm/h) 21.50 (10.75, 45.50) 15.50 (8.25, 24.00) 0.001
SII 638.36 (367.84, 1 375.35) 469.78 (227.87, 680.42) 0.001
SIRI 1.19 (0.70, 2.58) 0.82 (0.53, 1.30) 0.002

Table 3

Comparative analysis of SII and SIRI in clinical manifestations BD"

Manifestations Cases, n(%) SII，M(P25，P75) P value SIRI, M(P25，P75) P value
Oral aphthae 0.772 0.894
    Yes 192 (98.96) 510.55 (335.94, 858.82) 0.98 (0.59, 1.79)
    No 2 (1.04) 487.93 (335.75, 487.93) 1.24 (0.69, 1.24)
Genital aphthae 0.499 0.525
    Yes 153 (78.87) 508.22 (331.06, 808.88) 1.03 (0.60, 1.70)
    No 41 (21.13) 524.90 (351.78, 1 259.78)) 0.81 (0.51, 1.93)
Dermal 0.575 0.710
    Yes 81 (41.75) 504.20 (326.68, 724.67) 0.99 (0.57, 1.66)
    No 113 (58.25) 524.90 (341.59, 890.59) 0.97 (0.59, 1.81)
Uveitis < 0.001 < 0.001
    Yes 49 (25.26) 823.73 (498.34, 1 622.28) 1.61 (0.94, 2.90)
    No 145 (74.74) 453.16 (296.94, 684.78) 0.82 (0.54, 1.38)
Gastrointestinal 0.110 0.640
    Yes 25 (12.89) 704.76 (351.36, 1 441.90) 1.15 (0.57, 2.07)
    No 169 (87.11) 504.20 (332.88, 791.37) 0.97 (0.59, 1.71)
Vascular 0.040 0.038
    Yes 22 (11.34) 1 107.40 (422.73, 1 457.9) 1.56 (0.73, 1.72)
    No 172 (88.66) 671.45 (328.92, 772.03) 0.98 (0.57, 1.63)
Cardiovascular 0.363 0.340
    Yes 4 (2.06) 1 086.72 (349.43, 1 369.11) 1.93 (0.74, 2.72)
    No 190 (79.94) 506.85 (335.34, 813.91) 0.97 (0.59, 1.70)
Nervous system 0.435 0.856
    Yes 15 (7.73) 504.20 (335.75, 887.92) 1.07 (0.37, 2.55)
    No 179 (92.27) 512.89 (248.41, 707.32) 0.97 (0.60, 1.72)

Figure 1

SII and SIRI levels in BU, non-BU and control groups * *P < 0.01; * * *P < 0.001. A, SII levels in BU and non-BU; B, SIRI levels in BU and non-BU; C, SII levels in BU, non-BU and control groups; D, SIRI levels in BU, non-BU and control groups. BU, Behçet disease uveitis; SII, systemic immune inflammation index; SIRI, systemic inflammatory response index."

Table 4

Multivariate Logistic regression analysis of BU"

Items β SE t P OR OR 95%CI
SII 0.003 0.001 19.702 < 0.001 1.003 1.001-1.004
SIRI 0.041 0.141 0.083 0.773 0.960 0.729-1.265

Table 5

Comparative analysis of systemic inflammation in active and stable BU"

Items Active BU (n=26) Stable BU (n=23) P value
WBC/ (×109/L) 9.36 (7.32, 11.49) 6.74 (5.08, 9.71) 0.002
PLT/ (×109/L) 308.50 (232.00, 366.00) 258.00 (213.00, 304.00) 0.113
NEUT/ (×109/L) 6.85 (4.81, 8.95) 4.39 (3.05, 5.74) 0.001
LYMPH/ (×109/L) 1.51 (1.06, 2.50) 1.54 (1.31, 2.09) 0.113
MONO/ (×109/L) 0.56 (0.40, 0.69) 0.51 (0.36, 0.75) 0.440
CRP/ (mg/L) 2.53 (1.18, 7.82) 2.50 (1.00, 6.56) 0.920
ESR/ (mm/h) 19.00 (11.00, 38.75) 18.00 (9.00, 33.00) 0.865
SII 1 471.74 (639.23, 1 970.36) 683.47 (347.29, 1 309.66) 0.004
SIRI 1.86 (1.36, 3.21) 1.11 (0.64, 2.26) 0.015

Figure 2

ROC curves of SII and SIRI for BU prediction A, onset risk prediction in BU; B, disease activity in BU; C, predicting prognosis risk in BU. SII, systemic immune inflammation index; SIRI, systemic inflammatory response index; BU, Behçet disease uveitis; ROC, Receiver operating characteristic; AUC, area under curve."

Figure 3

Kaplan-Meier curves of BU patients in different SII groups SII, systemic immune inflammation index. BU, Behçet disease uveitis."

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