Associations between inflammatory indices derived from complete blood counts and mortality risk in diabetes and prediabetes patients: A cohort study from NHANES 1999--2018

BACKGROUND: The associations between blood count-derived inflammatory indices and mortality risk in individuals with diabetes and prediabetes have gained attention, but systematic studies are lacking. METHODS: Data from the National Health and Nutrition Examination Survey (NHANES) were analyzed to investigate various inflammatory indices (such as the SII and NLR) in relation to all-cause mortality, cardiovascular disease (CVD) mortality, and diabetes-specific mortality via the Cox proportional hazards model. RESULTS: A total of 12,119 participants were included, with an average age of 60 years and approximately 52 % being male. During the follow-up, the overall mortality rate was 25.7 %. All nine inflammatory indices were significantly associated with all-cause mortality and CVD mortality (P < 0.01), and seven indices were correlated with diabetes-specific mortality. Eight indices exhibited significant nonlinear relationships with all-cause mortality, with the exception of the NPR, whereas theSIRI, PLR, NPR, and MPRshowed significant nonlinear associations with CVD mortality. CONCLUSION: Inflammatory indices such as the SII, SIRI, and NLR are significantly associated with all-cause and CVD mortality among U.S. adults with diabetes and prediabetes, demonstrating index-specific association patterns and threshold characteristics.