Systemic inflammatory response index and its obesity-related derivatives as predictors of heart failure: A cross-sectional study from NHANES 2017–2020

Introduction: Heart failure (HF), a growing public health concern, is primarily driven by metabolic disorders. While the systemic inflammatory response index (SIRI) has demonstrated prognostic value in cardiometabolic diseases, its role in predicting HF remains unclear. Given the link between obesity and inflammation, integrating SIRI with obesity-related measures may enhance the stratification of HF risk. This study aims to examine the association between SIRI, integrated with obesity-related indices, and HF. Methods: Data from NHANES 2017-2020 were used, including 6572 adults aged 20-80 years with complete data on key indices. HF was defined based on self-reported physician diagnosis. SIRI was calculated as (neutrophil × monocyte)/lymphocyte count. Receiver operating characteristic (ROC) analysis was performed to assess the predictive value of inflammatory and obesity indices on HF risk. Multivariable logistic regression models, restricted cubic spline (RCS) and Interaction tests were used to examine the association between the index of interest and HF. Results: Of 6572 participants, 170 (2.6%) had HF. The SIRI × BMI × WHR index showed the highest predictive value (AUC: 0.68), improving in non-smokers (AUC: 0.73) and individuals with diabetes (AUC: 0.71). RCS analysis indicated a linear, dose-response relationship, with multivariable logistic regression analysis revealed the strongest association in the fourth quartile (AOR: 2.00, 95% CI: 1.07-3.75), and stronger effects in non-smokers (AOR: 7.25, 95% CI: 2.04-25.76) and those with diabetes (AOR: 5.63, 95% CI: 1.25-25.39). Conclusion: The SIRI × BMI × WHR index demonstrated predictive ability and an association with HF, particularly among individuals with diabetes and non-smokers. Given its accessibility and cost-effectiveness, this index may serve as a valuable tool for HF screening.