{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T12:20:27Z","timestamp":1785932427280,"version":"3.56.0"},"reference-count":27,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T00:00:00Z","timestamp":1764892800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Huai'an Municipal Health Commission Research Project","award":["HAWJ2024006"],"award-info":[{"award-number":["HAWJ2024006"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Accurate risk stratification is crucial for personalized management in peritoneal dialysis (PD). This study aimed to develop and validate a novel biomarker, the SII-PNI score, integrating systemic immunoinflammatory index (SII) and prognostic nutritional index (PNI), for personalized mortality risk prediction in PD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A retrospective cohort study analyzed data from 330 patients initiating PD between December 2005 and June 2023 at a single center. Patients were stratified into four risk groups based on median cut-off values for SII and PNI. The association between SII-PNI risk groups and mortality (all-cause, cardiovascular [CVD], infection-related) was assessed using Kaplan-Meier survival analysis and multivariable Cox proportional hazard models. The predictive performance of the SII-PNI score was evaluated using receiver-operating characteristic (ROC) curves and compared to individual components (SII, PNI) and CRP. Random survival forests assessed variable importance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The high-risk group (G4: high SII\u2009+\u2009low PNI) had the shortest PD duration, highest mortality, and worst survival outcomes. Compared to the low-risk group (G3: low SII\u2009+\u2009high PNI), G4 had significantly increased risks of all-cause mortality (adjusted HR 3.36, 95% CI 1.93\u20138.67), CVD mortality (adjusted HR 3.74, 95% CI 2.41\u201319.60), and infection mortality (adjusted HR 4.32, 95% CI 2.58\u201320.4) in fully adjusted models. The SII-PNI score demonstrated superior predictive ability (AUC: all-cause 0.80, CVD 0.80, infection 0.81) compared to SII, PNI, or CRP alone. Random survival forests confirmed the critical importance of the individual components (platelets, neutrophils, lymphocytes, albumin) for outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The SII-PNI score, derived from readily available blood parameters, is a powerful and convenient tool for personalized risk stratification in PD. Patients identified as high-risk warrant intensified monitoring and early interventions. This composite biomarker represents a significant step towards personalized and precision medicine in PD care, with potential for implementation in routine clinical practice using standard laboratory data.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0338086","type":"journal-article","created":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:31:07Z","timestamp":1764959467000},"page":"e0338086","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":4,"title":["The SII-PNI score: A novel composite biomarker for personalized mortality risk prediction in peritoneal dialysis patients"],"prefix":"10.1371","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8399-1492","authenticated-orcid":true,"given":"Min","family":"Zhou","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guoyi","family":"Wang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Yue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hua","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xuan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jinwen","family":"Zhao","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yong","family":"Xu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2025,12,5]]},"reference":[{"issue":"20","key":"pone.0338086.ref001","doi-asserted-by":"crossref","first-page":"4297","DOI":"10.3390\/nu14204297","article-title":"Evolving concepts on inflammatory biomarkers and malnutrition in chronic kidney disease","volume":"14","author":"F Graterol Torres","year":"2022","journal-title":"Nutrients"},{"key":"pone.0338086.ref002","doi-asserted-by":"crossref","first-page":"2180373","DOI":"10.1155\/2018\/2180373","article-title":"Inflammation-related mechanisms in chronic kidney disease prediction, progression, and outcome","volume":"2018","author":"S Mihai","year":"2018","journal-title":"J Immunol Res"},{"key":"pone.0338086.ref003","doi-asserted-by":"crossref","first-page":"630","DOI":"10.3389\/fphys.2019.00630","article-title":"Abnormalities in glucose metabolism, appetite-related peptide release, and pro-inflammatory cytokines play a central role in appetite disorders in peritoneal dialysis","volume":"10","author":"L Avila-Carrasco","year":"2019","journal-title":"Front Physiol"},{"key":"pone.0338086.ref004","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1159\/000504240","article-title":"A practical approach to nutrition, protein-energy wasting, sarcopenia, and cachexia in patients with chronic kidney disease","volume":"49","author":"RM Hanna","year":"2020","journal-title":"Blood Purif"},{"issue":"1","key":"pone.0338086.ref005","doi-asserted-by":"crossref","first-page":"2299601","DOI":"10.1080\/0886022X.2023.2299601","article-title":"Association of albumin to non-high-density lipoprotein cholesterol ratio with mortality in peritoneal dialysis patients","volume":"46","author":"Y Xie","year":"2024","journal-title":"Ren Fail"},{"issue":"1","key":"pone.0338086.ref006","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1186\/s12882-024-03792-8","article-title":"Platelet-to-albumin ratio: a potential biomarker for predicting all-cause and cardiovascular mortality in patients undergoing peritoneal dialysis","volume":"25","author":"H Ma","year":"2024","journal-title":"BMC Nephrol"},{"key":"pone.0338086.ref007","doi-asserted-by":"crossref","first-page":"1302603","DOI":"10.3389\/fmed.2024.1302603","article-title":"Albumin-to-alkaline phosphatase ratio as a novel prognostic indicator in patients undergoing peritoneal dialysis: a propensity score matching analysis","volume":"11","author":"W Xia","year":"2024","journal-title":"Front Med (Lausanne)"},{"issue":"1","key":"pone.0338086.ref008","doi-asserted-by":"crossref","first-page":"72","DOI":"10.1111\/sdi.13159","article-title":"Elevated fibrinogen to pre-albumin ratio predicts mortality in peritoneal dialysis patients","volume":"37","author":"W Xia","year":"2024","journal-title":"Semin Dial"},{"key":"pone.0338086.ref009","doi-asserted-by":"crossref","first-page":"699","DOI":"10.2147\/CIA.S357319","article-title":"The association between systemic immune-inflammation index and postoperative cognitive decline in elderly patients","volume":"17","author":"W Lu","year":"2022","journal-title":"Clin Interv Aging"},{"issue":"1","key":"pone.0338086.ref010","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1186\/s12882-023-03451-4","article-title":"Association between systemic immune inflammation Index and all-cause mortality in incident peritoneal dialysis-treated CKD patients: a multi-center retrospective cohort study","volume":"25","author":"R Tang","year":"2024","journal-title":"BMC Nephrol"},{"issue":"9","key":"pone.0338086.ref011","first-page":"1001","article-title":"Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients","volume":"85","author":"T Onodera","year":"1984","journal-title":"Nihon Geka Gakkai Zasshi"},{"issue":"3","key":"pone.0338086.ref012","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1159\/000316701","article-title":"Protein nutrition index as a function of patient survival rate in peritoneal dialysis","volume":"33","author":"K-H Chen","year":"2010","journal-title":"Kidney Blood Press Res"},{"key":"pone.0338086.ref013","doi-asserted-by":"crossref","first-page":"110963","DOI":"10.1016\/j.nut.2020.110963","article-title":"Evaluation of objective nutritional indexes as predictors of worse outcomes in peritoneal dialysis patients","author":"Y Yang","year":"2020","journal-title":"Nutrition"},{"key":"pone.0338086.ref014","doi-asserted-by":"crossref","first-page":"811288","DOI":"10.3389\/fnut.2021.811288","article-title":"Association between systemic inflammation and malnutrition with survival in patients with cancer sarcopenia-A prospective multicenter study","volume":"8","author":"G-T Ruan","year":"2022","journal-title":"Front Nutr"},{"key":"pone.0338086.ref015","doi-asserted-by":"crossref","first-page":"981533","DOI":"10.3389\/fnut.2022.981533","article-title":"Combined systemic inflammatory immunity index and prognostic nutritional index scores as a screening marker for sarcopenia in patients with locally advanced gastric cancer","volume":"9","author":"P Ding","year":"2022","journal-title":"Front Nutr"},{"key":"pone.0338086.ref016","doi-asserted-by":"crossref","first-page":"691364","DOI":"10.3389\/fimmu.2021.691364","article-title":"The relationship between preoperative systemic immune inflammation index and prognostic nutritional index and the prognosis of patients with alveolar hydatid disease","volume":"12","author":"B Ren","year":"2021","journal-title":"Front Immunol"},{"issue":"1","key":"pone.0338086.ref017","doi-asserted-by":"crossref","first-page":"2160348","DOI":"10.1080\/0886022X.2022.2160348","article-title":"The systemic inflammation indexes predict all-cause mortality in peritoneal dialysis patients","volume":"45","author":"Y Yang","year":"2023","journal-title":"Ren Fail"},{"key":"pone.0338086.ref018","doi-asserted-by":"crossref","first-page":"3871","DOI":"10.2147\/JIR.S426961","article-title":"Systemic immune-inflammation index was significantly associated with all-cause and cardiovascular-specific mortalities in patients receiving peritoneal dialysis","volume":"16","author":"G Li","year":"2023","journal-title":"J Inflamm Res"},{"issue":"3","key":"pone.0338086.ref019","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1038\/nrneph.2012.12","article-title":"Nutrition in patients on peritoneal dialysis","volume":"8","author":"S-H Han","year":"2012","journal-title":"Nat Rev Nephrol"},{"issue":"11","key":"pone.0338086.ref020","doi-asserted-by":"crossref","first-page":"3669","DOI":"10.1245\/s10434-016-5272-6","article-title":"Low preoperative prognostic nutritional index predicts poor survival post-gastrectomy in elderly patients with gastric cancer","volume":"23","author":"K Sakurai","year":"2016","journal-title":"Ann Surg Oncol"},{"issue":"5","key":"pone.0338086.ref021","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1053\/j.jrn.2021.09.005","article-title":"Predictive value of objective nutritional indexes in technique failure in peritoneal dialysis patients","volume":"32","author":"Y Yang","year":"2022","journal-title":"J Ren Nutr"},{"key":"pone.0338086.ref022","doi-asserted-by":"crossref","first-page":"8760615","DOI":"10.1155\/2022\/8760615","article-title":"Sexual effect of platelet-to-lymphocyte ratio in predicting cardiovascular mortality of peritoneal dialysis patients","volume":"2022","author":"H Sheng","year":"2022","journal-title":"Mediators Inflamm"},{"key":"pone.0338086.ref023","first-page":"9852507","article-title":"Monocyte\/lymphocyte ratio and cardiovascular disease mortality in peritoneal dialysis patients","volume":"2020","author":"Y Wen","year":"2020","journal-title":"Mediators Inflamm"},{"issue":"1","key":"pone.0338086.ref024","doi-asserted-by":"crossref","first-page":"2300730","DOI":"10.1080\/0886022X.2023.2300730","article-title":"The relationship of platelet distribution width with all-cause and cardiovascular mortality in peritoneal dialysis patients","volume":"46","author":"C Lu","year":"2024","journal-title":"Ren Fail"},{"key":"pone.0338086.ref025","doi-asserted-by":"crossref","first-page":"813","DOI":"10.2147\/JIR.S496703","article-title":"The clinical value of the combined detection of systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and prognostic nutritional index (PNI) in early diagnosis of gastric cancer","volume":"18","author":"J Zheng","year":"2025","journal-title":"J Inflamm Res"},{"issue":"6","key":"pone.0338086.ref026","doi-asserted-by":"crossref","first-page":"354","DOI":"10.1007\/s11748-022-01899-z","article-title":"Significance of preoperative evaluation of skeletal muscle index and immune-nutritional status for patients with early-stage non-small cell lung cancer","volume":"71","author":"S Sato","year":"2023","journal-title":"Gen Thorac Cardiovasc Surg"},{"issue":"1","key":"pone.0338086.ref027","doi-asserted-by":"crossref","first-page":"2446656","DOI":"10.1080\/0886022X.2024.2446656","article-title":"The impact of the triglyceride-glucose index on the deterioration of kidney function in patients with cardiovascular-kidney-metabolic syndrome: insight from a large cohort study in China","volume":"47","author":"Z Shang","year":"2025","journal-title":"Ren Fail"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338086","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,5]],"date-time":"2025-12-05T18:31:12Z","timestamp":1764959472000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0338086"}},"subtitle":[],"editor":[{"given":"Zubing","family":"Mei","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2025,12,5]]},"references-count":27,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12,5]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0338086","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,12,5]]}}}