{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T22:13:49Z","timestamp":1793830429875,"version":"4.6.1"},"reference-count":41,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T00:00:00Z","timestamp":1750204800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Osteoarthritis (OA) is one of the common joint diseases. Hematologic markers have been investigated to determine its severity and predict the prognosis of joint diseases. In this study, we investigated whether the systemic immune-inflammatory index (SII) is a marker for assessing the severity of OA. Methods: The records of patients diagnosed with OA at various stages between 1 January 2020 and 1 January 2022 were retrospectively analyzed. Patients aged 18\u201375 years with complete blood count within the last 15 days and not taking anti-inflammatory drugs were included in the study. Patients were classified according to the Kellgren\u2013Lawrance classification as stage 1-2-3 mild to moderate OA (Group I) and stage 4 severe OA (Group II). A total of 1580 patients were diagnosed with knee OA and 946 were included in the study. Of the patients, 246 (26%) were male and 700 (74%) were female. The mean age of the patients was 61.00 (53.00\u201368.00) years. Results: There were 449 (47.5%) patients in Group I and 497 (52.5%) patients in Group II. Statistically significant differences were found between the groups in age, gender, hemoglobin, lymphocytes, and SII (p &lt; 0.05). An SII value of 627.9 was found to distinguish severe OA from mild\u2013moderate OA with 42.5% sensitivity and 70.6% specificity. Conclusions: Although this study is the first in the literature, it shows that SII has limited predictive value in assessing the severity of knee OA. Future research should focus on longitudinal studies to establish causality and explore therapeutic implications.<\/jats:p>","DOI":"10.3390\/diagnostics15121556","type":"journal-article","created":{"date-parts":[[2025,6,18]],"date-time":"2025-06-18T09:36:00Z","timestamp":1750239360000},"page":"1556","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Can We Determine Osteoarthritis Severity Based on Systemic Immuno-Inflammatory Index?"],"prefix":"10.3390","volume":"15","author":[{"given":"Bilge Kagan","family":"Yilmaz","sequence":"first","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Afyonkarahisar Health Science University, 03030 Afyonkarahisar, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6162-0666","authenticated-orcid":false,"given":"Recep","family":"Altin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Traumatology, Afyonkarahisar Health Science University, 03030 Afyonkarahisar, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alper","family":"Sari","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Afyonkarahisar Health Science University, 03030 Afyonkarahisar, Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,6,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.berh.2005.09.007","article-title":"Osteoarthritis: Epidemiology","volume":"20","author":"Arden","year":"2006","journal-title":"Best Pract. Res. Clin. Rheumatol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"568","DOI":"10.1001\/jama.2020.22171","article-title":"Diagnosis and Treatment of Hip and Knee Osteoarthritis","volume":"325","author":"Katz","year":"2021","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1016\/j.biochi.2015.12.008","article-title":"Inter-relations between osteoarthritis and metabolic syndrome: A common link?","volume":"121","author":"Rannou","year":"2016","journal-title":"Biochimie"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1002\/jcp.21258","article-title":"Osteoarthritis","volume":"213","author":"Goldring","year":"2007","journal-title":"J. Cell. Physiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1097\/BOR.0b013e328349c2b1","article-title":"Inflammation in osteoarthritis","volume":"23","author":"Goldring","year":"2011","journal-title":"Curr. Opin. Rheumatol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1038\/nrrheum.2010.159","article-title":"The role of synovitis in pathophysiology and clinical symptoms of osteoarthritis","volume":"6","author":"Sellam","year":"2010","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1177\/1759720X12467868","article-title":"Role of inflammation in the pathogenesis of osteoarthritis: Latest findings and interpretations","volume":"5","author":"Sokolove","year":"2013","journal-title":"Ther. Adv. Musculoskelet. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"16","DOI":"10.1016\/j.joca.2012.11.012","article-title":"Osteoarthritis as an inflammatory disease (osteoarthritis is not osteoarthrosis!)","volume":"21","author":"Berenbaum","year":"2013","journal-title":"Osteoarthr. Cartil."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1263","DOI":"10.1136\/ard.2004.025270","article-title":"Synovial tissue inflammation in early and late osteoarthritis","volume":"64","author":"Benito","year":"2005","journal-title":"Ann. Rheum. Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"33","DOI":"10.1038\/nrrheum.2010.196","article-title":"Role of proinflammatory cytokines in the pathophysiology of osteoarthritis","volume":"7","author":"Kapoor","year":"2011","journal-title":"Nat. Rev. Rheumatol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2037","DOI":"10.1002\/art.24598","article-title":"Interleukin-6 is a significant predictor of radiographic knee osteoarthritis: The Chingford study","volume":"60","author":"Livshits","year":"2009","journal-title":"Arthritis Rheum."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"723","DOI":"10.1002\/art.1780400419","article-title":"Low-level increases in serum C-reactive protein are present in early osteoarthritis of the knee and predict progressive disease","volume":"40","author":"Spector","year":"1997","journal-title":"Arthritis Rheum."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"372","DOI":"10.3109\/14397595.2015.1091136","article-title":"Neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) were useful markers in assessment of inflammatory response and disease activity in SLE patients","volume":"26","author":"Qin","year":"2016","journal-title":"Mod. Rheumatol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"269","DOI":"10.7754\/Clin.Lab.2014.140927","article-title":"Neutrophil- and Platelet-to-Lymphocyte Ratios are Correlated with Disease Activity in Rheumatoid Arthritis","volume":"61","author":"Fu","year":"2015","journal-title":"Clin. Lab."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1016\/j.jinf.2019.02.006","article-title":"The utility of peripheral blood leucocyte ratios as biomarkers in infectious diseases: A systematic review and metaanalysis","volume":"78","author":"Russell","year":"2019","journal-title":"J. Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1186\/s13018-023-04157-x","article-title":"Neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune inflammation index (SII) to predict postoperative pneumonia in elderly hip fracture patients","volume":"18","author":"Yao","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1186\/s13027-021-00400-4","article-title":"Comparison of systemic immune-inflammation index (SII), early warning score (ANDC) and prognostic nutritional index (PNI) in hospitalized patients with malignancy, and their influence on mortality from COVID-19","volume":"16","author":"Bilge","year":"2021","journal-title":"Infect. Agents Cancer"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"580","DOI":"10.3389\/fonc.2020.00580","article-title":"Prognostic Value of Preoperative Systemic Immune-Inflammation Index in Breast Cancer: A Propensity Score-Matching Study","volume":"10","author":"Hua","year":"2020","journal-title":"Front. Oncol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"e13230","DOI":"10.1111\/eci.13230","article-title":"Systemic immune-inflammation index (SII) predicted clinical outcome in patients with coronary artery disease","volume":"50","author":"Yang","year":"2020","journal-title":"Eur. J. Clin. Investig."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1203","DOI":"10.1080\/00207454.2020.1784166","article-title":"Systemic immune-inflammation index (SII) but not platelet-albumin-bilirubin (PALBI) grade is associated with severity of acute ischemic stroke (AIS)","volume":"131","author":"Hou","year":"2021","journal-title":"Int. J. Neurosci."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1111\/jog.14320","article-title":"A cut-off value for systemic immune-inflammation index in the prediction of adverse neonatal outcomes in preterm premature rupture of the membranes","volume":"46","author":"Tanacan","year":"2020","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1136\/ard.16.4.494","article-title":"Radiological Assessment of Osteo-Arthrosis","volume":"16","author":"Kellgren","year":"1957","journal-title":"Ann. Rheum. Dis."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/art.23176","article-title":"Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II","volume":"58","author":"Lawrence","year":"2008","journal-title":"Arthritis Rheum."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1016\/S0140-6736(14)60802-3","article-title":"Osteoarthritis","volume":"386","author":"Palmer","year":"2015","journal-title":"Lancet"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"24","DOI":"10.1016\/j.joca.2009.08.010","article-title":"Risk factors for onset of osteoarthritis of the knee in older adults: A systematic review and meta-analysis","volume":"18","author":"Blagojevic","year":"2010","journal-title":"Osteoarthr. Cartil."},{"key":"ref_26","first-page":"161","article-title":"Obesity and osteoarthritis: More than just wear and tear","volume":"21","author":"Koonce","year":"2013","journal-title":"J. Am. Acad. Orthop. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"940","DOI":"10.1136\/bmj.312.7036.940","article-title":"Genetic influences on osteoarthritis in women: A twin study","volume":"312","author":"Spector","year":"1996","journal-title":"BMJ"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"355","DOI":"10.1002\/art.37726","article-title":"Valgus malalignment is a risk factor for lateral knee osteoarthritis incidence and progression: Findings from the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative","volume":"65","author":"Felson","year":"2013","journal-title":"Arthritis Rheum."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"321","DOI":"10.7326\/0003-4819-133-5-200009050-00007","article-title":"Joint injury in young adults and risk for subsequent knee and hip osteoarthritis","volume":"133","author":"Gelber","year":"2000","journal-title":"Ann. Intern. Med."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1002\/art.42089","article-title":"Prevalence Trends of Site-Specific Osteoarthritis From 1990 to 2019: Findings from the Global Burden of Disease Study 2019","volume":"74","author":"Long","year":"2022","journal-title":"Arthritis Rheumatol."},{"key":"ref_31","first-page":"365","article-title":"Synovial membrane inflammation and cytokine production in patients with early osteoarthritis","volume":"24","author":"Smith","year":"1997","journal-title":"J. Rheumatol."},{"key":"ref_32","first-page":"120","article-title":"Hematologic indices and osteoarthritis","volume":"42","author":"Hira","year":"2017","journal-title":"Cukurova Med. J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"1579","DOI":"10.1007\/s10067-016-3170-8","article-title":"Is blood neutrophil-lymphocyte ratio an independent predictor of knee osteoarthritis severity?","volume":"35","author":"Tasoglu","year":"2016","journal-title":"Clin. Rheumatol."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1002\/jcla.23964","article-title":"Systemic immune-inflammation index is associated with disease activity in patients with ankylosing spondylitis","volume":"35","author":"Wu","year":"2021","journal-title":"J. Clin. Lab. Anal."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1186\/s12877-021-02102-3","article-title":"Systemic immune-inflammation index independently predicts poor survival of older adults with hip fracture: A prospective cohort study","volume":"21","author":"Wang","year":"2021","journal-title":"BMC Geriatr."},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Xia, Y., Xia, C., Wu, L., Li, Z., Li, H., and Zhang, J. (2023). Systemic Immune Inflammation Index (SII), System Inflammation Response Index (SIRI) and Risk of All-Cause Mortality and Cardiovascular Mortality: A 20-Year Follow-Up Cohort Study of 42,875 US Adults. J. Clin. Med., 12.","DOI":"10.3390\/jcm12031128"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"952953","DOI":"10.3389\/fcvm.2022.952953","article-title":"Association of the systemic immune-inflammation index with all-cause mortality in patients with arteriosclerotic cardiovascular disease","volume":"9","author":"He","year":"2022","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"704235","DOI":"10.3389\/fsurg.2021.704235","article-title":"Postoperative Systemic Immune Inflammation Index (SII): A Superior Prognostic Factor of Endometrial Cancer","volume":"22","author":"Huang","year":"2021","journal-title":"Front. Surg."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1481","DOI":"10.2217\/imt-2022-0133","article-title":"Systemic Immune\u2013Inflammation Index Predicts Prognosis of Cancer Immunotherapy: Systemic Review and Meta-Analysis","volume":"14","author":"Tian","year":"2022","journal-title":"Immunotherapy"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Moldovan, F., Ivanescu, A.D., Fodor, P., Moldovan, L., and Bataga, T. (2023). Correlation between Inflammatory Systemic Biomarkers and Surgical Trauma in Elderly Patients with Hip Fractures. J. Clin. Med., 6.","DOI":"10.3390\/jcm12155147"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"2769","DOI":"10.1007\/s00264-020-04793-6","article-title":"Neutrophil to lymphocyte ratio and fracture severity in young and middle-aged patients with tibial plateau fractures","volume":"44","author":"Wang","year":"2020","journal-title":"Int. Orthop."}],"container-title":["Diagnostics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/12\/1556\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T17:54:23Z","timestamp":1760032463000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2075-4418\/15\/12\/1556"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,6,18]]},"references-count":41,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,6]]}},"alternative-id":["diagnostics15121556"],"URL":"https:\/\/doi.org\/10.3390\/diagnostics15121556","relation":{},"ISSN":["2075-4418"],"issn-type":[{"value":"2075-4418","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,6,18]]}}}