Systemic inflammation response index and total cholesterol in relation to the occurrence of major adverse cardiovascular and cerebrovascular events in patients with myeloproliferative neoplasms

This study sought to assess the prognostic utility of the systemic inflammatory response index (SIRI), total cholesterol (TC), and their synergistic combination in predicting major adverse cardiovascular and cerebrovascular events (MACCE) in myeloproliferative neoplasms (MPN) patients. We retrospectively enrolled 293 newly diagnosed MPN patients with complete baseline SIRI and TC measurements. Univariate and multivariate Cox proportional hazards regressions was used to identify independent predictors. Multiplicative interaction testing, subgroup stratification, receiver operating characteristic (ROC) curve, area under the curve (AUC) and Kaplan-Meier curve analyses were performed to quantify the synergistic predictive value of combined SIRI and TC. During a median of 34 months of follow-up, 115 patients with MPN (39.25% ) developed MACCE. Patients with elevated baseline SIRI displayed significantly higher MACCE cumulative incidence (log-rank P = 0.004). ROC analysis demonstrated that the combined SIRI and TC yielded an AUC of 0.643 for predicting MACCE, which was slightly superior to SIRI alone (AUC = 0.640) or TC alone (AUC = 0.579). Univariate Cox analysis indicated that elevated SIRI and higher TC levels were each significantly correlated with an increased risk of MACCE. Multivariable-adjusted regression revealed that patients with high SIRI combined with high TC exhibited the highest MACCE risk (HR = 1.780, 95%CI: 1.064–2.979, P = 0.028). Consistent with this finding, Kaplan-Meier curves demonstrated inferior long-term MACCE-free survival in this subgroup, which had the minimal survival proportion at the study endpoint. Concurrent elevated SIRI and high TC exert potential synergistic adverse effect on long-term MACCE-free survival. The dual biomarker SIRI-TC may provide a potential auxiliary predictive tool to optimize MACCE risk stratification in MPN patients, enabling targeted cardiovascular prevention for high-risk individuals.