ABSTRACT Introduction Late arteriovenous fistula (AV fistula) occlusion is a major cause of morbidity in hemodialysis patients. The Systemic Immune‐Inflammation Index (SII), Neutrophil‐to‐Lymphocyte Ratio (NLR), and Geriatric Nutritional Risk Index (GNRI) have emerged as candidate prognostic biomarkers. This study aimed to compare their predictive accuracy, evaluate their independent prognostic value, and develop a combined risk score. Methods This retrospective cohort study included 750 hemodialysis patients undergoing primary AV fistula creation. Baseline Systemic Immune‐Inflammation Index, Neutrophil‐to‐Lymphocyte Ratio, and Geriatric Nutritional Risk Index were collected preoperatively. The primary outcome was late AV fistula occlusion (> 90 days). Predictive performance was assessed using ROC analysis and Cox proportional hazards regression. Findings Over a median follow‐up of 48 months, 38.0% of patients developed late AV fistula occlusion. Systemic Immune‐Inflammation Index demonstrated the highest predictive accuracy (AUC: 0.79), significantly outperforming Geriatric Nutritional Risk Index ( p 850 (Hazard ratios 3.15, 95% CI: 2.28–4.35), Neutrophil‐to‐Lymphocyte Ratio > 4.5 (Hazard ratios 2.78, 95% CI: 2.02–3.82), and Geriatric Nutritional Risk Index < 92 (Hazard ratios 1.92, 95% CI: 1.41–2.62) were independent predictors. A combined risk score integrating these biomarkers achieved superior discrimination (AUC: 0.83). Baseline vascular diameters were not independently associated with occlusion risk in this cohort. Discussion The synergistic interaction between inflammation and malnutrition identifies a distinct high‐risk phenotype. The combined risk score is a readily implementable tool that may support personalized surveillance strategies to improve long‐term AV fistula outcomes in hemodialysis patients.
Badak et al. (Sun,) studied this question.