Diagnostic Utility of Pan-Immune-Inflammation Value (PIV) in Predicting Insulin Resistance: Results from the National Health and Nutrition Examination Survey (NHANES) 2017-2020.

Background: Insulin resistance (IR), a hallmark feature of diabetes and metabolic syndrome, is characterized by chronic low-grade inflammation. Pan-immune-inflammation value (PIV), an emerging immune cell count-based inflammatory index, is the global quantifier of systemic inflammation. This study analyses the levels of PIV and its association with various markers of IR. Materials and Methods: This retrospective, cross-sectional study was done using the Center for Disease Control-National Health and Nutritional Examination Survey (CDC-NHANES) pre-pandemic data from 2017-2020. Data from 4620 survey participants was included after screening. Homeostasis model assessments of insulin resistance (HOMA-IR) and beta-cell function (HOMA-B), triglyceride glucose (TyG) index, visceral adiposity index (VAI), and lipid accumulation product (LAP) were used as markers of IR. Multiple logistic regression and trend analysis were done to determine the associations, and receiver operator characteristic curve (ROC) analysis was done to estimate the diagnostic utility of PIV to predict IR. Results: PIV levels were significantly higher in obesity, diabetes, and metabolic syndrome. HOMA-IR, HOMA-B, LAP, VAI, and TyG levels were found to be higher in those with higher PIV (i.e., quartiles 4 and 3). Regression and trend analysis showed that the odds ratio for IR increased with PIV. However, ROC indicated that the diagnostic utility of PIV to predict IR is low compared to the other surrogate markers. Conclusions: PIV levels differed significantly based on glycemic status, BMI, and metabolic syndrome status. PIV showed a significant positive association with IR. However, the ability of PIV to predict IR is not optimal compared to other surrogate markers.