The area under the curve of the systemic immune-inflammation index could even be used in predicting the severity of coronary heart disease.11 TNF-a promotes cardiac apoptosis and fibrosis, which leads to a direct negative systolic and diastolic effect.31 Increased levels of IL-6 have been observed in patients with acute myocarditis and are associated with poor prognosis.24 The translocation of bacterial lipopolysaccharide (LPS) into the bloodstream leads to the development of endotoxemia, a condition that is known to be associated with an elevated risk of cardiometabolic disorders. Here, TNF is linked to serum lipopolysaccharide activity.