This study investigates the association between pan-immune-inflammation value (PIV) and abdominal aortic calcification (AAC) using data from the National Health and Nutrition Examination Survey (NHANES). The research employs weighted multivariable regression models to explore the relationship between PIV and AAC, with trend tests, subgroup analysis, and interaction tests to further examine the associations. The study also uses LASSO regression and multivariable logistic regression to construct prediction models for AAC and severe AAC (SAAC). The results show a positive correlation between higher PIV quartiles and higher AAC scores, with a 100-unit increment in PIV linked to an increase of 0.055 points in the AAC score. Subgroup analysis reveals that older individuals and those with a history of diabetes have a heightened association with AAC. The developed prediction models, including nomograms, show high accuracy and clinical benefit, with AUC values of 0.74 for AAC and 0.84 for SAAC. The study highlights the potential utility of PIV as a biomarker for assessing and managing individuals at risk of AAC.This study investigates the association between pan-immune-inflammation value (PIV) and abdominal aortic calcification (AAC) using data from the National Health and Nutrition Examination Survey (NHANES). The research employs weighted multivariable regression models to explore the relationship between PIV and AAC, with trend tests, subgroup analysis, and interaction tests to further examine the associations. The study also uses LASSO regression and multivariable logistic regression to construct prediction models for AAC and severe AAC (SAAC). The results show a positive correlation between higher PIV quartiles and higher AAC scores, with a 100-unit increment in PIV linked to an increase of 0.055 points in the AAC score. Subgroup analysis reveals that older individuals and those with a history of diabetes have a heightened association with AAC. The developed prediction models, including nomograms, show high accuracy and clinical benefit, with AUC values of 0.74 for AAC and 0.84 for SAAC. The study highlights the potential utility of PIV as a biomarker for assessing and managing individuals at risk of AAC.