This study explores the association between the pan-immune-inflammation value (PIV) and abdominal aortic calcification (AAC) using data from the National Health and Nutrition Examination Survey (NHANES). The study found a positive correlation between PIV and AAC scores, with higher PIV quartiles associated with increased AAC scores and severe AAC (SAAC) prevalence. The PIV, calculated as the product of neutrophil, platelet, monocyte, and lymphocyte counts, reflects systemic inflammation and may serve as a potential biomarker for assessing AAC risk. Subgroup analysis revealed that older individuals and those with a history of diabetes had a heightened association between PIV and AAC. The study also developed predictive models for AAC and SAAC using LASSO regression and multivariable logistic regression, with high accuracy and clinical utility. The models demonstrated good predictive performance, with areas under the curve (AUC) of 0.74 for AAC and 0.84 for SAAC. The findings suggest that PIV, combined with other easily accessible factors, could be a useful tool for assessing and managing individuals with AAC. The study highlights the potential utility of PIV as a simple and accessible tool for evaluating the incidence and severity of AAC. The research underscores the importance of systemic inflammation in the pathogenesis of vascular calcification and suggests that targeting inflammation could be a promising therapeutic approach for preventing and managing AAC. The study is limited by its cross-sectional design, which precludes establishing a causal relationship between PIV and AAC. Future longitudinal studies and randomized controlled trials are needed to further investigate the causal mechanisms and the effectiveness of anti-inflammatory interventions. The study also highlights the need for further research to explore the predictive potential of other covariates not included in the current model. The findings contribute to the understanding of the relationship between systemic inflammation and vascular calcification, and may have implications for the prevention and management of cardiovascular diseases.This study explores the association between the pan-immune-inflammation value (PIV) and abdominal aortic calcification (AAC) using data from the National Health and Nutrition Examination Survey (NHANES). The study found a positive correlation between PIV and AAC scores, with higher PIV quartiles associated with increased AAC scores and severe AAC (SAAC) prevalence. The PIV, calculated as the product of neutrophil, platelet, monocyte, and lymphocyte counts, reflects systemic inflammation and may serve as a potential biomarker for assessing AAC risk. Subgroup analysis revealed that older individuals and those with a history of diabetes had a heightened association between PIV and AAC. The study also developed predictive models for AAC and SAAC using LASSO regression and multivariable logistic regression, with high accuracy and clinical utility. The models demonstrated good predictive performance, with areas under the curve (AUC) of 0.74 for AAC and 0.84 for SAAC. The findings suggest that PIV, combined with other easily accessible factors, could be a useful tool for assessing and managing individuals with AAC. The study highlights the potential utility of PIV as a simple and accessible tool for evaluating the incidence and severity of AAC. The research underscores the importance of systemic inflammation in the pathogenesis of vascular calcification and suggests that targeting inflammation could be a promising therapeutic approach for preventing and managing AAC. The study is limited by its cross-sectional design, which precludes establishing a causal relationship between PIV and AAC. Future longitudinal studies and randomized controlled trials are needed to further investigate the causal mechanisms and the effectiveness of anti-inflammatory interventions. The study also highlights the need for further research to explore the predictive potential of other covariates not included in the current model. The findings contribute to the understanding of the relationship between systemic inflammation and vascular calcification, and may have implications for the prevention and management of cardiovascular diseases.