内皮活化和应激指数预测值与心力衰竭患者死亡风险的关联

doi:10.6040/j.issn.1671-7554.0.2025.0168

摘要/Abstract

摘要： 目的探讨内皮活化和应激指数预测值(pre-endothelial activation and stress index, pre-EASIX)与心力衰竭(heart failure, HF)患者死亡风险之间的关联,为临床评估HF预后提供新的参考指标。方法从开放数据库MIMIC-IV v3.1中提取7 146例HF患者的数据,计算每个患者的内皮活化和应激指数(endothelial activation and stress index, EASIX),将其转换为log₂值(pre-EASIX),并根据pre-EASIX的三分位数进行分组。采用限制性立方样条(restricted cubic spline, RCS)分析、Kaplan-Meier生存曲线和Cox回归模型评估pre-EASIX与HF患者死亡风险的相关性。结果 RCS分析结果显示,pre-EASIX与HF患者死亡风险呈“J”型曲线趋势,对HF患者死亡风险的预测能力有统计学意义(P<0.05);Kaplan-Meier生存曲线显示,随着pre-EASIX的升高,HF患者的生存率呈下降趋势,其对HF患者生存率的预测能力有统计学意义(P<0.001);多因素Cox回归分析显示,高pre-EASIX水平是HF患者30、90、180及365 d死亡的独立危险因素,具有统计学意义(P<0.01);根据左室射血分数对HF亚组患者进行Cox回归分析后,pre-EASIX是HF亚组患者死亡的独立危险因素,具有统计学意义(P<0.001)。结论 pre-EASIX与HF患者的死亡风险密切相关,有助于早期识别高风险患者,可作为评估HF患者及不同亚组预后的重要指标之一。

关键词: 内皮活化和应激指数预测值, 心力衰竭, 死亡风险, 内皮功能障碍, 预后

Abstract: Objective To provide a novel reference indicator for the clinical assessment of heart failure(HF)prognosis by exploring the correlation between the pre-endothelial activation and stress index(pre-EASIX)and mortality risk in HF patients. Methods Data from 7,146 HF patients in the open-source database MIMIC-IV v3.1 were used. The endothelial activation and stress index(EASIX)was calculated for each patient and converted into a log₂ value(pre-EASIX). Patients were categorized based on the tertiles of pre-EASIX. The correlation between pre-EASIX and mortality risk in HF patients was evaluated using restricted cubic spline(RCS)analysis, Kaplan-Meier survival curve, and Cox regression model. Results RCS analysis revealed a J-shaped curve relationship between pre-EASIX and mortality risk in HF patients, suggesting that the predictive capacity of pre-EASIX for HF patient mortality risk was statistically significant(P<0.05). Kaplan-Meier survival curve demonstrated that with increasing pre-EASIX, the survival rate of HF patients declined, and its predictive capacity for the survival rate of HF patients was statistically significant(P<0.001). Multivariate Cox regression analysis confirmed that pre-EASIX was an independent risk factor for 30-, 90-, 180-, and 365-day mortality in HF patients, with statistical significance(P<0.01). Following a subgroup analysis of Cox regression in HF patients stratified by left ventricular ejection fraction, pre-EASIX remained an independent risk factor for mortality in HF subgroup patients, with statistical significance(P<0.001). Conclusion Pre-EASIX is closely associated with the risk of mortality in HF patients. It aids in the early identification of high-risk patients and can serve as an important indicator for evaluating the prognosis of HF patients and different subgroups.

Key words: Pre-endothelial activation and stress index, Heart failure, Mortality risk, Endothelial dysfunction, Prognosis

中图分类号:

R541.6

刘文钊,张远,马湘萍,魏峰涛,卜培莉. 内皮活化和应激指数预测值与心力衰竭患者死亡风险的关联[J]. 山东大学学报 (医学版), 2025, 63(11): 27-35.

LIU Wenzhao, ZHANG Yuan, MA Xiangping, WEI Fengtao, BU Peili. Correlation between the pre-endothelial activation and stress index and the mortality risk of patients with heart failure[J]. Journal of Shandong University (Health Sciences), 2025, 63(11): 27-35.

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