内皮激活与应激指数在急性心肌梗死-肾脏-代谢综合征患者中的预后价值

Prognostic value of endothelial activation and stress index in AMI patients complicated with cardiovascular-kidney-metabolic syndrome

摘要:

目的]探讨内皮激活与应激指数(EASIX)在心血管-肾脏-代谢综合征(CKM)与急性心肌梗死(AMI)患者中的预测作用,并评估其与全因死亡及心血管死亡风险的相关性。 [方法]纳入2017年12月—2019年9月期间,因AMI住院且符合CKM 4期诊断标准的患者共3 996例。利用log₂(EASIX)最佳截断值为分组依据,评估EASIX与全因死亡及心血管死亡风险的相关性；此外,通过倾向评分匹配分析(PSM)、Fine-Gray竞争风险模型及亚组分析,进一步验证研究结论的稳健性。 [结果]限制性立方样条回归分析显示,log₂(EASIX)与全因死亡及心血管死亡风险均呈“J”型非线性关系。Kaplan-Meier生存曲线分析表明,高组患者的全因死亡及心血管死亡风险在随访早期即显著升高(P＜0.001),且该趋势在PSM后仍保持稳健。Fine-Gray竞争风险模型证实,无论是否进行匹配或多因素校正,EASIX均是心血管死亡的强力独立预测因子(全校正后SHR分别为4.799与5.741,均P＜0.05)。Cox回归分析显示,作为连续变量时,log₂(EASIX)每增加1个单位全因死亡风险增加1.665倍(95%CI:1.363~2.034,P＜0.001),充分校正所有混杂因素后关联仍为显著,为1.594倍(95%CI:1.293~1.966,P＜0.001),心血管死亡风险更高。组间比较显示高组全因死亡风险约为低组的4.718倍(95%CI:2.849~7.813,P＜0.001)。此外,时间依赖受试者工作特征曲线分析表明,EASIX在短期预后评估中具有更优的预测效能。 [结论]在CKM-AMI人群中,EASIX评分与死亡风险具有稳健且独立的关联。作为一种简便、高效的预测工具,EASIX有望辅助临床医生早期识别高危患者,并优化预后管理策略。

Abstract:

Aim To investigate the prognostic value of the endothelial activation and stress index (EASIX) in patients with cardiovascular-kidney-metabolic syndrome (CKM) and acute myocardial infarction (AMI), and to evaluate its association with the risks of all-cause and cardiovascular mortality. Methods This study enrolled a total of 3 996 patients hospitalized for AMI who met the diagnostic criteria for CKM stage 4 between December 2017 and September 2019.Using the optimal cutoff value of log₂(EASIX) as the grouping basis, we evaluated its association with the risk of all-cause and cardiovascular mortality. Furthermore, propensity score matching (PSM), Fine-Gray competing risk models, and subgroup analysis were performed to verify the robustness of the study's conclusions. Results Restricted cubic spline regression revealed a J-shaped nonlinear relationship between log₂(EASIX) and the risks of all-cause and cardiovascular mortality. Kaplan-Meier survival curves demonstrated that patients in the high-EASIX group experienced significantly elevated risks of mortality from the early follow-up period (P＜0.001), and this trend remained robust after PSM. Fine-Gray competing risk models confirmed that EASIX was a potent independent predictor of cardiovascular death, regardless of matching or multivariable adjustment (fully adjusted SHR of 4.799 and 5.741, respectively, both P＜0.05). In Cox regression analysis, each 1-unit increase in log₂(EASIX) as a continuous variable was associated with a 1.665-fold increase in the risk of all-cause mortality (95%CI:1.363～2.034, P＜0.001); this association remained significant after full adjustment for all confounders (HR 1.4,5%CI:1.293～1.966, P＜0.001), with an even higher risk observed for cardiovascular mortality. Intergroup comparisons showed that the risk of all-cause mortality in the high-EASIX group was approximately 4.718 times that of the low-EASIX group (95%CI:2.849～7.813, P＜0.001). Furthermore, time-dependent receiver operating characteristic curve analysis indicated that EASIX exhibited superior predictive performance in short-term prognostic assessment. Conclusions In the CKM-AMI population, the EASIX score demonstrates a robust and independent association with mortality risk. As a simple and efficient predictive tool, EASIX holds significant potential to assist clinicians in the early identification of high-risk patients and the optimization of prognostic management strategies.