Coronary Care Unit, National Institute of Cardiology, Mexico City, Mexico.
Department of Immunology, National Institute of Cardiology, Mexico City, Mexico; Department of Health Care, Metropolitan Autonomous University, Mexico City, Mexico.
J Cardiol. 2019 May;73(5):416-424. doi: 10.1016/j.jjcc.2018.11.010. Epub 2018 Dec 29.
Accurate assessment of inflammatory status of patients during acute coronary syndrome (ACS) has become of great importance in their risk classification and in the research of new anti-inflammatory therapies.
The study cohort included 7396 patients with ACS. We sought to derive and internally validate an inflammation-based score that included high-sensitivity C-reactive protein, white blood cell count, and serum albumin level at admission to evaluate the predictive role of systemic inflammation in the clinical outcome of these patients. We randomly assigned patients into derivation (66.6%) and validation (33.4%) cohorts. A total of four categories of systemic inflammation were defined.
Assessed individually, the three biomarkers were associated with a higher rate of in-hospital mortality. When we combined them into an inflammation score, in-hospital mortality was significantly different across the four categories of inflammation in the derivation cohort (1.8%, 2.8%, 4.1%, and 13.8% for without, mild, moderate, and severe inflammation, respectively; p<0.0001, C-statistic, 0.71). These results were similar in the validation cohort (1.1%, 2.9%, 5.2%, and 12.6%, respectively; p<0.0001, C-statistic, 0.71). After multivariate adjustment, only the category of severe systemic inflammation was associated with a threefold increased risk of in-hospital mortality (odds ratios 3.02, p<0.0001) and was the most powerful predictor of mortality. In the whole cohort, after subsetting patients based on GRACE risk score, the severe inflammation category was associated with a significant increase of in-hospital mortality across all sub-groups, mainly in patients with higher GRACE risk score. The inflammation-based risk score reclassified 25.3% of the population. The net reclassification index was 8.2% (p=0.001).
A risk score system based on biomarkers of inflammation readily available at admission in patients with ACS, could better assess the inflammatory status and predict in-hospital mortality, as well as severe systemic inflammation that contributes to a worse outcome independently of clinical risk factors.
在急性冠脉综合征（ACS）患者中，准确评估炎症状态对于风险分层和新的抗炎治疗研究非常重要。
本研究队列纳入了 7396 例 ACS 患者。我们旨在构建并内部验证一种基于炎症的评分，该评分纳入了入院时的高敏 C 反应蛋白、白细胞计数和血清白蛋白水平，以评估全身炎症对这些患者临床结局的预测作用。我们将患者随机分配到推导队列（66.6%）和验证队列（33.4%）。定义了全身炎症的四个类别。
单独评估时，这三个生物标志物与住院期间死亡率升高相关。当我们将它们组合成一个炎症评分时，在推导队列中，炎症的四个类别之间住院死亡率有显著差异（无炎症、轻度炎症、中度炎症和重度炎症的发生率分别为 1.8%、2.8%、4.1%和 13.8%；p<0.0001，C 统计量为 0.71）。在验证队列中，结果相似（发生率分别为 1.1%、2.9%、5.2%和 12.6%；p<0.0001，C 统计量为 0.71）。多变量调整后，只有重度全身炎症类别与住院期间死亡率增加三倍相关（比值比 3.02，p<0.0001），并且是死亡率的最强预测因素。在整个队列中，根据 GRACE 风险评分对患者进行亚组分析后，重度炎症类别与所有亚组的住院死亡率显著增加相关，主要发生在 GRACE 风险评分较高的患者中。基于炎症的风险评分重新分类了 25.3%的人群。净重新分类指数为 8.2%（p=0.001）。
ACS 患者入院时可获得的炎症生物标志物的风险评分系统，可以更好地评估炎症状态并预测住院死亡率，以及独立于临床危险因素导致不良结局的严重全身性炎症。
