Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
Department of Geriatrics, Guangdong Geriatrics Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
Clin Interv Aging. 2019 Jul 4;14:1199-1206. doi: 10.2147/CIA.S214222. eCollection 2019.
Emerging evidence suggests that systemic inflammation is a predictor of poor prognosis in acute myocardial infarction (AMI). In this study, we sought to assess whether inflammation-based prognostic scores are associated with in-hospital outcomes in elderly patients with AMI.
In this retrospective study, patients who were over 75-years-old and met the diagnostic criteria for AMI were consecutively recruited from January 1, 2016, to March 31, 2019. Logistic regression and receiver-operating characteristic (ROC) analyses were performed to evaluate the predictive value of the inflammation-based Glasgow Prognostic Score (GPS), Prognostic Index (PI) and Prognostic Nutritional Index (PNI).
A total of 273 patients were enrolled. The incidence of major cardiovascular adverse events (MACEs) and mortality during hospitalization increased significantly with increasing GPS and PI scores. Multiple logistic regression showed that the GPS was independently associated with MACEs (score 1, RR: 6.711, 95% CI: 1.409-31.968; score 2, RR: 14.063, 95% CI: 3.018-65.535) and mortality (score 1, RR: 8.656, 95% CI: 1.068-70.126; score 2, RR: 10.549, 95% CI: 1.317-84.465). The PI was also independently predictive of MACEs (score 2, RR: 5.132, 95% CI: 1.451-18.148). No significant difference was observed in the PNI between patients with different in-hospital outcomes. When in-hospital MACEs were used as an endpoint, the area under the curve (AUC) of the GPS was 0.740 (95% CI 0.678-0.802), and the AUC of the PI was 0.703 (95% CI 0.634-0.773). When mortality was used as an endpoint, the AUC of the GPS was 0.677 (95% CI 0.602-0.753), and the AUC of the PI was 0.667 (95% CI 0.577-0.757).
The severity of systemic inflammation is a strong predictor of poor prognosis in elderly patients with AMI. Among these three inflammation-based prognostic scores, the GPS has a better predictive value than the PI and PNI for in-hospital MACEs and mortality.
越来越多的证据表明，全身炎症是急性心肌梗死（AMI）预后不良的预测因素。本研究旨在评估炎症相关预后评分与老年 AMI 患者住院期间结局的相关性。
本回顾性研究纳入了 2016 年 1 月 1 日至 2019 年 3 月 31 日期间年龄大于 75 岁且符合 AMI 诊断标准的连续患者。采用 logistic 回归和受试者工作特征（ROC）分析评估基于炎症的格拉斯哥预后评分（GPS）、预后指数（PI）和预后营养指数（PNI）的预测价值。
共纳入 273 例患者。随着 GPS 和 PI 评分的升高，主要心血管不良事件（MACEs）和住院期间死亡率显著增加。多因素 logistic 回归显示 GPS 与 MACEs（评分 1：RR：6.711，95%CI：1.409-31.968；评分 2：RR：14.063，95%CI：3.018-65.535）和死亡率（评分 1：RR：8.656，95%CI：1.068-70.126；评分 2：RR：10.549，95%CI：1.317-84.465）独立相关。PI 也与 MACEs 独立相关（评分 2：RR：5.132，95%CI：1.451-18.148）。不同住院结局患者的 PNI 无显著差异。当以住院期间 MACEs 为终点时，GPS 的曲线下面积（AUC）为 0.740（95%CI 0.678-0.802），PI 的 AUC 为 0.703（95%CI 0.634-0.773）。当以死亡率为终点时，GPS 的 AUC 为 0.677（95%CI 0.602-0.753），PI 的 AUC 为 0.667（95%CI 0.577-0.757）。
全身炎症的严重程度是老年 AMI 患者预后不良的强烈预测因素。在这三种基于炎症的预后评分中，GPS 对住院期间 MACEs 和死亡率的预测价值优于 PI 和 PNI。
