Department of Cardiology, Zhuji People's Hospital of Zhejiang Province, Zhuji, China.
Department of Emergency, People's Hospital of Tiantai County, Taizhou, Zhejiang, China
BMJ Open. 2021 Jul 2;11(7):e044668. doi: 10.1136/bmjopen-2020-044668.
Inflammation plays a key role in the pathophysiology of cardiogenic shock (CS). Low-density lipoprotein cholesterol (LDL-C) is a biomarker of inflammation and is used to predict prognostic outcomes of several diseases. The primary purpose of this study was to evaluate if LDL-C can be used as a biomarker to predict the mortality of CS.
Records of critically ill patients with CS were identified from the Medical Information Mart for Intensive Care III database. A multivariate Cox regression model was employed to adjust for imbalances by incorporating parameters and potential confounders.A total of 551 critically ill patients with CS were enrolled for this analysis, including 207 with LDL-C <1.8 mmol/L and 344 with LDL-C ≥1.8 mmol/L. Results of multivariate Cox regression models found that higher concentration of LDL-C (LDL-C ≥1.8mmol/L) was associated with a reduced risk of in-hospital mortality (HR 0.66, 95% CI 0.50 to 0.87; p=0.003) and 28-day mortality (HR 0.61, 95% CI 0.46 to 0.80; p=0.002) LDL-C in patients with CS. Patients with LDL-C ≥1.8 mmol/L were independently associated with improved in-hospital survival (HR 0.32, 95% CI 0.20 to 0.52, p<0.001) and 28-day survival (HR 0.51, 95% CI 0.33 to 0.73, p=0.002) compared with patients with LDL-C <1.8 mmol/L. The impact of LDL-C on in-hospital mortality and 28-day mortality persisted in patients with acute coronary syndrome (ACS) and was not statistically significant in the non-ACS subgroup.
Our study observed that increased LDL-C level was related with improved survival in patients with CS, but not with improved outcomes in patients with uncomplicated ACS. The results need to be verified in randomised controlled trials.
炎症在心源性休克（CS）的病理生理学中起着关键作用。低密度脂蛋白胆固醇（LDL-C）是炎症的生物标志物，用于预测多种疾病的预后结果。本研究的主要目的是评估 LDL-C 是否可用作预测 CS 死亡率的生物标志物。
从医疗信息集市强化护理 III 数据库中确定了患有 CS 的危重病患者的记录。采用多变量 Cox 回归模型，通过纳入参数和潜在混杂因素来调整不平衡。共有 551 名患有 CS 的危重病患者纳入本分析，其中 207 名 LDL-C<1.8mmol/L，344 名 LDL-C≥1.8mmol/L。多变量 Cox 回归模型的结果发现，较高浓度的 LDL-C（LDL-C≥1.8mmol/L）与住院死亡率降低相关（HR 0.66，95%CI 0.50 至 0.87；p=0.003）和 28 天死亡率（HR 0.61，95%CI 0.46 至 0.80；p=0.002）。LDL-C 在 CS 患者中。LDL-C≥1.8mmol/L 的患者与住院生存率提高独立相关（HR 0.32，95%CI 0.20 至 0.52，p<0.001）和 28 天生存率（HR 0.51，95%CI 0.33 至 0.73，p=0.002）与 LDL-C<1.8mmol/L 的患者相比。与非 ACS 亚组相比，LDL-C 对住院死亡率和 28 天死亡率的影响在 ACS 患者中持续存在，但无统计学意义。
我们的研究观察到，LDL-C 水平升高与 CS 患者的生存率提高有关，但与不伴 ACS 的患者的预后改善无关。结果需要在随机对照试验中验证。
