Epidemiology, Medical Faculty, University of Augsburg, University Hospital Augsburg, Stenglinstraße 2, 86156, Augsburg, Germany.
Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany.
J Transl Med. 2022 Oct 8;20(1):457. doi: 10.1186/s12967-022-03644-9.
The aim of this study was to investigate the association between inflammatory markers and 28-day mortality in patients with ST-elevation myocardial infarction (STEMI).
In 398 STEMI patients recorded between 2009 and 2013 by the population-based Myocardial Infarction Registry Augsburg, 92 protein biomarkers were measured in admission arterial blood samples using the OLINK inflammatory panel. In multivariable-adjusted logistic regression models, the association between each marker and 28-day mortality was investigated. The values of the biomarkers most significantly associated with mortality were standardized and summarized to obtain a prediction score for 28-day mortality. The predictive ability of this biomarker score was compared to the established GRACE score using ROC analysis. Finally, a combined total score was generated by adding the standardized biomarker score to the standardized GRACE score.
The markers IL-6, IL-8, IL-10, FGF-21, FGF-23, ST1A1, MCP-1, 4E-BP1, and CST5 were most significantly associated with 28-day mortality, each with FDR-adjusted (false discovery rate adjusted) p-values of < 0.01 in the multivariable logistic regression model. In a ROC analysis, the biomarker score and the GRACE score showed comparable predictive ability for 28-day mortality (biomarker score AUC: 0.7859 [CI: 0.6735-0.89], GRACE score AUC: 0.7961 [CI: 0.6965-0.8802]). By combining the biomarker score and the Grace score, the predictive ability improved with an AUC of 0.8305 [CI: 0.7269-0.9187]. A continuous Net Reclassification Improvement (cNRI) of 0.566 (CI: 0.192-0.94, p-value: 0.003) and an Integrated Discrimination Improvement (IDI) of 0.083 ((CI: 0.016-0.149, p-value: 0.015) confirmed the superiority of the combined score over the GARCE score.
Inflammatory biomarkers may play a significant role in the pathophysiology of acute myocardial infarction (AMI) and AMI-related mortality and might be a promising starting point for personalized medicine, which aims to provide each patient with tailored therapy.
本研究旨在探讨炎症标志物与 ST 段抬高型心肌梗死（STEMI）患者 28 天死亡率之间的关系。
在基于人群的奥格斯堡心肌梗死登记处（Myocardial Infarction Registry Augsburg）于 2009 年至 2013 年期间记录的 398 例 STEMI 患者中，使用 OLINK 炎症面板测量入院动脉血样中的 92 种蛋白生物标志物。在多变量调整的逻辑回归模型中，研究了每种标志物与 28 天死亡率之间的关系。对与死亡率最显著相关的生物标志物的值进行标准化并进行汇总，以获得 28 天死亡率的预测评分。使用 ROC 分析比较了该生物标志物评分与既定的 GRACE 评分的预测能力。最后，通过将标准化的生物标志物评分添加到标准化的 GRACE 评分中，生成一个综合总分。
IL-6、IL-8、IL-10、FGF-21、FGF-23、ST1A1、MCP-1、4E-BP1 和 CST5 这 9 种标志物与 28 天死亡率最显著相关，在多变量逻辑回归模型中，每种标志物的 FDR 调整（错误发现率调整）p 值均小于 0.01。在 ROC 分析中，生物标志物评分和 GRACE 评分对 28 天死亡率具有相当的预测能力（生物标志物评分 AUC：0.7859[CI：0.6735-0.89]，GRACE 评分 AUC：0.7961[CI：0.6965-0.8802]）。通过结合生物标志物评分和 Grace 评分，预测能力得到提高，AUC 为 0.8305[CI：0.7269-0.9187]。连续净重新分类改善（cNRI）为 0.566（CI：0.192-0.94，p 值：0.003）和综合区分改善（IDI）为 0.083（CI：0.016-0.149，p 值：0.015），证实了组合评分优于 GRACE 评分。
炎症标志物可能在急性心肌梗死（AMI）和 AMI 相关死亡率的病理生理学中发挥重要作用，可能成为个体化医学的一个有前途的起点，个体化医学旨在为每位患者提供量身定制的治疗。
