直接胆红素与间接胆红素比值对急性冠状动脉综合征临床事件的预测作用：来自中国北方一项观察性队列研究的结果。

The predictive effect of direct-indirect bilirubin ratio on clinical events in acute coronary syndrome: results from an observational cohort study in north China.

机构信息

Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong'an Road, Xicheng District, 100050, Beijing, China.

Department of Internal Medical, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China.

出版信息

BMC Cardiovasc Disord. 2022 Nov 10;22(1):478. doi: 10.1186/s12872-022-02894-1.

DOI:10.1186/s12872-022-02894-1

PMID:36357834

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9650858/

Abstract

BACKGROUND

Patients with extremely high-risk ASCVD usually suffered poor prognosis, bilirubin is considered closely related to cardiovascular outcomes. However, there is controversy over the relationship between bilirubin and coronary artery disease. This study aimed to evaluate the predictive value of the DIBIL ratio in patients with extremely high-risk ASCVD.

METHODS

10,260 consecutive patients with extremely high-risk ASCVD were enrolled in this study. All patients were divided into three groups according to their DIBIL ratio. The incidence of MACCEs was recorded, and in a competing risk regression, the incidence of MACCEs and their subgroups were recorded. The direct-indirect bilirubin ratio (DIBIL ratio) was calculated by the direct bilirubin (umol/L)/indirect bilirubin (umol/L) ratio, all laboratory values were obtained from the first fasting blood samples during hospitalization.

RESULTS

The area under the ROC curve of the DIBIL ratio to predict the occurrence of all-cause death was 0.668, the cut-off value of which is 0.275. Competing risk regression indicated that DIBIL ratio was positively correlated with all-cause death [1.829 (1.405-2.381), p < 0.001], CV death [1.600 (1.103, 2.321), p = 0.013]. The addition of DIBIL ratio to a baseline risk model had an incremental effect on the predictive value for all-cause death [IDI 0.004(0, 0.010), p < 0.001; C-index 0.805(0.783-0.827), p < 0.001].

CONCLUSION

The DIBIL ratio was an excellent tool to predict poor prognosis, suggesting that this index may be developed as a biomarker for risk stratification and prognosis in extremely ASCVD patients.

摘要

背景

极高危 ASCVD 患者通常预后较差，胆红素被认为与心血管结局密切相关。然而，胆红素与冠状动脉疾病之间的关系存在争议。本研究旨在评估 DIBIL 比值在极高危 ASCVD 患者中的预测价值。

方法

本研究纳入了 10260 例连续的极高危 ASCVD 患者。所有患者根据 DIBIL 比值分为三组。记录 MACCEs 的发生率，并在竞争风险回归中记录 MACCEs 及其亚组的发生率。直接-间接胆红素比值（DIBIL 比值）通过直接胆红素（umol/L）/间接胆红素（umol/L）比值计算，所有实验室值均来自住院期间第一次空腹血样。

结果

DIBIL 比值预测全因死亡的 ROC 曲线下面积为 0.668，截断值为 0.275。竞争风险回归表明 DIBIL 比值与全因死亡呈正相关[1.829（1.405-2.381），p < 0.001]，心血管死亡[1.600（1.103，2.321），p = 0.013]。DIBIL 比值加入基线风险模型对全因死亡的预测价值具有增量效应[IDI 0.004（0，0.010），p < 0.001；C 指数 0.805（0.783-0.827），p < 0.001]。