Hua Yang, Sun Jin-Yu, Lou Yu-Xuan, Sun Wei, Kong Xiang-Qing
Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing 210000, China.
Southeast University, Nanjing, Jiangsu, China.
Int J Cardiol. 2023 May 15;379:118-126. doi: 10.1016/j.ijcard.2023.03.016. Epub 2023 Mar 9.
Systemic chronic inflammation (SCI) is closely involved in the pathogenesis of many diseases. This study aims to investigate the association between MLR with mortality and cardiovascular disease (CVD) mortality in US adults.
35,813 adults were enrolled from the 1999-2014 National Health and Nutrition Examination Survey (NHANES) cycle. Individuals were categorized according to MLR tertiles and followed until 31 December 2019. Kaplan-Meier plots and log-rank tests were utilized to explore survival differences among the MLR tertiles. Adjusted multivariable Cox analysis was employed to investigate the relationship of MLR with mortality and CVD mortality. Restricted cubic spline and subgroup analysis were further used to discern non-linear relationship and the relationship in categories.
During a median follow-up of 134 months, 5865 (16.4%) all-cause deaths and 1602 (4.5%) cardiovascular deaths occurred. Kaplan-Meier plots revealed significant differences in all-cause and cardiovascular mortality among the MLR tertiles. In the fully-adjusted Cox regression model, individuals in the highest tertile of MLR had higher risk of mortality (HR = 1.26, 95% CI: 1.17-1.35) and CVD mortality (HR = 1.41, HR, 95% CI: 1.23-1.62) than those in the lowest tertile. The restricted cubic spline exhibited a J-shaped relationship between MLR with mortality and CVD mortality (P for non-linearity <0.001). The further subgroup analysis demonstrated a robust trend across categories.
Our study demonstrated that increased baseline MLR was positively associated with a higher risk of death in US adults. MLR was a strong independent predictor of mortality and CVD mortality in the general population.
全身性慢性炎症（SCI）与许多疾病的发病机制密切相关。本研究旨在调查美国成年人中单核细胞与淋巴细胞比值（MLR）与死亡率及心血管疾病（CVD）死亡率之间的关联。
从1999 - 2014年国家健康与营养检查调查（NHANES）周期中纳入35813名成年人。根据MLR三分位数对个体进行分类，并随访至2019年12月31日。采用Kaplan - Meier曲线和对数秩检验来探索MLR三分位数之间的生存差异。使用调整后的多变量Cox分析来研究MLR与死亡率及CVD死亡率之间的关系。进一步采用受限立方样条和亚组分析来识别非线性关系及各分类中的关系。
在中位随访134个月期间，发生了5865例（16.4%）全因死亡和1602例（4.5%）心血管死亡。Kaplan - Meier曲线显示MLR三分位数之间在全因和心血管死亡率方面存在显著差异。在完全调整的Cox回归模型中，MLR最高三分位数的个体比最低三分位数的个体有更高的死亡风险（风险比[HR]=1.26，95%置信区间[CI]：1.17 - 1.35）和CVD死亡风险（HR = 1.41，95% CI：1.23 - 1.62）。受限立方样条显示MLR与死亡率及CVD死亡率之间呈J形关系（非线性P<0.001）。进一步的亚组分析显示各分类间有明显趋势。
我们的研究表明，美国成年人中基线MLR升高与更高的死亡风险呈正相关。MLR是一般人群中死亡率和CVD死亡率的强有力独立预测因素。
