Sadeghi Roxana, Roshdi Dizaji Shayan, Vazirizadeh-Mahabadi Mohammadhossein, Sarveazad Arash, Forouzannia Seyed Ali
Prevention of Cardiovascular Disease Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Arch Acad Emerg Med. 2023 Mar 1;11(1):e25. doi: 10.22037/aaem.v11i1.1915. eCollection 2023.
In recent years, studies have provided evidence on the prognostic value of the leuko-glycemic index (LGI) in acute myocardial infarction (MI), but there is a lack of consensus. In addition, various reported cut-offs for LGI have raised concern regarding its clinical applicability. So, to conclude, through this systematic review and meta-analysis, we aimed to investigate all available evidence on the prognostic value of LGI in acute MI.
Two independent researchers summarized records available in the four main databases of Medline (Via PubMed), Embase, Scopus, and Web of Science until 15 Sep 2022. Articles studying the prognostic value of the LGI in acute MI were included. Finally, sensitivity, specificity, prognostic odds ratio, and the area under the curve (AUC) for LGI were analyzed and reported.
Eleven articles were included (3701 patients, 72.1% male). Based on the analyses, AUC, sensitivity, and specificity for LGI in prediction of mortality following acute MI were 0.77 (95% CI: 0.73 to 0.80), 0.75 (95% CI: 0.62 to 0.84), and 0.66 (95% CI: 0.51 to 0.78), respectively. Positive and negative post-test probability of LGI in prediction of mortality were 21% and 5%, respectively. AUC, sensitivity, and specificity for LGI in prediction of major cardiac complications after acute MI were 0.81 (95% CI: 0.77 to 0.84), 0.84 (95% CI: 0.70 to 0.92), and 0.64 (95% CI: 0.49 to 0.84), respectively. Also, the Positive and negative post-test probability of LGI in this regard were 59% and 13%, respectively.
Although the results demonstrated that the LGI could predict mortality and acute cardiac complication after MI, the low post-test probability of LGI in risk stratification of patients raises questions regarding its applicability. Nevertheless, as most of the available studies have been conducted in the Latino/Hispanic population, further evidence is warranted to generalize the validity of this tool to other racial populations.
近年来，已有研究提供了关于白细胞-血糖指数（LGI）在急性心肌梗死（MI）中的预后价值的证据，但尚未达成共识。此外，文献报道的LGI的各种临界值引发了对其临床适用性的担忧。因此，通过本系统评价和荟萃分析，我们旨在研究关于LGI在急性心肌梗死中的预后价值的所有现有证据。
两名独立研究人员汇总了截至2022年9月15日Medline（通过PubMed）、Embase、Scopus和Web of Science这四个主要数据库中的记录。纳入研究LGI在急性心肌梗死中的预后价值的文章。最后，分析并报告了LGI的敏感性、特异性、预后比值比和曲线下面积（AUC）。
纳入11篇文章（3701例患者，72.1%为男性）。基于分析，LGI在预测急性心肌梗死后死亡率方面的AUC、敏感性和特异性分别为0.77（95%CI：0.73至0.80）、0.75（95%CI：0.62至0.84）和0.66（95%CI：0.51至0.78）。LGI在预测死亡率方面的阳性和阴性验后概率分别为21%和5%。LGI在预测急性心肌梗死后主要心脏并发症方面的AUC、敏感性和特异性分别为0.81（95%CI：0.77至0.84）、0.84（95%CI：0.70至0.92）和0.64（95%CI：0.49至0.84）。同样，LGI在这方面的阳性和阴性验后概率分别为59%和13%。
尽管结果表明LGI可预测心肌梗死后的死亡率和急性心脏并发症，但LGI在患者风险分层中的低验后概率引发了对其适用性的质疑。然而，由于大多数现有研究是在拉丁裔/西班牙裔人群中进行的，因此需要进一步的证据来将该工具的有效性推广到其他种族人群。
