Huang Yongwei, Wang Xiaoyi, Li Zongping, Yin Xiaoshuang
Department of Neurosurgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
Department of Immunology, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
Front Nutr. 2024 Jul 5;11:1408372. doi: 10.3389/fnut.2024.1408372. eCollection 2024.
This investigation aimed to delineate the association between the advanced lung cancer inflammation index (ALI) and all-cause mortality (ACM) in individuals experiencing acute ischemic stroke (AIS).
Drawing on information from the Medical Information Mart for Intensive Care (MIMIC)-IV database, release 2.2, covering the years 2012 to 2019, this research assessed the advanced lung cancer inflammation index (ALI) by factoring in body mass index (BMI), serum albumin levels (ALB), and the neutrophil-to-lymphocyte ratio (NLR). Patients with AIS were identified using codes from the International Classification of Diseases (ICD). To address potential confounding factors, a 1:1 propensity score matching (PSM) method was utilized. The investigation identified the pivotal ALI level impacting patient survival using maximally selected rank statistics. It then examined the effects on short- and long-term ACM through multivariate Cox proportional hazards regression models and Kaplan-Meier (K-M) survival analysis. Additionally, restricted cubic spline (RCS) methods were applied to delve into the linear or nonlinear nature of the relationship between ALI and ACM, with further insights gained from interaction and subgroup analyses.
The cohort comprised 838 AIS patients. Post-PSM, analysis involved 199 matched patient pairs. Adjusted Cox proportional hazard models indicated a significant association of low ALI (<10.38) with increased in-hospital ACM, both before (HR: 1.98; 95% CI: 1.36-2.88; < 0.001) and after PSM (HR: 2.16; 95% CI: 1.32-3.52; = 0.002). Associations of low ALI with elevated risk were consistent across ICU, 30 days, 90 days, and 1 year ACM pre- and post-PSM. Subsequent RCS analysis post-PSM underscored a negative nonlinear relationship between ALI and ACM over both short and long terms, without significant interaction effects across different subgroups for ACM.
In this retrospective cohort study, by utilizing a nationally representative sample of United States patients with AIS, our analysis elucidates a negative correlation between the ALI and ACM in individuals with AIS, underscoring the utility of ALI as a novel, efficacious, and accessible inflammatory biomarker for prognosticating ACM. These results carry profound implications for public health policy and practice. A deeper comprehension of these associations can empower public health practitioners and researchers to devise more targeted interventions and policies, aimed specifically at catering to the distinct needs of the AIS patient population, thereby enhancing their health outcomes. The further research in other races/ethnicity is urgent, particularly before applying these findings in clinical practice.
本研究旨在阐明急性缺血性卒中（AIS）患者的晚期肺癌炎症指数（ALI）与全因死亡率（ACM）之间的关联。
本研究利用重症监护医学信息数据库（MIMIC-IV）2.2版本中2012年至2019年的信息，通过纳入体重指数（BMI）、血清白蛋白水平（ALB）和中性粒细胞与淋巴细胞比值（NLR）来评估晚期肺癌炎症指数（ALI）。使用国际疾病分类（ICD）编码识别AIS患者。为解决潜在的混杂因素，采用1:1倾向评分匹配（PSM）方法。本研究使用最大选择秩统计量确定影响患者生存的关键ALI水平。然后通过多变量Cox比例风险回归模型和Kaplan-Meier（K-M）生存分析检查对短期和长期ACM的影响。此外，应用受限立方样条（RCS）方法深入研究ALI与ACM之间关系的线性或非线性性质，并通过交互作用和亚组分析获得进一步见解。
该队列包括838例AIS患者。PSM后，分析涉及199对匹配患者。调整后的Cox比例风险模型表明，低ALI（<10.38）与住院期间ACM增加显著相关，PSM前（HR：1.98；95%CI：1.36 - 2.88；<0.001）和PSM后（HR：2.16；95%CI：1.32 - 3.52；=0.002）均如此。低ALI与风险升高的关联在PSM前后的ICU、30天、90天和1年ACM中均一致。PSM后的后续RCS分析强调了ALI与ACM在短期和长期均呈负非线性关系，不同亚组的ACM无显著交互作用。
在这项回顾性队列研究中，通过使用具有全国代表性的美国AIS患者样本，我们的分析阐明了AIS患者中ALI与ACM之间的负相关关系，强调了ALI作为一种用于预测ACM的新型、有效且可获取的炎症生物标志物的实用性。这些结果对公共卫生政策和实践具有深远意义。对这些关联的更深入理解可以使公共卫生从业者和研究人员制定更有针对性的干预措施和政策，专门针对满足AIS患者群体的独特需求，从而改善他们的健康结果。在其他种族/族裔中进行进一步研究迫在眉睫，尤其是在将这些发现应用于临床实践之前。
