Sun Xiaoqian, Zhang Xinyu, Tang Rui, Tian Jiangyue, Li Ying, Hu Xiaoxia, Sun Ziru, Wu Anhu, Xiao Jie, Dong Mei, Yao Guihua, Lu Huixia
State Key Laboratory for Innovation and Transformation of Luobing Theory; Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, China.
Department of Cardiology, Qilu Hospital (Qingdao), Cheeloo College of Medicine, Shandong University, Qingdao, China.
ESC Heart Fail. 2025 Feb;12(1):508-516. doi: 10.1002/ehf2.15098. Epub 2024 Oct 2.
Nutrition and inflammation status play a vital role in the prognosis of patients with heart failure (HF). This study aimed to investigate the association between the advanced lung cancer inflammation index (ALI), a novel composite indicator of inflammation and nutrition, and short-term mortality among critically ill patients with HF.
This retrospective study included 548 critically ill patients with HF from the MIMIC-IV database. ALI was computed using body mass index, serum albumin and neutrophil-lymphocyte ratio. The primary endpoint was all-cause in-hospital mortality, and the secondary endpoint was 90 day mortality. Kaplan-Meier survival curve analysis with long-rank test and Cox proportional hazards regression models were employed to assess the relationship between baseline ALI and short-term mortality risk. The incremental predictive ability of ALI was evaluated by C-statistic, continuous net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
The average age of 548 patients was 72.2 (61.9, 82.1) years, with 60% being male. Sixty-three patients (11.5%) died in the hospital, and 114 patients (20.8%) died within 90 days of intensive care unit admission. The Kaplan-Meier analysis revealed that the cumulative incidences of both in-hospital and 90 day mortality were significantly higher in patients with lower ALI (log-rank test, in-hospital mortality: P < 0.001; 90 day mortality: P < 0.001). The adjusted Cox proportional hazard model revealed that ALI was inversely associated with both in-hospital and 90 day mortality after adjusting for confounders [hazard ratio (HR) (95% confidence interval) (CI): 0.97 (0.94, 0.99), P = 0.035; HR (95% CI): 0.62 (0.39, 0.99), P = 0.046]. A linear relationship was observed between ALI and in-hospital mortality (P for non-linearity = 0.211). The addition of ALI significantly improved the prognostic ability of GWTG-HF score in the in-hospital mortality [C-statistic improved from 0.62 to 0.68, P = 0.001; continuous NRI (95% CI): 0.44 (0.20, 0.67), P < 0.001; IDI (95% CI): 0.03 (0.01, 0.04), P < 0.001] and 90 day mortality [C-statistic improved from 0.63 to 0.70, P < 0.001; continuous NRI (95% CI): 0.31 (0.11, 0.50), P = 0.002; IDI (95% CI): 0.01 (0.00, 0.02), P = 0.034]. Subgroup analysis revealed stronger correlations between ALI and in-hospital mortality in males and patients aged over 65 years (interaction P = 0.031 and 0.010, respectively). The C-statistic of in-hospital mortality in patients over 65 years was 0.66 (95% CI: 0.58, 0.74).
ALI at baseline can independently predict the risk of short-term mortality in critically ill patients with HF, with lower ALI significantly associated with higher mortality. Further large prospective research with extended follow-up periods is necessary to validate the findings of this study.
营养和炎症状态在心力衰竭（HF）患者的预后中起着至关重要的作用。本研究旨在探讨晚期肺癌炎症指数（ALI）这一新型炎症与营养综合指标与重症HF患者短期死亡率之间的关联。
这项回顾性研究纳入了来自MIMIC-IV数据库的548例重症HF患者。使用体重指数、血清白蛋白和中性粒细胞与淋巴细胞比值计算ALI。主要终点是全因院内死亡率，次要终点是90天死亡率。采用Kaplan-Meier生存曲线分析和长秩检验以及Cox比例风险回归模型来评估基线ALI与短期死亡风险之间的关系。通过C统计量、连续净重新分类改善（NRI）和综合判别改善（IDI）评估ALI的增量预测能力。
548例患者的平均年龄为72.2（61.9，82.1）岁，男性占60%。63例患者（11.5%）在医院死亡，114例患者（20.8%）在重症监护病房入院后90天内死亡。Kaplan-Meier分析显示，ALI较低的患者院内和90天死亡率的累积发生率显著更高（长秩检验，院内死亡率：P<0.001；90天死亡率：P<0.001）。调整后的Cox比例风险模型显示，在调整混杂因素后，ALI与院内和90天死亡率均呈负相关[风险比（HR）（95%置信区间）（CI）：0.97（0.94，0.99），P=0.035；HR（95%CI）：0.62（0.39，0.99），P=0.046]。观察到ALI与院内死亡率之间存在线性关系（非线性P=0.211）。ALI的加入显著提高了GWTG-HF评分在院内死亡率方面的预后能力[C统计量从0.62提高到0.68，P=0.001；连续NRI（95%CI）：0.44（0.20，0.67），P<0.001；IDI（95%CI）：0.03（0.01，0.04），P<0.001]和90天死亡率方面的预后能力[C统计量从0.63提高到0.70，P<0.001；连续NRI（95%CI）：0.31（0.11，0.50），P=0.002；IDI（95%CI）：0.01（0.00，0.02），P=0.034]。亚组分析显示，ALI与男性和65岁以上患者的院内死亡率之间的相关性更强（交互作用P分别为0.031和0.010）。65岁以上患者院内死亡率的C统计量为0.66（95%CI：0.58，0.74）。
基线时的ALI可独立预测重症HF患者的短期死亡风险，ALI较低与较高的死亡率显著相关。需要进一步进行大规模前瞻性研究并延长随访期以验证本研究结果。
