修改、验证和比较那不勒斯预后评分以确定ST段抬高型心肌梗死患者的院内死亡率。
Modification, validation and comparison of Naples prognostic score to determine in-hospital mortality in ST-segment elevation myocardial infarction.
作者信息
Genc Omer, Yildirim Abdullah, Erdogan Aslan, Ibisoglu Ersin, Guler Yeliz, Capar Gazi, Goksu M Mert, Akgun Huseyin, Acar Gamze, Ozdogan G Cansu, Uredi Gunseli, Sen Furkan, Halil Ufuk S, Er Fahri, Genc Murside, Ozkan Eyup, Guler Ahmet, Kurt Ibrahim H
机构信息
Department of Cardiology, Basaksehir Cam & Sakura City Hospital, University of Health Sciences, Istanbul, Turkey.
Department of Cardiology, Adana City Training and Research Hospital, University of Health Sciences, Adana, Turkey.
出版信息
Eur J Clin Invest. 2025 Jan;55(1):e14332. doi: 10.1111/eci.14332. Epub 2024 Oct 14.
AIM
The relationship between inflammatory status and poor outcomes in acute coronary syndromes is a significant area of current research. This study investigates the association between in-hospital mortality and the modified Naples prognostic score (mNPS) as well as other inflammatory biomarkers in STEMI patients.
METHODS
This single-centre, cross-sectional study included 2576 consecutive STEMI patients who underwent primary percutaneous coronary intervention between January 2022 and November 2023. Participants were randomly divided into derivation and validation cohorts in a 6:4 ratio. The following inflammatory indices were calculated: pan-immune-inflammation value (PIV), systemic immune-inflammation-index (SII), systemic inflammation-response index (SIRI) and conventional NPS. The mNPS was derived by integrating hs-CRP into the conventional NPS. The performance of these indices in determining in-hospital mortality was assessed using regression, calibration, discrimination, reclassification and decision curve analyses.
RESULTS
Inflammatory biomarkers, including PIV, SII, SIRI, NPS and mNPS, were significantly higher in patients who died during in-hospital follow-up compared to those discharged alive in both the derivation and validation cohorts. Multivariable logistic regression analyses were performed separately for the derivation and validation cohorts. In the derivation cohort, mNPS was associated with in-hospital mortality (aOR = 1.490, p < .001). Similarly, in the validation cohort, mNPS was associated with in-hospital mortality (aOR = 2.023, p < .001). mNPS demonstrated better discriminative and reclassification power than other inflammatory markers (p < .05 for all). Additionally, regression models incorporating mNPS were well-calibrated and showed net clinical benefit in both cohorts.
CONCLUSION
mNPS may be a stronger predictor of in-hospital mortality in STEMI patients compared to the conventional scheme and other inflammatory indices.
目的
炎症状态与急性冠状动脉综合征不良预后之间的关系是当前研究的一个重要领域。本研究调查了ST段抬高型心肌梗死（STEMI）患者院内死亡率与改良那不勒斯预后评分（mNPS）以及其他炎症生物标志物之间的关联。
方法
这项单中心横断面研究纳入了2022年1月至2023年11月期间连续接受直接经皮冠状动脉介入治疗的2576例STEMI患者。参与者按6:4的比例随机分为推导队列和验证队列。计算了以下炎症指标：全免疫炎症值（PIV）、全身免疫炎症指数（SII）、全身炎症反应指数（SIRI）和传统的NPS。mNPS是通过将高敏C反应蛋白（hs-CRP）纳入传统NPS而得出的。使用回归、校准、鉴别、重新分类和决策曲线分析评估这些指标在确定院内死亡率方面的表现。
结果
在推导队列和验证队列中，与存活出院的患者相比，院内随访期间死亡的患者的炎症生物标志物，包括PIV、SII、SIRI、NPS和mNPS均显著更高。对推导队列和验证队列分别进行多变量逻辑回归分析。在推导队列中，mNPS与院内死亡率相关（调整后比值比[aOR]=1.490，p<0.001）。同样，在验证队列中，mNPS与院内死亡率相关（aOR=2.023，p<0.001）。mNPS显示出比其他炎症标志物更好的鉴别和重新分类能力（所有p<0.05）。此外，纳入mNPS的回归模型校准良好，并且在两个队列中均显示出净临床获益。
结论
与传统方案和其他炎症指标相比，mNPS可能是STEMI患者院内死亡率更强的预测指标。
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