血液嗜酸性粒细胞计数的变化可预测心肌梗死患者出院后的死亡情况。
Changes in Blood Eosinophil Counts Predict the Death of Patients With Myocardial Infarction After Hospital Discharge.
作者信息
Lin Kaiyang, Luo Manqing, Gu Xia, Xu Jun-Yan, Tian Jinwei, Libby Peter, Shi Guo-Ping, Guo Junli
机构信息
Department of Cardiology Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou University Affiliated Provincial Hospital, Fujian Provincial Key Laboratory of Cardiovascular Disease Fuzhou China.
Department of Cardiology The Second Affiliated Hospital of Harbin Medical University Harbin Heilongjiang China.
出版信息
J Am Heart Assoc. 2025 Jan 7;14(1):e035383. doi: 10.1161/JAHA.124.035383. Epub 2024 Dec 20.
BACKGROUND
Preclinical studies demonstrate a cardioprotective role of eosinophils in acute myocardial infarction. Yet clinical studies show conflicting correlations between blood eosinophil counts and acute myocardial infarction risk and mortality. This study evaluates blood eosinophil counts of patients with acute myocardial infarction at hospital admission (EOS) and discharge (EOS) on all-cause and cardiac mortalities.
METHODS AND RESULTS
Of 2681 consecutive patients with a median follow-up of 2.55 years, 45 patients died within 30 days, 28 died within 30 to 150 days, and 92 died within 150 days or later postdischarge. Cardiac death occurred in 108 patients. According to the receiver operating characteristic analyses, the best cutoffs of EOS and EOS were 0.02×10/L and 0.03×10/L, respectively, to predict 30-day all-cause death (area under the curve [AUC], 0.60; AUC, 0.67). The optimal cutoffs of EOS and EOS were 0.20×10/L and 0.14×10/L to predict long-term all-cause mortality (1-year AUC, 0.59; 1-year AUC, 0.61). Multivariate logistic analysis showed that low EOS (<0.02×10/L) or low EOS (<0.03×10/L) predicted the 30-day all-cause (odds ratio [OR], 2.56; =0.005; OR, 8.14; <0.001) and cardiac (OR, 2.16; =0.025; OR, 7.89; <0.001) mortalities. Patients with combined low EOS (<0.02×10/L) and low EOS (<0.03×10/L) displayed synergistic risk of 30-day all-cause (OR, 13.93; <0.001) and cardiac (OR, 11.38; <0.001) deaths. In contrast, adjusted Cox proportional hazard test indicated that high EOS (≥0.14×10/L) was an independent risk for long-term all-cause mortality (hazard ratio, 1.84; =0.010).
CONCLUSIONS
High and low blood eosinophil counts both predict the risk of all-cause and cardiac deaths in patients with acute myocardial infarction depending on the time of data collection. Dynamic changes of blood eosinophil counts offer a more accurate prediction of post-myocardial infarction deaths than a single time point data analysis.
背景
临床前研究表明嗜酸性粒细胞在急性心肌梗死中具有心脏保护作用。然而，临床研究显示血液嗜酸性粒细胞计数与急性心肌梗死风险及死亡率之间的相关性存在矛盾。本研究评估急性心肌梗死患者入院时（EOS）和出院时（EOS）的血液嗜酸性粒细胞计数对全因死亡率和心脏死亡率的影响。
方法与结果
在2681例连续患者中，中位随访时间为2.55年，45例患者在30天内死亡，28例在30至150天内死亡，92例在出院后150天或更晚死亡。108例患者发生心脏死亡。根据受试者工作特征分析，EOS和EOS预测30天全因死亡的最佳截断值分别为0.02×10/L和0.03×10/L（曲线下面积[AUC]，0.60；AUC，0.67）。EOS和EOS预测长期全因死亡率的最佳截断值为0.20×10/L和0.14×10/L（1年AUC，0.59；1年AUC，0.61）。多因素逻辑回归分析显示，低EOS（<0.02×10/L）或低EOS（<0.03×10/L）可预测30天全因死亡率（比值比[OR]，2.56；P = 0.005；OR，8.14；P < 0.001）和心脏死亡率（OR，2.16；P = 0.025；OR，7.89；P < 0.001）。合并低EOS（<0.02×10/L）和低EOS（<0.03×10/L）的患者显示出30天全因死亡率（OR，13.93；P < 0.001）和心脏死亡率（OR，11.38；P < 0.001）的协同风险。相比之下，校正后的Cox比例风险检验表明，高EOS（≥0.14×10/L）是长期全因死亡率的独立危险因素（风险比，1.84；P = 0.010）。
结论
血液嗜酸性粒细胞计数的高低均能预测急性心肌梗死患者的全因死亡和心脏死亡风险，这取决于数据收集的时间。与单次时间点数据分析相比，血液嗜酸性粒细胞计数的动态变化能更准确地预测心肌梗死后的死亡情况。
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