Wang Jianjun, Chen Xi, Qin Chuan, Zeng Xintao, Du Xiaobo, Wang Decai
Department of Hepatobiliary Surgery, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
NHC Key Laboratory of Nuclear Technology Medical Transformation, Mianyang Central Hospital, School of Medicine, University of Electronic Science and Technology of China, Mianyang, China.
Front Med (Lausanne). 2024 Dec 11;11:1498148. doi: 10.3389/fmed.2024.1498148. eCollection 2024.
The endothelial activation and stress index (EASIX) serves as a dependable and efficient surrogate marker for endothelial dysfunction, which plays an essential role in the pathophysiology of acute pancreatitis (AP). Hence, we investigated the prognostic value of EASIX in AP.
This was a retrospective study, using patient information obtained from the Medical Information Market for Intensive Care-IV (MIMIC-IV) database. EASIX was calculated using lactate dehydrogenase, serum creatinine, and platelet counts obtained during the first measurement within 24 h of admission. Patients were grouped into three cohorts based on log2-transformed EASIX. The main endpoint of the study was 28-day all-cause mortality (ACM) in AP patients, with the secondary endpoint being 90-day ACM. The relationship between EASIX and prognosis in patients with AP was evaluated using Cox proportional hazards models, Kaplan-Meier curves, restricted cubic spline (RCS) curves, and subgroup analyses. Receiver operating characteristic (ROC) curves were constructed to evaluate the predictive performance of EASIX compared to other indicators.
The study cohort comprised 620 patients in total. Multivariate Cox proportional hazards analysis indicated that an increased log2 (EASIX) was linked to a higher risk of 28-day ACM in AP patients (HR, 1.32; 95% CI: 1.14-1.52; < 0.001). The risk of 28-day ACM was higher in Tertiles 2 and 3 compared with Tertile 1 [(HR, 2.80; 95% CI: 1.21-6.45); (HR, 3.50; 95% CI: 1.42-8.66)]. Comparable findings were noted for 90-day ACM. Kaplan-Meier curves demonstrated that patients with elevated log2 (EASIX) had lower 28- and 90-day survival rates. The RCS curves suggested a non-linear relationship between log2 (EASIX) and 28- and 90-day ACM. ROC curves indicated that log2 (EASIX) was not inferior to sequential organ failure assessment and systemic inflammatory response syndrome scores in predicting the prognosis of patients with AP. Subgroup analyses demonstrated no interaction between log2 (EASIX) and any subgroup.
Elevated EASIX levels were significantly correlated with a heightened risk of 28- and 90-day ACM in AP patients.
内皮激活和应激指数（EASIX）是内皮功能障碍可靠且有效的替代标志物，其在急性胰腺炎（AP）的病理生理学中起着至关重要的作用。因此，我们研究了EASIX在AP中的预后价值。
这是一项回顾性研究，使用从重症监护医学信息市场-IV（MIMIC-IV）数据库获取的患者信息。EASIX通过入院后24小时内首次测量时获得的乳酸脱氢酶、血清肌酐和血小板计数来计算。根据log2转换后的EASIX将患者分为三个队列。该研究的主要终点是AP患者的28天全因死亡率（ACM），次要终点是90天ACM。使用Cox比例风险模型、Kaplan-Meier曲线、限制性立方样条（RCS）曲线和亚组分析评估AP患者中EASIX与预后的关系。构建受试者工作特征（ROC）曲线以评估EASIX与其他指标相比的预测性能。
该研究队列共包括620例患者。多变量Cox比例风险分析表明，log2（EASIX）升高与AP患者28天ACM风险较高相关（HR，1.32；95%CI：1.14-1.52；P<0.001）。与第1三分位数相比，第2和第3三分位数的28天ACM风险更高[（HR，2.80；95%CI：1.21-6.45）；（HR，3.50；95%CI：1.42-8.66）]。90天ACM也有类似发现。Kaplan-Meier曲线表明，log2（EASIX）升高的患者28天和90天生存率较低。RCS曲线表明log2（EASIX）与28天和90天ACM之间存在非线性关系。ROC曲线表明，在预测AP患者预后方面，log2（EASIX）不劣于序贯器官衰竭评估和全身炎症反应综合征评分。亚组分析表明log2（EASIX）与任何亚组之间均无相互作用。
EASIX水平升高与AP患者28天和90天ACM风险增加显著相关。
