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不同心力衰竭表型的危重症患者血嗜酸性粒细胞水平与预后的关系。

Association between blood eosinophil levels and prognosis in critically ill patients with different heart failure phenotypes.

作者信息

Guan Chengjian, Wang Keke, Gong Angwei, Zhao Yan, Yu Hangtian, Zhang Shuaidan, Jin Sheng, Wang Lixuan, Xiao Bing

机构信息

Department of Cardiology, The Second Hospital of Hebei Medical University, No.215, West Heping Road, Shijiazhuang, 050000, People's Republic of China.

Department of Physiology, Hebei Medical University, Shijiazhuang, 050017, People's Republic of China.

出版信息

Sci Rep. 2025 Feb 19;15(1):6008. doi: 10.1038/s41598-025-90778-7.

Abstract

Heart failure (HF) is associated with poor prognosis. While various immune markers have been linked to HF outcomes, the relationship between eosinophils (EOS) and prognosis across different HF phenotypes remains unclear and controversial. In this study, we analyzed 2,677 HF patients from the Medical Information Mart for Intensive Care III (MIMIC-III) database, categorizing them into reduced ejection fraction (≤ 50%) and preserved ejection fraction (> 50%) groups. Multiple logistic regression, Kaplan-Meier survival curve estimation, Cox proportional hazards model, and restricted cubic splines were employed to assess the association between admission EOS and mortality. Subgroup analyses were conducted based on age, gender, sepsis, atrial fibrillation, hypertension and rheumatic and immunological diseases and mechanical ventilation. A total of 954 patients with heart failure with reduced ejection fraction (HFrEF) and 1723 patients with heart failure with preserved ejection fraction (HFpEF) were enrolled, with a female proportion of 37.84% and 56.88%, respectively. The median age of patients was 74.46 (IQR: 63.34-83.26) years and the median EOS was 0.09 (IQR: 0.04-0.20). Among these patients, in-hospital mortality was 14.5% (389 patients), and the overall 90-day mortality rate reached 27.12% (726 patients). There were no significant differences in EOS levels between the HFrEF and HFpEF groups (0.1 vs. 0.09, P = 0.154). After adjusting for confounders, multivariate logistic regression showed that higher EOS quartiles were associated with reduced in-hospital mortality in HFrEF patients, with quartile 3 (Q3) (OR 0.54, 95% CI 0.31-0.96, P = 0.035) and Q4 (OR 0.37, 95% CI 0.19-0.71, P = 0.003) showing significant protective effects compared with the lowest EOS quartile (Q1), while Q2 did not reach statistical significance (P = 0.931). Subgroup analyses yielded similar findings. Multivariate Cox regression demonstrated a reduced hazard ratio in Q4 (HR 0.64, 95% CI 0.44-0.94, P = 0.023) compared with Q1 in HFrEF patients. However, no significant association was observed between EOS and prognosis in HFpEF. Our findings indicated that higher EOS was associated with improved in-hospital and 90-day survival in ICU patients with HFrEF, but not in those with HFpEF.

摘要

心力衰竭(HF)与预后不良相关。虽然各种免疫标志物已与HF结局相关联,但嗜酸性粒细胞(EOS)与不同HF表型的预后之间的关系仍不明确且存在争议。在本研究中,我们分析了医学重症监护三期信息数据库(MIMIC-III)中的2677例HF患者,将他们分为射血分数降低(≤50%)和射血分数保留(>50%)组。采用多因素逻辑回归、Kaplan-Meier生存曲线估计、Cox比例风险模型和限制性立方样条来评估入院时EOS与死亡率之间的关联。基于年龄、性别、脓毒症、心房颤动、高血压、风湿和免疫性疾病以及机械通气进行亚组分析。共纳入954例射血分数降低的心力衰竭(HFrEF)患者和1723例射血分数保留的心力衰竭(HFpEF)患者,女性比例分别为37.84%和56.88%。患者的中位年龄为74.46(四分位间距:63.34 - 83.26)岁,中位EOS为0.09(四分位间距:0.04 - 0.20)。在这些患者中,住院死亡率为14.5%(389例患者),90天总死亡率达到27.12%(726例患者)。HFrEF组和HFpEF组之间的EOS水平无显著差异(0.1对0.09,P = 0.154)。在调整混杂因素后,多因素逻辑回归显示,较高的EOS四分位数与HFrEF患者住院死亡率降低相关,与最低的EOS四分位数(Q1)相比,四分位数3(Q3)(比值比0.54,95%置信区间0.31 - 0.96,P = 0.035)和Q4(比值比0.37,95%置信区间0.19 - 0.71,P = 0.003)显示出显著的保护作用,而Q2未达到统计学意义(P = 0.931)。亚组分析得出了类似的结果。多因素Cox回归显示,与HFrEF患者的Q1相比,Q4的风险比降低(风险比0.64,95%置信区间0.44 - 0.94,P = 0.023)。然而,在HFpEF患者中未观察到EOS与预后之间的显著关联。我们的研究结果表明,较高的EOS与ICU中HFrEF患者的住院和90天生存率改善相关,但与HFpEF患者无关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/5690/11840013/bc53d17fe658/41598_2025_90778_Fig1_HTML.jpg

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