Liuzhuang Xiongyi, Yang Sirui, Yang Yunhong, Gu Wenyi, Shi Tao, Xu Chenggong, Chen Lixing
Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, Yunnan, China.
Department of Cardiology, Kunming Medical University First Affiliated Hospital, Kunming, Yunnan, China
BMJ Open. 2025 Mar 21;15(3):e084099. doi: 10.1136/bmjopen-2024-084099.
To clarify whether the high-density lipoprotein cholesterol/C reactive protein (HDL-C/CRP) ratio can be used as a new prognosticator of all-cause mortality in patients with chronic heart failure (CHF) (New York Heart Association (NYHA) cardiac class III/IV).
Retrospective study.
Several papers have revealed that HDL-C and CRP can act as anti-inflammatory and pro-inflammatory factors, respectively, to affect disease progression in patients with heart failure, and the balance of the two has been shown to affect the prognosis of patients with heart failure with preserved ejection fraction (HFpEF), but none of the above studies involved patients with the more severe forms of heart failure with mildly reduced ejection fraction and heart failure with reduced ejection fraction; therefore, the present study is to extend the balance of HDL-C and CRP to the whole range of types of patients CHF to further confirm its importance.
This study is from a single centre in Yunnan Province, China.
After excluding ineligible patients, we finally included 1192 patients with CHF from January 2017 to October 2021.
The primary outcome was all-cause mortality in patients with CHF between January 2017 and October 2021. No secondary outcome measures were performed.
All patients were divided into four groups according to the quartiles of the HDL-C/CRP ratio. Using the Kaplan-Meier analysis, the risk of all-cause mortality was always the highest for Q1 (HDL-C/CRP<0.395) and the lowest for group Q4 (HDL-C/CRP≥3.4163). Cox univariate and multivariate regression analyses showed that HDL-C/CRP was consistently an independent risk factor for death from CHF. Based on the receiver operating characteristic curve, the area under the curve for HDL-C/CRP was 0.7254 (p<0.001), with a sensitivity of 65.5% and a specificity of 69.6%.
The HDL-C/CRP ratio is an independent prognostic indicator of all-cause mortality in patients with CHF in NYHA cardiac function class III/IV, which has good specificity and sensitivity. Patients with lower levels of the HDL-C/CRP ratio are at a greater risk of death than patients with higher levels of the HDL-C/CRP ratio.
明确高密度脂蛋白胆固醇/ C反应蛋白（HDL-C/CRP）比值是否可作为慢性心力衰竭（CHF）（纽约心脏协会（NYHA）心功能Ⅲ/Ⅳ级）患者全因死亡率的新预后指标。
回顾性研究。
多篇论文表明，HDL-C和CRP可分别作为抗炎和促炎因子，影响心力衰竭患者的疾病进展，两者的平衡已被证明会影响射血分数保留的心力衰竭（HFpEF）患者的预后，但上述研究均未涉及射血分数轻度降低的更严重心力衰竭形式以及射血分数降低的心力衰竭患者；因此，本研究旨在将HDL-C与CRP的平衡扩展至CHF患者的全类型范围，以进一步证实其重要性。
本研究来自中国云南省的一个单一中心。
排除不符合条件的患者后，我们最终纳入了2017年1月至2021年10月期间的1192例CHF患者。
主要结局是2017年1月至2021年10月期间CHF患者的全因死亡率。未进行次要结局测量。
所有患者根据HDL-C/CRP比值的四分位数分为四组。使用Kaplan-Meier分析，Q1组（HDL-C/CRP<0.395）的全因死亡风险始终最高，Q4组（HDL-C/CRP≥3.4163）的风险最低。Cox单因素和多因素回归分析表明，HDL-C/CRP始终是CHF死亡的独立危险因素。基于受试者工作特征曲线，HDL-C/CRP的曲线下面积为0.7254（p<0.001），敏感性为65.5%，特异性为69.6%。
HDL-C/CRP比值是NYHA心功能Ⅲ/Ⅳ级CHF患者全因死亡率的独立预后指标，具有良好的特异性和敏感性。HDL-C/CRP比值较低的患者比HDL-C/CRP比值较高的患者死亡风险更大。
