Zhong Yuhua, Zhou Kesi, Li Sheng, Zhang Renzi, Wang Daoxin
Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People's Republic of China.
Department of Anesthesiology, Sichuan Second Hospital of T.C.M, Chengdu, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2025 Mar 28;20:857-868. doi: 10.2147/COPD.S508481. eCollection 2025.
The non-high-density lipoprotein cholesterol-to-high-density lipoprotein cholesterol ratio (NHHR) is a new composite blood lipid index. We aimed to investigate the relationships of the NHHR with mortality from all-causes, cardiovascular disease (CVD), and chronic lower respiratory disease (CLRD) in US patients with COPD.
We assessed the association between the NHHR and mortality via weighted multivariate Cox proportional hazards regression models with restricted cubic splines (RCSs). Between-group survival rates at specific time points were compared via Kaplan‒Meier (KM) curves and Log rank tests. Receiver operating characteristic (ROC) curves were constructed to evaluate the efficiency of the NHHR for predicting mortality risk in COPD patients.
After adjusting for confounding factors, weighted multivariate Cox proportional hazards regression model showed that higher NHHR was not significantly associated with all-cause mortality (HRs = 1.74), CVD mortality (HRs = 1.19), and CLRD-related mortality (HRs = 0.65), but HRs tended to increase as NHHR increased. RCS revealed U-shaped associations between the NHHR and all-cause mortality. KM survival analysis revealed a significantly lower survival rate for patients in the high-NHHR group (Log rank test P<0.001). In addition, the NHHR had superior performance in predicting mortality, with AUC values of 0.85 and 0.883 for all-cause mortality, 0.769 and 0.815 for CVD mortality, and 0.765 and 0.815 for CLRD-related mortality at 5 and 10 years, respectively.
The higher the NHHR is, the greater the risk of all-cause mortality in COPD patients. The NHHR was significantly superior to other haematological biomarkers in predicting mortality.
非高密度脂蛋白胆固醇与高密度脂蛋白胆固醇比值（NHHR）是一种新的复合血脂指标。我们旨在研究美国慢性阻塞性肺疾病（COPD）患者中NHHR与全因死亡率、心血管疾病（CVD）死亡率和慢性下呼吸道疾病（CLRD）死亡率之间的关系。
我们通过带有受限立方样条（RCS）的加权多变量Cox比例风险回归模型评估NHHR与死亡率之间的关联。通过Kaplan-Meier（KM）曲线和对数秩检验比较特定时间点的组间生存率。构建受试者工作特征（ROC）曲线以评估NHHR预测COPD患者死亡风险的效率。
在调整混杂因素后，加权多变量Cox比例风险回归模型显示，较高的NHHR与全因死亡率（风险比=1.74）、CVD死亡率（风险比=1.19）和CLRD相关死亡率（风险比=0.65）无显著关联，但风险比倾向于随NHHR升高而增加。RCS显示NHHR与全因死亡率之间呈U形关联。KM生存分析显示高NHHR组患者的生存率显著较低（对数秩检验P<0.001）。此外，NHHR在预测死亡率方面表现优异，5年和10年时全因死亡率的AUC值分别为0.85和0.883，CVD死亡率的AUC值分别为0.769和0.815，CLRD相关死亡率的AUC值分别为0.765和0.815。
COPD患者的NHHR越高，全因死亡风险越大。NHHR在预测死亡率方面明显优于其他血液生物标志物。
