Zheng Tao, Guo Mengmeng, Han Yating, Li Guanglu, Wang Xianhua, Li Shenjie, Gao Yuting, Tang Wenxiong, Liu Zunjing
Beijing University of Chinese Medicine, Beijing, China.
Department of Neurology, Peking University People's Hospital, Beijing, China.
Front Neurol. 2025 Apr 30;16:1567767. doi: 10.3389/fneur.2025.1567767. eCollection 2025.
Recent studies have shown that alkaline phosphatase to albumin ratio (APAR) is a prognostic biomarker for coronary heart disease and cancer. However, the effect of APAR on the prognosis of ischemic stroke (IS) remains unclear. We aimed to assess the association of APAR with all-cause mortality in critically ill patients with IS.
Critically ill patients with IS were identified from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) Version 3.0 database, and classified into quartiles based on APAR index levels. Clinical outcomes included all-cause mortality at 28-days, 90-days and 365-days after admission. Cox proportional hazards regression analysis and restricted cubic spline method were used to clarify the relationship between APAR index and clinical outcomes in critically ill patients with IS.
A total of 1,690 critically ill patients with IS were selected from the MIMIC-IV database. Multivariate Cox proportional hazard analysis showed that increased APAR index was significantly associated with all-cause mortality. After adjusting for potential confounding factors, patients with higher APAR (Q4: 1.524-2.794) had significantly increased all-cause mortality at 28-days, 90-days, and 365-days after admission (HR 2.05, 95%CI 1.47-2.86, = 0; HR 2.09, 95%CI 1.53-2.85, = 0; HR 2.11, 95%CI 1.55-2.87, = 0). APAR had a linear relationship with 28-days and 365-days mortality ( for non-linearity: 0.098 and 0.051), but a nonlinear relationship with 90-days mortality ( for non-linearity: 0.042). Subgroup analyses further revealed that higher APAR was also associated with increased long-term mortality in IS patients without hypertension, DM, cardiovascular disease, liver disease or CKD. In addition, we did not observe any interaction between subgroup variables and APAR.
A higher APAR index was significantly associated with increased all-cause mortality at 28-days, 90-days and 365-days after admission for critically ill patients with IS. The APAR index may help identify patients with IS at high risk of all-cause death.
近期研究表明，碱性磷酸酶与白蛋白比值（APAR）是冠心病和癌症的一种预后生物标志物。然而，APAR对缺血性脑卒中（IS）预后的影响仍不明确。我们旨在评估APAR与重症IS患者全因死亡率之间的关联。
从重症监护医学信息数据库-IV（MIMIC-IV）3.0版数据库中识别出重症IS患者，并根据APAR指数水平分为四分位数。临床结局包括入院后28天、90天和365天的全因死亡率。采用Cox比例风险回归分析和限制性立方样条法来阐明APAR指数与重症IS患者临床结局之间的关系。
从MIMIC-IV数据库中总共选取了1690例重症IS患者。多变量Cox比例风险分析显示，APAR指数升高与全因死亡率显著相关。在调整潜在混杂因素后，APAR较高的患者（Q4：1.524 - 2.794）在入院后28天、90天和365天的全因死亡率显著增加（HR 2.05，95%CI 1.47 - 2.86，P = 0；HR 2.09，95%CI 1.53 - 2.85，P = 0；HR 2.11，95%CI 1.55 - 2.87，P = 0）。APAR与28天和365天死亡率呈线性关系（非线性检验P值：0.098和0.051），但与90天死亡率呈非线性关系（非线性检验P值：0.042）。亚组分析进一步显示，在无高血压、糖尿病、心血管疾病、肝病或慢性肾脏病的IS患者中，较高的APAR也与长期死亡率增加相关。此外，我们未观察到亚组变量与APAR之间存在任何相互作用。
较高的APAR指数与重症IS患者入院后28天、90天和365天的全因死亡率增加显著相关。APAR指数可能有助于识别有全因死亡高风险的IS患者。
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