Yin Fang, Wang Kai
Department of Infectious Diseases, The Affiliated Yongchuan Hospital of Chongqing Medical University, Chongqing, China.
Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.
Front Med (Lausanne). 2025 May 1;12:1560947. doi: 10.3389/fmed.2025.1560947. eCollection 2025.
The connection between endothelial activation and stress index (EASIX) and risk of mortality in critically ill patients with heart failure (HF) remains unclear. This research sought to explore this relationship.
MIMIC-IV database (version 3.1) was utilized to provide clinical data. Due to the non-normal distribution, EASIX was logarithmic. An optimal cut-off value for log2(EASIX) was determined to serve as an indicator of mortality risk under the maximally selected rank statistics. Kaplan-Meier survival analysis and Cox regression models were used to assess the link between log2(EASIX) and mortality within 1 year. Subgroup analyses were performed to ascertain the prognostic impact of log2(EASIX) in various patient groups. Mediation analysis was employed to uncover and elucidate causal pathways connecting log2(EASIX) to mortality.
It encompassed 7,901 patients. According to the Kaplan-Meier curves, increased log2(EASIX) levels correlated with a higher likelihood of all-cause mortality ( < 0.001). Cox models and subgroup analyses further revealed that groups with high log2(EASIX) levels exhibited a greater mortality risk than those with lower levels (hazard ratio (HR): 1.62, 95% CI: 1.47-1.78), a trend that persisted across most subgroups, with the exception of varying levels of APS III, body mass index, white blood cell counts, or albumin (p for interaction < 0.05 for all). Subsequent mediation analysis suggested that blood urea nitrogen and red cell distribution width partially mediated the relationship between log2(EASIX) and mortality with 17.3% and 36.5% of the mediating effect.
It found an independent association between elevated log2(EASIX) levels and a higher risk of 1 year all-cause mortality in ICU patients suffering from HF, with a stronger effect observed in patients with low levels of APS III or white blood cell counts, or high levels of body mass index or albumin. This association may be partially mediated by blood urea nitrogen and red cell distribution width.
内皮激活与应激指数（EASIX）和重症心力衰竭（HF）患者的死亡风险之间的关系尚不清楚。本研究旨在探讨这种关系。
利用MIMIC-IV数据库（3.1版）提供临床数据。由于分布不呈正态，对EASIX进行对数转换。在最大选择秩统计量下确定log2（EASIX）的最佳截断值，作为死亡风险的指标。采用Kaplan-Meier生存分析和Cox回归模型评估log2（EASIX）与1年内死亡率之间的联系。进行亚组分析以确定log2（EASIX）在不同患者组中的预后影响。采用中介分析来揭示和阐明连接log2（EASIX）与死亡率的因果途径。
该研究纳入了7901例患者。根据Kaplan-Meier曲线，log2（EASIX）水平升高与全因死亡率较高相关（P<0.001）。Cox模型和亚组分析进一步显示，log2（EASIX）水平高的组比水平低的组表现出更高的死亡风险（风险比（HR）：1.62，95%可信区间：1.47-1.78），除了急性生理学与慢性健康状况评分系统III（APS III）、体重指数、白细胞计数或白蛋白水平不同外，这一趋势在大多数亚组中持续存在（所有交互作用P<0.05）。随后的中介分析表明，血尿素氮和红细胞分布宽度部分介导了log2（EASIX）与死亡率之间的关系，中介效应分别为17.3%和36.5%。
研究发现，log2（EASIX）水平升高与ICU中HF患者1年全因死亡风险较高存在独立关联，在APS III或白细胞计数水平低、体重指数或白蛋白水平高的患者中观察到更强的效应。这种关联可能部分由血尿素氮和红细胞分布宽度介导。
