Chen Zhenzhen, Guo Juan, Chen Haoying, Guan Yingying, Wang Simin, Zhou Jianyu
Department of Ultrasound, Taizhou Central Hospital, Taizhou, Zhejiang Province, China.
Clinical Education Team, GE HealthCare Ultrasound, Wuhan, Hubei Province, China.
PLoS One. 2025 Jun 2;20(6):e0322633. doi: 10.1371/journal.pone.0322633. eCollection 2025.
Transferrin saturation (TS) is associated with mortality across populations, but its nonlinear relationship with all-cause mortality in coronary artery disease (CAD) and the role of systemic inflammation remain unclear. This study explored the association between TS and mortality in CAD patients, focusing on systemic inflammation as a potential mediator.
Data from National Health and Nutrition Examination Survey (NHANES) 1999-2006 included 769 CAD patients (>18 years) with available TS and mortality records. Systemic inflammation markers, such as the systemic immune-inflammation index (SII) and systemic inflammation response index (SIRI), were analyzed. Kaplan-Meier curves, Cox proportional hazards models, and mediation analyses examined the interactions between TS, inflammation, and mortality.
A U-shaped relationship between TS and all-cause mortality was observed, with an inflection point at 30.5%. TS levels ≤30.5% were inversely associated with mortality (HR = 0.98; 95% CI, 0.96-0.99; P < 0.0001), while levels >30.5% increased mortality risk (HR = 1.05; 95% CI, 1.02-1.08; P < 0.001). Systemic inflammation markers (SII/SIRI) were associated with and may partially mediate the relationship between low TS (≤30.5%) and mortality. (mediation proportions: 28.5% and 21.8%, respectively). No mediation effects were found for TS > 30.5%.
TS demonstrates a U-shaped relationship with all-cause mortality in CAD patients. Systemic inflammation is linked to both TS and mortality outcomes, suggesting potential mechanistic interplay. Maintaining TS within 20-30% and addressing inflammation may reduce mortality risk.
转铁蛋白饱和度（TS）与不同人群的死亡率相关，但其与冠状动脉疾病（CAD）全因死亡率的非线性关系以及全身炎症的作用仍不明确。本研究探讨了CAD患者中TS与死亡率之间的关联，重点关注全身炎症作为潜在的中介因素。
1999 - 2006年美国国家健康与营养检查调查（NHANES）的数据包括769例有可用TS和死亡率记录的CAD患者（年龄>18岁）。分析了全身炎症标志物，如全身免疫炎症指数（SII）和全身炎症反应指数（SIRI）。采用Kaplan-Meier曲线、Cox比例风险模型和中介分析来研究TS、炎症和死亡率之间的相互作用。
观察到TS与全因死亡率呈U形关系，拐点为30.5%。TS水平≤30.5%与死亡率呈负相关（HR = 0.98；95% CI，0.96 - 0.99；P < 0.0001），而水平>30.5%则增加死亡风险（HR = 1.05；95% CI，1.02 - 1.08；P < 0.001）。全身炎症标志物（SII/SIRI）与低TS（≤30.5%）和死亡率之间相关，并且可能部分介导了这种关系（中介比例分别为28.5%和21.8%）。未发现TS>30.5%有中介作用。
TS在CAD患者中与全因死亡率呈U形关系。全身炎症与TS和死亡结局均相关，提示可能存在潜在的机制相互作用。将TS维持在20 - 30%以内并控制炎症可能降低死亡风险。
