血浆致动脉粥样硬化指数与急性心肌梗死患者28天院内死亡率的关联：一项来自电子重症监护病房的回顾性队列研究

Associations of the atherogenic index of plasma with 28-day in-hospital mortality in patients with acute myocardial infarction: a retrospective cohort study from the eICU.

作者信息

Wang Yan, Zhang Hong-Fei

机构信息

Department of Anesthesiology, Zhujiang Hospital, Southern Medical University, Guangzhou, 510280, China.

Institute of Perioperative Medicine and Organ Protection, Zhujiang Hospital of Southern Medical University, Guangzhou, 510280, China.

出版信息

Lipids Health Dis. 2025 Jun 6;24(1):202. doi: 10.1186/s12944-025-02630-6.

DOI:10.1186/s12944-025-02630-6

PMID:40481528

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12142996/

Abstract

BACKGROUND

Despite substantial advancements in treatment strategies, acute myocardial infarction (AMI) continues to exhibit high mortality. Recent research has identified the atherogenic index of plasma (AIP) as a significant measure of cardiovascular outcomes. However, the relationship between the AIP and 28-day mortality during hospitalization in AMI patients remains to be further clarified.

METHODS

A retrospective analysis was conducted based on data sourced from the eICU Collaborative Research Database, encompassing records of 2,517 AMI patients treated in 208 critical care facilities across the U.S. from 2014 to 2015. AIP measurements were derived via log10 (triglyceride/high-density lipoprotein cholesterol) calculations. The primary endpoint was 28-day in-hospital mortality. The analysis utilized adjusted multivariable logistic models with restricted cubic splines for nonlinear associations. Subgroup analyses were performed to evaluate the relationships between AIP and mortality across various demographic and clinical subgroups. These subgroups included age, sex, body mass index (BMI), congestive heart failure, intubation status, mechanical ventilation, pneumonia, diabetes mellitus, antihyperlipidaemic agents, and AMI types.

RESULTS

Among the 2,517 patients enrolled in the cohort (median age: 64.42 years), 138 (5.48%) died within 28 days. The analysis revealed a nonlinear association between the AIP and mortality, presenting a J-curve shape with a threshold of 0.60 (P for nonlinearity = 0.028). Each 0.1-unit elevation above 0.60 corresponded to a 22% increased mortality risk (adjusted OR = 1.22, 95% CI: 1.09-1.36; P = 0.0004). The highest AIP quartile had a 112% greater mortality risk than the lowest quartile (adjusted OR = 2.12, 95% CI: 1.15-3.88; P = 0.0154). Subgroup analyses revealed consistent patterns across the strata.

CONCLUSION

The relationship between the AIP and 28-day hospital mortality in AMI patients may be characterized by a J-shaped curve, where elevated AIP values are associated with increased mortality risk.

摘要

背景

尽管治疗策略取得了重大进展，但急性心肌梗死（AMI）的死亡率仍然很高。最近的研究已将血浆致动脉粥样硬化指数（AIP）确定为心血管疾病预后的一项重要指标。然而，AMI患者住院期间AIP与28天死亡率之间的关系仍有待进一步阐明。

方法

基于eICU协作研究数据库的数据进行回顾性分析，该数据库涵盖了2014年至2015年在美国208个重症监护机构接受治疗的2517例AMI患者的记录。通过log10（甘油三酯/高密度脂蛋白胆固醇）计算得出AIP测量值。主要终点是28天院内死亡率。分析采用调整后的多变量逻辑模型和受限立方样条来分析非线性关联。进行亚组分析以评估AIP与不同人口统计学和临床亚组死亡率之间的关系。这些亚组包括年龄、性别、体重指数（BMI）、充血性心力衰竭、插管状态、机械通气、肺炎、糖尿病、抗高血脂药物和AMI类型。

结果

在纳入队列的2517例患者中（中位年龄：64.42岁），138例（5.48%）在28天内死亡。分析显示AIP与死亡率之间存在非线性关联，呈现J形曲线，阈值为0.60（非线性P值 = 0.028）。高于0.60每升高0.1个单位，死亡风险增加22%（调整后的OR = 1.22，95% CI：1.09 - 1.36；P = 0.0004）。AIP最高四分位数的死亡风险比最低四分位数高112%（调整后的OR = 2.12，95% CI：1.15 - 3.88；P = 0.0154）。亚组分析显示各层之间存在一致的模式。