Su Xiaozhou, Rao Huiqing, Zhao Chunli, Zhang Xianwei, Li Donghua
Department of Cardiology, Minzu Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People's Republic of China.
Department of Internal Medicine, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2025 Jul 18;20:2481-2492. doi: 10.2147/COPD.S516286. eCollection 2025.
Identifying reliable prognostic markers is critical for improving chronic obstructive pulmonary disease (COPD) management. The advanced lung cancer inflammation index (ALI) is a novel marker reflecting inflammation and nutritional status. This study evaluated the association between ALI and all-cause and cause-specific mortality in COPD patients.
Data from 4616 adults with COPD in the National Health and Nutrition Examination Survey (1999-2018) were analyzed. Mortality outcomes were obtained from the National Death Index. Multivariable Cox proportional hazards models and restricted cubic splines assessed the association between the natural logarithm of ALI (lnALI) and mortality. Time-dependent receiver operating characteristic (ROC) curves evaluated the predictive performance of lnALI at 3, 5, and 10 years. Mediation analysis examined whether estimated glomerular filtration rate (eGFR) mediated these associations.
During a median 80-month follow-up, 1202 participants died: 349 from cardiovascular disease, 263 from cancer, and 194 from chronic lower respiratory diseases (CLRD). Higher lnALI was significantly associated with lower risks of all-cause, cardiovascular, and CLRD mortality. L-shaped associations were observed for all-cause and cardiovascular mortality, with inflection points at 4.04 and 3.64, respectively. The AUCs for predicting all-cause mortality were 0.670, 0.646, and 0.634; for cardiovascular mortality, 0.659, 0.653, and 0.629; and for CLRD mortality, 0.770, 0.751, and 0.739 at 3, 5, and 10 years. eGFR partially mediated the associations between lnALI and both all-cause and cardiovascular mortality.
Higher lnALI values were significantly associated with lower risks of all-cause, cardiovascular, and CLRD mortality in COPD patients.
识别可靠的预后标志物对于改善慢性阻塞性肺疾病（COPD）的管理至关重要。晚期肺癌炎症指数（ALI）是一种反映炎症和营养状况的新型标志物。本研究评估了ALI与COPD患者全因死亡率和特定病因死亡率之间的关联。
分析了国家健康与营养检查调查（1999 - 2018年）中4616例成年COPD患者的数据。死亡结局来自国家死亡指数。多变量Cox比例风险模型和受限立方样条评估了ALI的自然对数（lnALI）与死亡率之间的关联。时间依赖性受试者工作特征（ROC）曲线评估了lnALI在3年、5年和10年时的预测性能。中介分析检验了估计肾小球滤过率（eGFR）是否介导了这些关联。
在中位80个月的随访期间，1202名参与者死亡：349例死于心血管疾病，263例死于癌症，194例死于慢性下呼吸道疾病（CLRD）。较高的lnALI与全因、心血管和CLRD死亡率的较低风险显著相关。在全因和心血管死亡率方面观察到L形关联，拐点分别为4.04和3.64。预测全因死亡率的AUC在3年、5年和10年时分别为0.670、0.646和0.634；心血管死亡率分别为0.659、0.653和0.629；CLRD死亡率分别为0.770、0.751和0.739。eGFR部分介导了lnALI与全因和心血管死亡率之间的关联。
较高的lnALI值与COPD患者全因、心血管和CLRD死亡率的较低风险显著相关。
