He Yili, Li Yang, Xiaojin Yuan, Wu Dan, Jiang Wenyan, Xie Xianlong
Department of Critical Care, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, China.
Front Med (Lausanne). 2025 Jul 9;12:1622944. doi: 10.3389/fmed.2025.1622944. eCollection 2025.
EASIX (Endothelial Activation and Stress Index) has been shown to be associated with the prognosis of various diseases in numerous studies, but its relationship with short- and medium-term outcomes in asthma patients admitted to the ICU (Intensive Care Unit) remains unclear.
This retrospective cohort study included 3,737 asthma patients from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database (2008-2019). We calculated log2(EASIX) using platelet count, creatinine, and lactate dehydrogenase levels measured on ICU admission day 1. We analyzed the association between log2(EASIX) and 28-day and 60-day in-hospital mortality using multivariable Cox regression and restricted cubic splines. Proportional hazards assumptions were tested to ensure no time-dependent bias. Subgroup analyses and interaction tests were conducted to verify the stability. ROC (Receiver Operating Characteristic) analysis was performed to assess the prognostic performance of log2(EASIX).
The mean age of patients was 62.5 years, with 289 deaths at 28 days and 432 at 60 days. Higher log2(EASIX) was independently associated with increased mortality at both 28 days [hazard ratio (HR) = 1.14, 95% confidence interval (CI): 1.02-1.27, = 0.017] and 60 days (HR = 1.13, 95% CI: 1.02-1.24, = 0.017). The highest tertile had significantly higher mortality than the lowest tertile (28-day: HR = 1.84, 95% CI: 1.16- 2.90, = 0.009; 60-day: HR = 1.65, 95% CI: 1.08-2.51, = 0.019). A linear relationship was observed between log2(EASIX) and both 28-day and 60-day mortality (P for non-linearity test = 0.29 and 0.633). Subgroup analyses and interaction tests indicated that the association between log2(EASIX) and mortality was stable. The ROC curve analysis revealed AUC (Area Under the Curve) values for 28- and 60-day mortality of 0.892 and 0.881, respectively, with Youden indices of 0.63 and 0.61, indicating good predictive performance.
Elevated log2(EASIX) levels are independently associated with increased in-hospital mortality in patients with asthma. Endothelial Activation and Stress Index show good predictive performance for short- and medium-term mortality in this patient population.
多项研究表明，内皮激活与应激指数（EASIX）与多种疾病的预后相关，但其与入住重症监护病房（ICU）的哮喘患者短期和中期预后的关系仍不明确。
这项回顾性队列研究纳入了医学重症监护信息数据库-IV（MIMIC-IV，2008 - 2019年）中的3737例哮喘患者。我们使用患者入住ICU第1天测得的血小板计数、肌酐和乳酸脱氢酶水平计算log2（EASIX）。我们使用多变量Cox回归和受限立方样条分析log2（EASIX）与28天和60天院内死亡率之间的关联。进行比例风险假设检验以确保无时间依赖性偏倚。进行亚组分析和交互检验以验证稳定性。进行受试者工作特征（ROC）分析以评估log2（EASIX）的预后性能。
患者的平均年龄为62.5岁，28天时有289例死亡，60天时有432例死亡。较高的log2（EASIX）与28天（风险比[HR]=1.14，95%置信区间[CI]：1.02 - 1.27，P = 0.017）和60天（HR = 1.13，95% CI：1.02 - 1.24，P = 0.017）的死亡率增加独立相关。最高三分位数的死亡率显著高于最低三分位数（28天：HR = 1.84，95% CI：1.16 - 2.90，P = 0.009；60天：HR = 1.65，95% CI：1.08 - 2.51，P = 0.019）。观察到log2（EASIX）与28天和60天死亡率之间呈线性关系（非线性检验P值分别为0.29和0.633）。亚组分析和交互检验表明log2（EASIX）与死亡率之间的关联是稳定的。ROC曲线分析显示28天和60天死亡率的曲线下面积（AUC）值分别为0.892和0.881，约登指数分别为0.63和0.61，表明预测性能良好。
log2（EASIX）水平升高与哮喘患者院内死亡率增加独立相关。内皮激活与应激指数在该患者群体中对短期和中期死亡率显示出良好的预测性能。
