Li Yanze, Jin Hongjin, Zhang Guolin, Zhang Yangyou, Ding Yanchun
Departments of Cardiology, The Second Hospital of Dalian Medical University, Dalian, Liaoning, China.
Front Cardiovasc Med. 2025 Aug 21;12:1577385. doi: 10.3389/fcvm.2025.1577385. eCollection 2025.
This study aims to investigate the relation of inflammatory markers to the long-term prognosis of patients with severe non-ST-segment elevation myocardial infarction (NSTEMI) in the intensive care unit (ICU), and to further develop a predictive model for their long-term outcomes.
This study utilized data on eligible NSTEMI patients from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were grouped based on mortality outcomes. The link of inflammatory markers to all-cause mortality (ACM) at 180 and 360 days in the ICU was analyzed through the Cox proportional hazards model and restricted cubic spline (RCS) curves. Survival differences across groups were evaluated via Kaplan-Meier (KM) survival analysis. The sample population was randomized into training and validation sets, and a novel prediction model for the risk of long-term death in ICU-admitted NSTEMI patients was constructed in the training group and validated in both groups.
1,607 NSTEMI patients were encompassed, with ACM rates of 9.7% at 180 days and 12.9% at 360 days. Multivariable Cox proportional hazards model analysis revealed that, in contrast to the low-level group (Q1), higher levels of neutrophil-to-lymphocyte ratio(NLR), neutrophil-to-lymphocyte-platelet ratio (NLPR), red blood cell distribution width (RDW), systemic immune-inflammation index (SII), and systemic inflammation response index (SIRI) were positively associated with ACM within 180 days and 360 days (all < 0.05). The novel predictive model demonstrated high prognostic accuracy for long-term death in ICU-admitted NSTEMI individuals, with areas under the receiver operating characteristic (ROC) curve (AUC) of 0.730 in the training set and 0.751 in the validation set. Calibration curves revealed good concordance between predicted and observed probabilities.
NLR, NLPR, and RDW are independent risk factors for long-term death in the ICU-admitted NSTEMI population. The long-term prognostic prediction model constructed for NSTEMI patients based on the aforementioned associations demonstrates high clinical predictive value.
本研究旨在探讨炎症标志物与重症监护病房（ICU）中重症非ST段抬高型心肌梗死（NSTEMI）患者长期预后的关系，并进一步建立其长期预后的预测模型。
本研究利用重症监护医学信息集市IV（MIMIC-IV）数据库中符合条件的NSTEMI患者的数据。根据死亡率结局对患者进行分组。通过Cox比例风险模型和限制性立方样条（RCS）曲线分析炎症标志物与ICU中180天和360天全因死亡率（ACM）的关联。通过Kaplan-Meier（KM）生存分析评估各组之间的生存差异。将样本人群随机分为训练集和验证集，在训练组中构建了ICU收治的NSTEMI患者长期死亡风险的新型预测模型，并在两组中进行验证。
纳入1607例NSTEMI患者，180天时ACM发生率为9.7%，360天时为12.9%。多变量Cox比例风险模型分析显示，与低水平组（Q1）相比，较高水平的中性粒细胞与淋巴细胞比值（NLR）、中性粒细胞与淋巴细胞血小板比值（NLPR）、红细胞分布宽度（RDW）、全身免疫炎症指数（SII）和全身炎症反应指数（SIRI）与180天和360天内的ACM呈正相关（均<0.05）。该新型预测模型对ICU收治的NSTEMI患者的长期死亡具有较高的预后准确性，训练集中受试者操作特征（ROC）曲线下面积（AUC）为0.730，验证集中为0.751。校准曲线显示预测概率与观察概率之间具有良好的一致性。
NLR、NLPR和RDW是ICU收治的NSTEMI人群长期死亡的独立危险因素。基于上述关联为NSTEMI患者构建的长期预后预测模型具有较高的临床预测价值。
