Low serum albumin: A neglected predictor in patients with cardiovascular disease

The correlation between protein energy wasting and the incidence of main adverse cardiovascular events in adult maintenance hemodialysis patients: a single-center retrospective cohort study

BACKGROUND

Protein energy wasting (PEW) is prevalent in adult maintenance hemodialysis (MHD) patients. Concurrently, cardiovascular diseases (CVD) remain a leading cause of mortality in MHD patients. However, the relationship between PEW and CVD in MHD patients remains unclear.

METHODS

We conducted a retrospective cohort study at Shanghai East Hospital. According to the inclusion and exclusion criteria, a total of 210 adult MHD patients were finally enrolled. Patients were categorized into two groups based on PEW diagnostic criteria, including 122 patients (58.1%) with PEW and 88 patients (41.9%) without PEW. We further analyzed the incidence of major adverse cardiovascular events (MACE) and all-cause mortality in one year, along with their risk factors.

RESULTS

MACE incidence was significantly higher in the PEW group compared with the non-PEW group (p = 0.015). Multivariate Cox regression showed PEW, CVD, high N-terminal pro-B-type natriuretic peptide (NT-proBNP) and low Kt/V urea were the risk factors of MACE. Age ≥ 65 years and high NT-proBNP were the risk factors of all-cause death. Among patients aged ≥ 65 years, PEW was associated with a higher risk of all-cause death (p = 0.043). Total cholesterol < 3.4 mmol/L, albumin < 38 g/L and prealbumin < 280 mg/L were the thresholds for MACE incidence in MHD patients with PEW.

CONCLUSION

Adult MHD patients with PEW had an increased risk of MACE and all-cause mortality. Strategies aimed at optimizing total cholesterol, albumin, and prealbumin levels may improve cardiovascular outcomes in adult MHD patients with PEW.

C-reactive protein-to-albumin ratio is associated with increased depression: An exploratory cross-sectional analysis

BACKGROUND

Depression, prevalent globally, significantly impacts psychological and physical health. As a burgeoning biomarker, C-reactive protein-to-albumin ratio (CAR) offers insights into metabolism-immune status and disease diagnosis. This exploratory investigation seeks to elucidate the relationship between CAR and depression.

METHODS

This cross-sectional investigation utilized data from the National Health and Nutrition Examination Survey (NHANES). Depression was assessed using the PHQ-9 questionnaire. To examine the relationship between CAR and depression risk, we employed a multivariable logistic regression analysis and a restricted cubic spline (RCS) approach. Furthermore, subgroup analyses were performed to validate the consistency of the findings across specific populations.

RESULTS

This investigation enrolled 13,159 adult participants, comprising 8.15 % with depression. Compared with participants without depression, those diagnosed with depression showed a significantly higher CAR level. Each one - unit increase in log10-transformed CAR (log-CAR) was associated with an 58 % increase in the incidence of depression (Odds Ratio = 1.58, 95 % Confidence Interval: 1.33-1.88). A non-linear dose-response relationship was detected between CAR and depression risk (non-linear p < 0.001). Furthermore, the strength of this association persisted undiminished throughout multiple subgroup analyses. Notably, among individuals with a prior history of metabolic diseases, the observed association remained consistent.

CONCLUSIONS

A distinct positive correlation was observed between CAR and depression in U.S. adults. Further large-scale, well-controlled studies are needed to validate the reliability and establish the generalizability of these findings.

Long-term prognostic value of CRP-albumin-lymphocyte index in elderly patients with heart failure with preserved ejection fraction

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) is a complex and heterogeneous clinical condition characterized by the interplay of malnutrition and immune inflammation, especially in elderly patients. The CRP-Albumin-Lymphocyte (CALLY) index, a novel composite indicator reflecting immune inflammation and nutritional status, has not yet been validated as a prognostic tool in elderly patients with HFpEF.

METHODS

This retrospective study included 320 elderly patients hospitalized at the Air Force Medical Center from October 2016 to April 2019 due to HFpEF. Patients were stratified into the all-cause mortality and the survival groups according to follow-up outcomes. Kaplan-Meier analysis and Cox regression were performed to identify risk factors associated with poor prognosis. Additionally, we constructed and evaluated a nomogram based on the CALLY index to predict survival rates.

RESULTS

During the follow-up period, 137 cases (42.81 %) of patients experienced all-cause mortality. Kaplan-Meier survival curves and Cox regression analysis revealed that a lower CALLY index (HR 0.811, 95 % CI 0.714-0.921, P = 0.001) was independently associated with adverse prognosis in elderly patients with HFpEF. The nomogram incorporating the CALLY index exhibited robust predictive performance for predicting 1-year, 3-year, and 5-year survival outcomes.

CONCLUSION

Our findings demonstrate that the CALLY index is an independent predictor of long-term mortality in elderly patients with HFpEF. The developed nomogram incorporating the CALLY index could effectively predict survival probabilities.

Using Risk Factors and Preoperative Inflammatory Markers to Predict 3-Year Mortality in Patients with Unstable Intertrochanteric Femur Fractures

Purpose

Preoperative biomarkers such as the neutrophil‑to‑lymphocyte ratio (NLR), lymphocyte‑to‑C‑reactive protein ratio (LCR), and albumin have been proposed to predict postoperative outcomes in various conditions. This study investigated their association with 3‑year mortality in elderly patients undergoing closed reduction and internal fixation with proximal femoral nail anti‑rotation (CRIF with PFNA) for unstable intertrochanteric femur fractures (UIFF).

Materials and Methods

We retrospectively reviewed 306 patients aged ≥65 years who underwent CRIF with PFNA for UIFF between April 2012 and December 2020. Receiver operating characteristic curve analysis determined optimal cutoffs: LCR 0.441 (sensitivity 48.2%, specificity 78.4%), NLR 3.573 (sensitivity 83.2%, specificity 36.3%), and albumin 3.250 g/dL (sensitivity 52.0%, specificity 76.1%). Patients were dichotomized into low versus high groups for each marker. Univariate and multivariate Cox regression analyses assessed associations with 3‑year mortality.

Results

At 3 years postoperatively, 76 patients (30.4%) had died. Kaplan-Meier survival analysis revealed that patients with low LCR (<0.441) and low albumin (<3.250 g/dL) had significantly shorter survival compared to those with higher values. In contrast, stratification by NLR did not yield significant differences in survival. Multivariate Cox regression identified both low LCR and low albumin as independent predictors of increased 3‑year mortality (P<0.05), whereas NLR showed no prognostic significance.

Conclusion

Preoperative LCR and albumin levels are valuable prognostic biomarkers for 3‑year survival following CRIF with PFNA in elderly UIFF patients. Incorporating these parameters into preoperative risk assessment may improve clinical decision‑making and patient counseling, while NLR appears less predictive.

U-Shaped Relationship of Serum Albumin and Neurological Functional Outcomes After Acute Ischemic Stroke: A Prospective Cohort Study

INTRODUCTION

Several studies indicate that individuals with acute ischemic stroke (AIS) who have low levels of serum albumin (SA) have a dismal prognosis. However, intravenously administering albumin 25% at a dose of 2 g/kg did not lead to improved outcomes for patients with AIS after 90 days. Our objective was to examine the possible correlation between SA levels and stroke outcomes in a prospective cohort investigation.

METHODS

The research included a total of 5111 participants diagnosed with AIS. The correlation between SA level and modified Rankin Scale (mRS) scores 90 days after onset was examined via univariate and multivariate logistic analyses. The relationships were examined employing restricted cubic splines. An investigation was conducted to ascertain the connection between SA levels and neurological functional results by employing mediation analysis, with the mediation impact of low-density lipoprotein (LDL) taken into account. In addition, the subgroup analyses were performed using the logistic regression.

RESULTS

The connection between levels of SA and neurological functional outcomes following AIS exhibited a U-shaped pattern. The likelihood of a negative result dropped significantly with an elevation in SA (per g/L: OR (odds ratio) 0.88; 95% CI (confidence interval) 0.847-0.913) among individuals with SA levels below 42.2 g/L. Conversely, the likelihood of a negative outcome rose with an increase in SA (per g/L: OR 1.033, 95% CI 1.009-1.058) among people with SA levels of 42.2 g/L or above. Comparable findings were seen for mortality outcomes. A mediation study revealed that LDL had a mediating function in the statistical connection between SA levels and neurological functional outcomes, accounting for 12.3% of the connection. No significant interactions were seen in any of the groupings.

CONCLUSION

Among patients with AIS, there was a U-shaped relationship between SA levels at admission and the likelihood of poor outcomes, which was partially mediated by LDL. There is a Graphical Abstract available for this article.

Total bilirubin-to-albumin ratio and short- and long-term all-cause mortality in acute pancreatitis: Evidence from the MIMIC-IV database

BACKGROUND

The Total Bilirubin-to-Albumin Ratio (TBAR) is widely recognized and applied as a biomarker in the prognostic evaluation of various diseases. However, its role in predicting survival outcomes in patients with acute pancreatitis (AP) remains underexplored. This study aims to investigate the association between TBAR levels and mortality rates in AP patients, thereby providing a novel prognostic indicator for clinical use.

METHODS

This study investigates the association between TBAR and mortality in AP patients. We stratified patient data using X-tile software to analyze intergroup differences. Risk factors significantly associated with mortality were identified through univariate and multivariate regression analyses. Kaplan-Meier (KM) analysis evaluated TBAR's impact on survival, while Receiver Operating Characteristic (ROC) analysis assessed its predictive accuracy, sensitivity, and Area Under the Curve (AUC) for mortality. To ensure robustness, we used Restricted Cubic Spline (RCS) modeling to explore non-linear relationships and performed subgroup analyses to verify the consistency of the TBAR mortality association across patient subgroups.

RESULT

This study included 477 patients. Using X-tile software, we set the optimal TBAR cutoff at 1.33 based on 28-day mortality. Patients were categorized into high-risk (TBAR ≥ 1.33) and low-risk (TBAR < 1.33) groups. Elevated TBAR significantly correlated with increased mortality at multiple time points (7, 14, 21, 28, 90, and 365 days; P < 0.05). KM analysis confirmed lower survival rates in the high-risk group at all time points (P < 0.05). ROC analysis showed TBAR's predictive accuracy for mortality was comparable to the SOFA score and superior to other indicators. RCS modeling revealed a linear TBAR mortality relationship. Subgroup analyses showed no significant interactions between TBAR and most subgroups.

CONCLUSION

The TBAR is strongly correlated with short-term and long-term mortality in patients with acute pancreatitis.

Association Between the C-Reactive Protein-Albumin-Lymphocyte (CALLY) Index and Length of Hospital Stay in Patients With Heart Failure

Prolonged hospital stays for patients with heart failure (HF) are associated with increased morbidity and mortality. In this study, we investigated the relationship between the C-reactive protein (CRP)-albumin-lymphocyte (CALLY) index, a new marker in patients with decompensated HF, and the length of hospital stay. Consecutive patients (n = 4745) who were hospitalized with decompensated HF between January 2016 and January 2024 (COVID-19 period was excluded) were included in the study. The CALLY index ([albumin × lymphocyte]/[CRP × 104]) was calculated. A relationship was found between the CALLY index and the length of hospital stay in the patients with HF in linear regression analysis. Also, the CALLY index was an independent predictive variable of the length of hospital stay (odds ratio: 0.327; 95% CI: 0.278-0.385; P < .001). CALLY index value of 0.258 can predict long-term hospitalization with 69.2% sensitivity and 70.1% specificity (area under the curve [AUC]: 0.729, 95% CI = 0.714-0.743, P < .001). In addition, the CALLY index was negatively correlated with the length of hospital stay (r = -.47, P < .001). In conclusion, the CALLY index, an inexpensive and easily measured laboratory variable, may be a valuable for estimating the length of hospital stay in decompensated HF.

Combined Risk Stratification With Patient Characteristics and Biomarkers in Patients Treated With the Impella for Cardiogenic Shock

BACKGROUND

In patients with cardiogenic shock (CS), a percutaneous microaxial ventricular assist device (Impella, Abiomed, Danvers, MA) is a choice for temporary mechanical circulatory support. Given the high morbidity and mortality in this patient population, early risk stratification is relevant when making treatment decisions.

METHODS

Using nationwide registry data between February 2020 and December 2022 in Japan, we included a total of 4122 patients with cardiogenic shock treated with the Impella devices. Using logistic regression analysis, we incorporated patient characteristics and biomarkers to develop a risk-stratifying model for in-hospital mortality. The model was also tested if applicable to composite outcomes of in-hospital death and major complications.

RESULTS

Of the 4122 patients with cardiogenic shock, the Impella was indicated for acute myocardial infarction in 2575 (62.5%). Multivariable analysis identified 4 patient characteristics (age, body mass index, out-of-hospital cardiac arrest, and blood pressure) and 6 biomarkers (lactate, lactate dehydrogenase, creatinine, total bilirubin, albumin, and creatinine kinase) with cutoff values as factors significantly associated with in-hospital mortality. We developed a risk-stratifying model using the 10 variables, which was predictive of in-hospital death (area under the curve, 0.711; P<0.001). Adding biomarkers to patient characteristics significantly improved the diagnostic accuracy (area under the curve, from 0.649 to 0.711; P<0.001). This risk score was also predictive of death and major complications (area under the curve, 0.680; P<0.001).

CONCLUSIONS

In patients with cardiogenic shock treated with the Impella devices, our risk-stratifying system, consisting of 4 patient characteristics and 6 biomarkers, strongly correlated with in-hospital mortality, potentially facilitating clinical decision-making.

Association between controlling nutritional status score and diabetic retinopathy: Data from National Health and Nutrition Examination Survey

ObjectiveThis study aimed to examine the association between controlling nutritional status (CONUT) score and diabetic retinopathy (DR) risk, as well as investigate the impact of CONUT score on mortality risk among DR patients.MethodsThis retrospective study included 5,256 patients with diabetes from National Health and Nutrition Examination Surveys. These participants were classified into two groups: the DR group (n = 641) and the non-DR group (n = 4,615). We used weighted univariate and multivariate logistic regression models to assess the correlation of CONUT score and DR risk. Weighted univariate and multivariate Cox models were adopted to explore the association of CONUT score with all-cause mortality and cardiovascular disease (CVD)-related mortality in patients with DR.Results305 patients diagnosed with DR had died by the end of the follow-up period, among whom 111 individuals died due to CVD. After adjusting all potential confounding factors, there was an association between CONUT score and DR development in patients with diabetes [odd ratio (OR) = 1.18, 95% confidence interval (CI): 1.05-1.33]. Additionally, CONUT score was found to be associated with all-cause mortality of patients with DR [hazard ratio (HR) = 1.11, 95%CI: 1.01-1.22, P= 0.041]. However, there was no significant difference in the CONUT score and CVD-related mortality of patients with DR.ConclusionsCONUT score may be a valuable tool for assessing the risk of developing DR, and predicting prognosis in patients with DR. However, as this was a cross-sectional study, we cannot infer the causality of CONUT score and DR risk.

Transport and action of sesame protein-derived ACE inhibitory peptides ITAPHW and IRPNGL

Vascular endothelial dysfunction is an important pathogenic factor in hypertension, in which angiotensin-converting enzyme (ACE) plays an important role. Peptides that bind to ACE may attenuate vascular endothelial dysfunction by altering the structure of ACE. This study demonstrated that ITAPHW and IRPNGL were resistant to simulated gastrointestinal fluid and were transported across the Caco-2 monolayer via the intercellular space, with ITAPHW showing a high apparent permeability coefficient of (1.44 ± 0.01) × 10-5 cm/s. Subsequently, multispectral analysis and molecular dynamic simulation revealed the stability, conformation changes, and potential binding sites of ITAPHW- and IRPNGL-ACE complex. Furthermore, ITAPHW and IRPNGL alleviated endothelial dysfunction in the angiotensin I-induced human umbilical vein endothelial cells (HUVECs) by reducing ACE activity and the concentrations of angiotensin II and endothelin-1 (ET-1), while promoting the level of nitric oxide (NO), endothelial nitric oxide synthase (eNOS), cyclic guanosine 3', 5'-monophosphate (cGMP), and ACE2.

Association of alkaline-phosphatase/albumin ratio with all-cause mortality in critically ill patients with ischemic stroke: a retrospective study

Background

Recent studies have shown that alkaline phosphatase to albumin ratio (APAR) is a prognostic biomarker for coronary heart disease and cancer. However, the effect of APAR on the prognosis of ischemic stroke (IS) remains unclear. We aimed to assess the association of APAR with all-cause mortality in critically ill patients with IS.

Methods

Critically ill patients with IS were identified from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) Version 3.0 database, and classified into quartiles based on APAR index levels. Clinical outcomes included all-cause mortality at 28-days, 90-days and 365-days after admission. Cox proportional hazards regression analysis and restricted cubic spline method were used to clarify the relationship between APAR index and clinical outcomes in critically ill patients with IS.

Results

A total of 1,690 critically ill patients with IS were selected from the MIMIC-IV database. Multivariate Cox proportional hazard analysis showed that increased APAR index was significantly associated with all-cause mortality. After adjusting for potential confounding factors, patients with higher APAR (Q4: 1.524-2.794) had significantly increased all-cause mortality at 28-days, 90-days, and 365-days after admission (HR 2.05, 95%CI 1.47-2.86, p = 0; HR 2.09, 95%CI 1.53-2.85, p = 0; HR 2.11, 95%CI 1.55-2.87, p = 0). APAR had a linear relationship with 28-days and 365-days mortality (P for non-linearity: 0.098 and 0.051), but a nonlinear relationship with 90-days mortality (P for non-linearity: 0.042). Subgroup analyses further revealed that higher APAR was also associated with increased long-term mortality in IS patients without hypertension, DM, cardiovascular disease, liver disease or CKD. In addition, we did not observe any interaction between subgroup variables and APAR.

Conclusion

A higher APAR index was significantly associated with increased all-cause mortality at 28-days, 90-days and 365-days after admission for critically ill patients with IS. The APAR index may help identify patients with IS at high risk of all-cause death.

Nonlinear association between serum albumin levels and all-cause mortality in elderly patients with chronic aortic regurgitation

BACKGROUND

Low serum albumin levels are established predictors of adverse outcomes in various cardiovascular conditions. However, the role of serum albumin in mortality among elderly patients with chronic aortic regurgitation (AR) has not been thoroughly investigated. This study aims to assess the relationship between serum albumin levels and mortality in this specific patient population.

METHODS

Our analysis included 873 elderly AR patients from the China Valvular Heart Disease study, with baseline serum albumin measured at enrollment. Mortality outcomes were monitored for two years post-enrollment, employing a Cox proportional hazards model with a two-piecewise Cox proportional hazards framework to investigate the nonlinear relationship between serum albumin levels and all-cause mortality.

RESULTS

During the 2-year follow-up period, we observed 63 all-cause deaths. The association between serum albumin levels and all-cause mortality displayed an approximating L-shaped curve, indicating a mortality threshold at 35 g/L. For serum albumin levels below 35 g/L, each 1 g/L decrease was associated with a 25% higher risk of all-cause mortality (HR = 1.25, 95% CI: 1.07-1.45). In contrast, no significant change in mortality risk was observed when serum albumin levels were greater than or equal to 35 g/L. Moreover, when serum albumin is classified as hypoproteinemia (serum albumin < 35 g/L), the higher risks of all-cause death were observed in hypoproteinemic patients (HR = 2.93, 95% CI: 1.50-5.74). More importantly, the association between serum albumin and death was significantly stronger in overweight/obese patients (≥ 24 kg/m2 vs. < 24 kg/m2, P interaction = 0.006).

CONCLUSIONS

In elderly patients with AR, serum albumin levels showed an approximating L-shaped relationship with all-cause death, with thresholds of 35 g/L. Body mass index was significant effect modifiers of the association. These results suggest that serum albumin, as an inexpensive and readily available biochemical marker, may further improve the stratified risk of mortality in older AR patients.

Association of blood urea nitrogen to albumin ratio with mortality in acute pancreatitis

Blood urea nitrogen (BUN) and serum albumin (ALB) are strongly associated with the prognosis in acute pancreatitis (AP). The BUN/ALB ratio (BAR) reflects renal, nutritional, inflammatory, and endothelial functions. In this study, we investigated the association between the BAR and all-cause mortality in critically ill patients with AP. Using data from the Medical Information Market for Intensive Care (MIMIC-IV) database, we conducted a retrospective cohort analysis. The relationship between BAR and mortality was assessed through Kaplan-Meier survival curves, restricted cubic spline models, and multivariable Cox proportional hazards regression. The predictive capacity of BAR for 30-day and 1-year mortality was evaluated using receiver operating characteristic analysis. Our study included 780 participants, with 30-day and 1-year mortality rates of 12.6% and 23.6%, respectively. Higher BAR values were associated with poorer survival outcomes. BAR demonstrated superior predictive performance achieving an area under the curve of 0.74, surpassing BUN, ALB, and SOFA scores. The Cox model indicated a significant independent association between elevated BAR and increased mortality risk, with hazard ratios of 1.43 (95% CI 1.20-1.70) for 30-day mortality and 1.37 (95% CI 1.17-1.60) for 1-year mortality. Stratified and sensitivity analyses confirmed the robustness of these findings. Our results suggest that elevated BAR is associated with poor prognosis in critically ill patients with AP and may serve as a valuable tool for early risk stratification and for assessing both short- and long-term prognosis.

Comparing machine learning models for predicting preoperative DVT incidence in elderly hypertensive patients with hip fractures: a retrospective analysis

Hip fractures in the elderly present a significant public health challenge globally, especially among patients with hypertension, who are at an increased risk of developing preoperative deep vein thrombosis (DVT). DVT not only heightens surgical risks but also severely impacts the rehabilitation and quality of life of patients. Early risk assessment and management in this population are therefore critically important. This study aimed to develop and validate a machine learning-based predictive model to enhance the accuracy of predicting preoperative DVT in elderly patients with hypertension undergoing hip fracture surgery, thereby optimizing preoperative assessment and management. A retrospective study design was employed, selecting patients with hypertension and hip fractures treated at the First Hospital of Qinhuangdao from January 2018 to December 2022. Key predictive factors were identified using LASSO regression, and logistic regression was utilized to construct both a nomogram and an online interactive nomogram. Various machine learning algorithms were also employed to build predictive models. The contribution of variables in the models was explained using SHAP values, and model performance was evaluated through ROC curves, AUC values, and other statistical methods. The study included 637 patients, with LASSO regression selecting key variables that were further used to develop a logistic regression-based nomogram and its online version, providing intuitive tools for assessing DVT incidence. Among the multiple machine learning predictive models, the LightGBM model exhibited the best performance, achieving an AUC of 0.910. The model's effectiveness and reliability were confirmed through decision curves, calibration plots, and precision-recall curves. SHAP value analysis highlighted the significance of factors such as age, time from injury to hospital admission, atrial fibrillation, C-reactive protein, hypoalbuminemia, and D-dimer levels in the predictions, enhancing the model's transparency and interpretability. This study successfully developed a logistic regression-based nomogram and multiple machine learning algorithms to predict the risk of preoperative DVT in elderly hypertensive patients with hip fractures. The nomogram provides clinicians with a practical tool for rapid risk assessment, thus optimizing patient management and prognosis. The LightGBM model, recommended for its high predictive accuracy, along with SHAP value analysis, enhanced the transparency and clinical applicability of the models. These findings not only deepen our understanding of DVT incidence factors but also demonstrate the potential of machine learning technologies in enhancing medical decision-making and advancing precision medicine.

Lactate dehydrogenase to albumin ratio and poor prognosis after thrombolysis in ischemic stroke patients: developing a novel nomogram

BACKGROUND

Ischemic stroke (IS) is associated with high disability and mortality. This study aimed to identify the prognostic predictors and develop a nomogram for a prediction model for ischemic stroke patients after thrombolysis.

METHODS

We retrospectively analyzed data from 359 IS patients who underwent thrombolysis. Clinical characteristics, laboratory parameters, and prognosis data were collected. One-third of the subjects were randomly selected as a validation set (n = 108) for internal validation. Logistic regression analysis was used to derive independent risk indicators. A nomogram was constructed using these indicators, and the performance of the nomogram was assessed by the Area Under the Curve (AUC) of the Receiver Operating Characteristic (ROC). The agreement of the model predictions with actual observations was assessed via calibration curves, and the clinical utility of the nomogram was assessed via decision curve analysis.

RESULTS

Multivariate logistic regression analysis showed that age, leukocytes, Lactate Dehydrogenase to Albumin Ratio (LAR) and NIHSS were independent predictors of three-month post-thrombolysis prognosis in IS patients. We created a nomogram based on the weighting coefficients of these factors. The AUC curves showed that our model including age, leukocytes, LAR and NIHSS was more accurate in predicting prognosis than a single factor. The calibration curves showed a good fit between actual and predicted probabilities in both the training and validation groups.

CONCLUSION

LAR has a good predictive power for the prognosis of IS patients 3 months after thrombolytic therapy and can be used as a new clinical indicator to establish a practical nomogram.

The Naples Prognostic Score as a Predictor of High-Risk Coronary Plaques Detected on Coronary CT Angiography in Chronic Coronary Syndrome

Background/Objectives: High-risk coronary plaques (HRP), identified through coronary CT angiography (CCTA), are closely linked to cardiovascular events. Nutritional status and systemic inflammation may play a critical role in the development of HRP. The Naples Prognostic Score (NPS), which integrates markers of nutritional status and systemic inflammation, has emerged as a potential predictor of outcomes in various cardiovascular conditions. This study aimed to investigate the association between NPS and HRP as assessed by CCTA. Methods: A retrospective analysis was performed on 753 patients with chronic coronary syndrome (CCS) who underwent CCTA. The patients were categorized into two groups: those with high-risk plaques (HRP present), and those without (HRP absent). Additionally, they were further stratified based on their NPS. Univariable and multivariable logistic regression analyses were conducted to identify the most relevant clinical factors and the role of NPS in relation to HRP and the need for revascularization. Results: The study population had a mean age of 56.9 ± 10.7 years, with 40% being female. The NPS was significantly higher in the HRP-present group compared to the HRP-absent group (p = 0.001). Stratification by NPS groups revealed that higher NPS groups were associated with increased coronary artery calcification scores (CAC) and revascularization rates (p < 0.001 and p = 0.003, respectively). Multivariable regression analysis demonstrated a significant association between NPS and HRP (OR = 1.228, 95% CI: 1.013-1.489, p = 0.036). Conclusions: The NPS is independently associated with the presence of high-risk coronary plaques in patients with chronic coronary syndrome. NPS may serve as a complementary risk stratification tool by reflecting systemic inflammation and nutritional status. Further prospective studies are needed to validate its prognostic value.

The relationship between blood urea nitrogen to serum albumin ratio and cardiovascular diseases, cardiovascular mortality, and all-cause mortality in patients with diabetes mellitus

Background

The relationship between the Blood Urea Nitrogen to Albumin Ratio (BAR) and cardiovascular diseases in diabetes, as well as cardiovascular and all-cause mortality, is not yet entirely understood. This study aimed to examine the correlation between the serum urea nitrogen to albumin ratio and cardiovascular diseases, cardiovascular mortality, and all-cause mortality in diabetes.

Methods

A total of 7043 adult diabetes patients were included from the NHANES database from 2001 to 2018. The relationship between BAR and cardiovascular diseases, cardiovascular mortality and all-cause mortality in patients with diabetes mellitus was verified using baseline characteristic analysis, multivariate logistic regression analysis, multivariate Cox proportional hazards model, Kaplan-Meier (K-M) analysis, smoothed fitted curves, and subgroup analysis.

Results

Results of the logistic regression analysis indicated a substantial positive association, between the BAR and the risk of cardiovascular disease in individuals with diabetes (HR, 1.09 [95% CI 1.06-1.12], p < 0.001). Cox regression analysis revealed a substantial positive association between the BAR and the risk of cardiovascular (OR, 1.13 [95% CI, 1.10-1.17], p < 0.001) and all-cause mortality (OR, 1.12 [95% CI 1.11-1.14], p < 0.001) in diabetes. The restricted cubic spline (RCS) curves indicated a non-linear relationship between BAR and the risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality in diabetes (p < 0.01). The receiver operating characteristic (ROC) curves demonstrated that the BAR had superior predictive performance for cardiovascular risk (AUC: 0.648), cardiovascular mortality (AUC: 0.618), and all-cause mortality (AUC: 0.674) compared to the body mass index (BMI) (cardiovascular risk AUC: 0.525, cardiovascular mortality AUC: 0.563, all-cause mortality AUC: 0.571) and the weight-adjusted-waist index (WWI) (cardiovascular risk AUC: 0.579, cardiovascular mortality AUC: 0.497, all-cause mortality AUC: 0.570). These results underscore the enhanced ability of the BAR to discriminate between positive and negative outcomes, making it a more effective predictor than WWI. Kaplan-Meier analysis further verified the predictive capacity of BAR, for cardiovascular mortality and all-cause mortality in diabetes patients. Subgroup analysis revealed consistent associations between BAR and a variety of subgroups.

Conclusion

The incidence of cardiovascular disease, cardiovascular mortality, and all-cause mortality was substantially elevated, in patients with diabetes with a higher BAR level. Cardiovascular disease, cardiovascular mortality, and all-cause mortality may be more prevalent among diabetic patients with elevated BAR levels. BAR is a novel marker for the prediction of cardiovascular disease, cardiovascular mortality, and all-cause mortality in diabetes.

Association between neutrophil-percentage-to-albumin ratio and periodontitis: insights from a population-based study

Background

Periodontal diseases, characterized by the loss of tooth-supporting structures, are highly prevalent in the general population. The Neutrophil-Percentage-To-Albumin Ratio (NPAR) has been identified as a promising biomarker for systemic inflammation, but its relationship with periodontal disease has not been thoroughly investigated. Despite growing interest in its role in other chronic conditions, the specific connection between NPAR and periodontal disease remains underexplored and requires further examination to understand its potential clinical applications.

Methods

A population-based analysis was performed using data from the National Health and Nutrition Examination Survey (NHANES), with a total of 8,389 participants included with complete full-mouth periodontal examination, NPAR related index and covariates. NPAR was employed as the primary independent variable, the periodontitis and clinical periodontal parameters were set to the outcomes along with tooth counts and functional dentition as the sensitivity outcomes. To investigate its association between NPAR and periodontitis, weighted multivariate linear and logistic regression analyses were conducted. Sensitivity and replication analyses were also carried out to assess the robustness and reliability of the findings.

Results

This population-based study revealed a significant association between elevated NPAR levels and a higher likelihood of periodontitis, increased attachment loss (AL), and probing depth (PD). After full adjustment for potential confounders, NPAR was significantly associated with periodontitis (OR = 1.04, p = 0.005), attachment loss (β = 0.03, p < 0.001), and probing depth (β = 0.02, p < 0.001). Furthermore, the highest quartile of NPAR remained significantly associated with periodontitis (OR = 1.34, p = 0.010), AL (β = 0.15, p < 0.001) and PD (β = 0.09, p < 0.001). A significant trend was observed, with periodontitis strongly associated with increasing NPAR levels. These findings were further validated by the sensitivity analyses with decreased tooth counts (β = -0.08, p < 0.005) and the lower incidence of functional dentition (OR = 0.96, p = 0.030). Additionally, the replication analysis also enhanced the roundness of the results (OR = 1.07, p < 0.001).

Conclusion

This population-based study demonstrated a statistically significant positive relationship between NPAR and the prevalence of periodontitis, NPAR has been recognized as a potential biomarker for periodontal disease. Additional longitudinal research are needed to confirm these findings and investigate the clinical implications of NPAR in managing periodontal conditions.

Association between the red blood cell distribution width-albumin ratio and cardiovascular diseases

Background

Cardiovascular disease (CVD) is the major cause of death globally, ranking first in terms of morbidity and mortality among non-communicable diseases. Red blood cell distribution width (RDW) and albumin (ALB) possess potential clinical application values. Moreover, the ratio of the two, namely RAR, might hold more advantages in disease diagnosis. However, the relationship between RAR and CVD in the general population has not been studied yet.

Method

This represents a study encompassing 12,765 subjects. Logistic regression, Cox regression, restricted cubic splines, mediation analysis, and receiver operating characteristic curves were utilized to probe into the association between RAR and CVD, cardiovascular mortality rate and all-cause mortality rate.

Result

A total of 12,765 participants were enrolled in this study, The mean age was 47.47 ± 16.33 years. Logistic regression revealed that RAR was positively correlated with the CVD. Furthermore, COX regression also illustrated that RAR was non-linearly and positively associated with both all-cause mortality rate and cardiovascular mortality rate (all-cause mortality: p-non-linear = 0.0322; cardiovascular mortality: p-non-linear = 0.0280). Additionally, the ROC results indicated that at various time points, RAR exhibited a stronger discriminatory capacity for cardiovascular mortality rate compared to all-cause mortality rate. HbA1c partially mediated the relationship between RAR and CVD. Subgroup analysis and interaction findings demonstrated that hypertension and race exerted a significant influence on the relationship between RAR and both all-cause mortality rate and cardiovascular mortality rate.

Conclusion

RAR was significantly linked to an elevated risk of CVD. The higher the RAR level, the greater the cardiovascular mortality rate and all-cause mortality rate. Thus, RAR could potentially be an independent risk factor for CVD. This underscores the crucial value of RAR in the discrimination and management of CVD.

Liver biomarkers as predictors of prognosis in heart failure with preserved ejection fraction: a systematic review and meta-analysis

BACKGROUND

Heart failure with preserved ejection fraction (HFpEF) accounts for 50% of heart failure cases, with increasing prevalence due to aging and risk factors such as hypertension and obesity. Liver dysfunction is common in HFpEF and may impact prognosis. This systematic review and meta-analysis aimed to evaluate the prognostic value of liver function markers (albumin, bilirubin, AST, ALT, ALP) in HFpEF patients.

METHODS

A systematic search of PubMed, Embase, Web of Science, and Scopus was conducted for studies assessing the association of liver markers with adverse outcomes in HFpEF. The primary outcome was a composite of heart failure-related hospitalization or death. Hazard ratios (HR) were pooled using a random-effects model, and heterogeneity was assessed using the I² statistic.

RESULTS

Twenty studies involving 30,623 patients were included. Serum albumin, the main marker of our study, was significantly associated with a reduced risk of adverse outcomes in a meta-analysis of 16 studies (HR 0.71, 95% CI: 0.61-0.83; I² = 87%). After excluding outliers, heterogeneity decreased (I² = 23%), and the association remained significant (HR 0.75, 95% CI: 0.69-0.82). Although no significant associations were found for AST, ALT, ALP, or bilirubin with adverse outcomes, the limited number of studies for these markers may have contributed to the lack of statistical significance.

CONCLUSION

Higher serum albumin levels predict better outcomes in HFpEF, while other liver function markers showed limited prognostic utility. Serum albumin may serve as a valuable marker for risk stratification in HFpEF.

Factors Associated With Sacubitril/Valsartan Continuation and the Methods of Combining Heart Failure Medications in Patients With Heart Failure

BACKGROUND

Sacubitril/valsartan (SV) is recommended for patients with heart failure (HF). In addition, a combination of 4 HF medications, including SV, is recommended in patients with HF with reduced ejection fraction (HFrEF). However, evidence on the characteristics of patients who could continue SV and its initiation methods is limited.

OBJECTIVE

To investigate the factors associated with SV continuation and methods of combining HF medications.

METHODS

This retrospective cohort study included HF patients who initiated with SV at our institution. The endpoint was SV continuation for 6 months after its initiation. Multivariate analysis was used to extract factors associated with SV continuation. The relationship between the methods of combining HF medications (renin-angiotensin system inhibitors, beta-blockers, mineralocorticoid receptor antagonists, or sodium-glucose cotransporter 2 inhibitors), including the number of HF medications, their combination patterns, and the timing of their initiation, and SV continuation was examined in patients with HFrEF.

RESULTS

Of 186 eligible patients, 68.8% had HFrEF, and 79.0% continued SV for 6 months. Significant factors associated with SV continuation were albumin ≥ 3.5 g/dL (odds ratio, 4.81; 95% confidence interval, 2.19-10.59), body mass index (BMI) ≥ 18.5 kg/m2 (4.17; 1.10-15.85), and systolic blood pressure (SBP) ≥ 110 mmHg (2.66; 1.12-6.28). In patients with HFrEF, the proportion of HF medications not initiated simultaneously with SV was significantly higher in the continuation group than in the discontinuation group (67.3% vs 33.3%, P = 0.002). The number of HF medications and their combination patterns were not significantly associated with SV continuation.

CONCLUSION AND RELEVANCE

Albumin, BMI, and SBP are useful indicators for selecting patients who are likely to continue SV. In addition, initiating only SV without simultaneously initiating other HF medications in patients with HFrEF may lead to SV continuation.

Application of Metabolomics and the Discovery of Potential Serum Biomarkers for Diuretic Resistance in Heart Failure

Background

Diuretic resistance (DR) is characterized by insufficient fluid and sodium excretion enhancement despite maximum loop diuretic doses, indicating a phenotype of refractory heart failure (HF). Recently, metabolomics has emerged as a crucial tool for diagnosing and understanding the pathogenesis of various diseases. This study aimed to differentiate diuretic-resistant patients from non-resistant HF to identify biomarkers linked to the emergence of DR.

Methods

Serum samples from HF patients, both with and without DR, were subjected to non-targeted metabolomic analysis using liquid chromatography-tandem mass spectrometry. Metabolite variations between groups were identified using principal component analysis and orthogonal partial least-square discriminant analysis. Metabolic pathways were assessed through the Kyoto Encyclopedia of Genes and Genomes database enrichment analysis, and potential biomarkers were determined using receiver operating characteristic curves (ROCs).

Results

In total, 192 metabolites exhibited significant differences across the two sample groups. Among these, up-regulation was observed in 164 metabolites, while 28 metabolites were down-regulated. A total of 28 pathways involving neuroactive ligand-receptor interaction and amino acid biosynthesis were affected. The top five metabolites identified by ROC analysis as potential DR biomarkers were hydroxykynurenine, perillic acid, adrenic acid, 5-acetamidovalerate, and adipic acid.

Conclusions

Significant differences in metabolite profiles were observed between the diuretic-resistant and non-diuretic-resistant groups among patients with HF. The top five differentially expressed endogenous metabolites were hydroxykynurenine, perillic acid, adrenic acid, 5-acetamidovalerate, and adipic acid. The metabolic primary pathways implicated in DR were noted as amino acid, energy, and nucleotide metabolism.

Clinical Trial Registration

This study was registered with the China Clinical Trials Registry (https://www.chictr.org.cn/hvshowproject.html?id=197183&v=1.7, ChiCTR2100053587).

A novel indicator of all-cause mortality in acute coronary syndrome: the CALLY index

AIMS

This study aimed to identify the prognostic significance of the C-reactive protein-albumin-lymphocyte (CALLY) index for predicting all-cause mortality in acute coronary syndrome (ACS) patients who have undergone primary percutaneous coronary intervention (pPCI) for revascularization.

MATERIALS AND METHODS

505 patients who presented with ACS and underwent pPCI were retrospectively included in this single center study. CALLY index and other five prognostic scores were calculated. The median follow-up was 40 months. All-cause mortality was defined as the primary endpoint.

RESULTS

The median age of the patients was 59 years, 23.4% were female. The CALLY index was categorized into low (<0.7) and high (≥0.7). Age (p = 0.038), concomitant atrial fibrillation (p = 0.023), previous CABG (p = 0.001), ACE-I/ARB/ARNI use (p = 0.015), diuretic use (p = 0.021), and a low-CALLY index (p < 0.001) were identified as independent predictors of all-cause mortality in multivariate cox regression analysis. When compared to other prognostic scores according to AUC in ROC analysis, the CALLY index demonstrated the best ability to predict all-cause mortality. Additionally, patients with a high-CALLY index exhibited significantly better survival outcomes compared to those with a low-CALLY index (log-rank:p < 0.001).

CONCLUSIONS

CALLY index can be utilized as a novel prognostic score for predicting all-cause mortality in ACS patients who have undergone pPCI.

Incremental Prognostic Value of Admission Blood Glucose to Albumin Ratio in Patients with Acute Coronary Syndrome: A Retrospective Observational Cohort Study

Background

Blood glucose and serum albumin can be biomarkers at admission since they are easily accessible and demonstrate correlations with cardiovascular diseases. The predictive ability of the admission blood glucose to albumin ratio (AAR) for long-term prognosis in patients with acute coronary syndrome (ACS) and its potential to elevate the predictive value of the Global Registry of Acute Coronary Events (GRACE) risk score in ACS patients post-percutaneous coronary intervention (PCI) remains unknown. Hence, this study aimed to investigate the incremental prognostic value of the AAR in patients with ACS undergoing PCI.

Methods

A rigorous development-validation approach was implemented to optimize the GRACE risk score, utilizing the AAR parameter in 1498 patients suffering from ACS after PCI at the Third People's Hospital of Chengdu, Sichuan, China.

Results

Over a median of 31.25 (27.53, 35.10) months, the incidence of major adverse cardiac events (MACEs), defined as a composite outcome encompassing all-cause death, cardiac death, nonfatal myocardial infarction, nonfatal stroke, and unplanned repeat revascularization, was higher in individuals with higher AARs. Thus, the AAR was an independent predictor of long-term prognosis in ACS patients undergoing PCI (HR, 1.145; 95% CI: 1.045-1.255; p = 0.004). The integration of the AAR score with the GRACE risk score increased the C statistic from 0.717 (95% CI: 0.694-0.740) to 0.733 (95% CI: 0.690-0.776) (p < 0.01).

Conclusions

The AAR is an independent predictor of prognosis in ACS patients and significantly increased the predictive value of the GRACE risk score.

Predictive value of uric acid to albumin ratio for carotid atherosclerosis in type 2 diabetes mellitus: A retrospective study

BACKGROUND

This study aims to evaluate the correlation between the uric acid (UA) to albumin (ALB) ratio (UAR) and carotid atherosclerosis (CAS) in patients with type 2 diabetes mellitus (T2DM), as well as to assess the predictive value of UAR for CAS.

METHODS

A cross-sectional, single-center study was conducted, retrospectively analyzing hematological parameters from 259 T2DM patients with CAS (T2DM-CAS) and 131 T2DM patients without CAS (T2DM-WCAS). Carotid intima-media thickness (IMT) and carotid plaques (CAP) were measured using Doppler ultrasound.

RESULTS

The UAR level in the T2DM-CAS group was significantly higher than that in the T2DM-WCAS group (P <  0.001). Multivariate logistic regression analysis revealed that UAR is an independent risk factor for T2DM-CAS (P <  0.001). The area under the ROC curve (AUC) for UAR in predicting T2DM-CAS was 0.712, with a Youden index of 0.278.

CONCLUSION

High levels of UAR are closely associated with the occurrence of T2DM-CAS and may serve as a useful biomarker for predicting T2DM-CAS.

Associations of Naples prognostic score with stroke in adults and all cause mortality among stroke patients

This study seeks to assess the associations of Naples Prognostic Score with stroke in adults and all cause mortality among stroke patients. We analyzed data from 44,601 participants in the 2005-2018 National Health and Nutrition Examination Survey (NHANES). The Naples Prognostic Score (NPS) was derived from total cholesterol, serum albumin, neutrophil-to-lymphocyte ratio (NLR), and lymphocyte-to-monocyte ratio (LMR). Participants were classified into three groups based on their NPS. Stroke incidence was determined through self-reported questionnaires, and mortality data were diligently tracked using the National Death Index. We investigated the relationship between NPS and stroke prevalence using multiple logistic regression analysis. To explore the association between NPS and all cause mortality in stroke survivors, we applied Kaplan-Meier survival analysis and Cox proportional hazards models. Furthermore, we conducted a detailed subgroup analysis to assess interaction effects on all cause mortality risk within this population. The median age of the participants was 50.00 years [interquartile range: 35.00-64.00], with males comprising 49.36% of the study. The overall stroke prevalence was 3.93%. Participants were categorized into three groups based on their NPS: 6,328 (18.1%) in Group 0 (NPS 0), 24,015 (68.8%) in Group 1 (NPS 1 or 2), and 4,580 (13.1%) in Group 2 (NPS 3 or 4). After adjusting for covariates, individuals in Group 2 exhibited a significantly higher stroke prevalence compared to Group 0, with an odds ratio (OR) of 1.82 [95% confidence interval: 1.48-2.23]. Among the 1372 patients with a history of stroke, with a median follow-up duration of 5.94 years, we utilized Cox proportional hazards models to assess the relationship between NPS and all cause mortality risk. The analysis revealed that, after adjusting for covariates, stroke patients in Group 2 faced a significantly elevated risk of all cause mortality (hazard ratio [HR] = 2.21 [95% confidence interval: 1.44-3.11]) compared to those in Group 0. Subsequent subgroup analyses to explore interaction effects on all cause mortality risk among stroke patients shown no significant interactions (p for interaction > 0.05). This study indicate a positive correlation between NPS and the risk of stroke in adults, as well as all cause mortality in stroke patients.

Plant-based diets and all-cause and cause-specific mortality among patients with cardiovascular disease: a population-based cohort study

The role of plant-based diets in preventing premature death among patients with cardiovascular disease (CVD) has remained unknown. We aim to explore the association of plant-based dietary patterns with all-cause and cause-specific mortality among patients with CVD. A total of 10 824 participants with CVD at the baseline were followed up in the UK Biobank. We constructed three types of plant-based diet indexes [an overall plant-based diet index (PDI), a healthful PDI (hPDI), and an unhealthful PDI (uPDI)] by assigning different weights to various food groups from web-based 24 h dietary recall questionnaires. The national death registry documented the primary causes of death. The Cox proportional hazards regression models were utilized to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality. Over a median of 9.5 years follow-up, 1273 death cases were ascertained. After multivariable adjustment, PDI had an inverse correlation with all-cause mortality [HRT3 vs. T1: 0.81 (0.70-0.94), Ptrend = 0.005] and marginal inverse association with CVD mortality [HRT3 vs. T1: 0.78 (0.61-0.99), Ptrend = 0.038], while uPDI displayed a positive correlation with all-cause mortality [HRT3 vs. T1: 1.33 (1.16-1.53), Ptrend < 0.001], CVD, and cancer mortality. Additionally, in mediation analyses, serum concentration of C-reactive protein (CRP) accounted for 6.2%, 4.0%, and 5.1% of the relationship between uPDI and all-cause, CVD, and cancer mortality, respectively. No significant associations were detected between hPDI and mortality. Our findings support dietary guidelines that recommend limiting the consumption of unhealthy plant-based foods.

Predictive model development combining CT-FFR and SYNTAX score for major adverse cardiovascular events in complex coronary artery disease

Patients with complex coronary artery disease (CAD) often have poor clinical outcomes. This study aimed to develop a predictive model for assessing the 1-year risk of major adverse cardiovascular events (MACE) in patients with stable complex CAD, using retrospective data collected from January 2020 to September 2023 at Guangzhou Red Cross Hospital. The goal was to enable early risk stratification and intervention to improve clinical outcomes. A total of 369 patients were included and randomly divided into a training set (70%) for model development and a validation set (30%) for performance evaluation. Predictive factors were selected using least absolute shrinkage and selection operator (LASSO) regression, followed by logistic regression to construct the model and create a nomogram. Seven independent predictors were identified: functional SYNTAX score (OR 1.257, 95% CI 1.159-1.375), low-density lipoprotein cholesterol (LDL-C, OR 1.487, 95% CI 1.147-1.963, /1mmol/L), left ventricular ejection fraction (LVEF, OR 0.934, 95% CI 0.882-0.985, /1%), albumin (OR 0.889, 95% CI 0.809-0.974, /1g/L), pulse pressure ≥ 72 mmHg (OR 3.358, 95% CI 1.621-7.118), angiotensin-converting enzyme 2 (ACE2) ≥ 27.5 U/L (OR 2.503, 95% CI 1.290-5.014), and diabetes (OR 2.261, 95% CI 1.186-4.397). Among these, the functional SYNTAX score was the strongest predictor. The area under the receiver operating characteristic curve (AUC) was 0.843 for the training set and 0.844 for the validation set, with Youden indices of 0.561 and 0.601, respectively. Calibration curves and decision curve analysis demonstrated good predictive accuracy and clinical utility of the model. These findings suggest that the developed model has strong predictive performance for 1-year MACE risk in patients with complex CAD, and early risk stratification and intervention based on this model may improve clinical outcomes.

Construction of a prediction model for coronary heart disease in type 2 diabetes mellitus: a cross-sectional study

Type 2 diabetes mellitus (T2DM), as a globally prevalent metabolic disorder, is continuously rising in prevalence and significantly increases the risk of developing coronary heart disease (CHD). Studies have shown that the risk of CHD is higher in T2DM patients compared to those without diabetes, making early identification and prevention essential. Therefore, establishing an effective prediction model to identify high-risk individuals for CHD among T2DM patients is crucial. This study aims to develop and validate a prediction model for coronary heart disease in patients with type 2 diabetes mellitus, accurately identifying high-risk individuals to support early intervention and personalized treatment. The study included 423 patients with type 2 diabetes mellitus (T2DM) who were hospitalized in the endocrinology department of a tertiary hospital in Anhui Province between February 1, 2023, and February 1, 2024. Based on the presence of hypertension, patients were divided into a T2DM with coronary heart disease (CHD) group (193 patients) and a T2DM group (230 patients). Data were collected through questionnaires and clinical indicators. Univariate and multivariate logistic regression analyses were used to identify significant predictors, and the model was validated. Model performance was evaluated using the ROC curve and AUC value. Hypertension, smoking, neuropathy, vascular complications, cerebral infarction, bilateral lower extremity arteriosclerosis, microalbuminuria, and elevated uric acid levels. were identified as significant predictors for T2DM with hypertension. The AUC of the prediction model was 0.83, indicating good predictive performance. The prediction model developed in this study effectively identifies high-risk patients with T2DM and CHD, providing a reliable tool for clinical use. This model facilitates early intervention and personalized treatment for hypertension, smoking, neuropathy, vascular complications, cerebral infarction, bilateral lower extremity arteriosclerosis, microalbuminuria, and elevated uric acid levels, improving overall health outcomes for patient.

Hs-CRP/ALB Levels Are Associated With Poor Long-term Prognosis in Patients With STEMI Undergoing Percutaneous Coronary Intervention

Research has explored the relationship between inflammatory biomarkers and cardiovascular diseases, highlighting the potential prognostic significance of the high-sensitivity C-reactive protein (hs-CRP)/albumin (ALB) ratio. However, it remains unclear whether this ratio is associated with adverse prognosis in patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). This retrospective cohort study included 752 STEMI patients undergoing PCI at Tianjin Chest Hospital between January 2017 and December 2018. During a median follow-up of 52 months, 183 cases (24.0%) experienced major adverse cardiovascular events (MACE) events and 75 cases (10.0%) died. Cox regression analysis demonstrated that hs-CRP/ALB was independently associated with MACE as both a continuous (hazard ratio [HR] 1.152, 95% CI 1.097-1.210, P < .001) and categorical variable (HR 1.257, 95% CI 1.084-1.458, P = .027). Similar findings were observed for all-cause mortality (HR 1.119, 95% CI 1.058-1.183, P < .001; HR 2.228, 95% CI 1.009-4.920, P = .032). The receiver operating characteristic (ROC) curve indicated that hs-CRP/ALB levels have predictive capability for overall mortality in patients (the area under the curve [AUC] = 0.68). hs-CRP/ALB levels independently correlate with poor long-term prognosis in STEMI patients with prior PCI.

Development and validation of a risk prediction model for 30-day readmission in elderly type 2 diabetes patients complicated with heart failure: a multicenter, retrospective study

Background

Elderly type 2 diabetes mellitus (T2DM) patients complicated with heart failure (HF) exhibit a high rate of 30-day readmission. Predictive models have been suggested as tools for identifying high-risk patients. Thus, we aimed to develop and validate a predictive model using multicenter electronic medical records (EMRs) data to estimate the risk of 30-day readmission in elderly T2DM patients complicated with HF.

Methods

EMRs data of elderly T2DM patients complicated with HF from five tertiary hospitals, spanning 2012 to 2023, were utilized to develop and validate the 30-day readmission model. The model were evaluated using holdout data with the area under the receiver operating characteristic curve (AUROC), calibration curves, decision curve analysis (DCA), and clinical impact curves (CIC).

Results

A total of 1899 patients were included, with 955, 409, and 535 in the derivation, internal validation, and external validation cohorts, respectively. Pulmonary infections (odds ratio [OR]: 3.816, 95% confidence interval [CI]: 2.377-6.128, P < 0.001), anti-hypertensive drug use (OR: 5.536, 95% CI: 1.658-18.486, P = 0.005), and neutrophil percentage-to-albumin ratio (NPAR) (OR: 1.144, 95% CI: 1.093-1.197, P < 0.001) were independent predictors of 30-day readmission risk. AUROC in the derivation, internal validation, and external validation cohorts were 0.782 (95% CI: 0.737-0.826), 0.746 (95% CI: 0.654-0.838), and 0.753 (95% CI: 0.684-0.813), respectively. The calibration curve, DCA results, and CIC results indicated that the model also possessed good predictive power. Additionally, an operation interface on a web page (https://cqykdxtjt.shinyapps.io/readmission/) was created for clinical practitioners to apply.

Conclusion

A 30-day readmission risk prediction model was developed and externally validated. This model facilitates the targeting of interventions for elderly T2DM patients complicated with HF who are at high risk of an early readmission.

Prognostic Nutritional Index as a Predictor of Recurrence in Patients Undergoing Pericardiocentesis: A Retrospective Analysis

Objective: Recurrence of pericardial effusion is possible despite the successful completion of pericardiocentesis and initiation of treatment. Predicting recurrence is important for determining treatment strategies. This study aimed to examine the factors that influence the recurrence of effusion in patients who had undergone pericardiocentesis. Method: A total of 113 patients with the evidence of tamponade or pericardial effusion over 10 mm were included in the study. The mean follow-up period was 49 months. Patients with and without recurrent effusion were divided into two groups. PNI calculation (PNI = 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (mm3) formula was used. Results: Recurrent pericardial effusion was observed in 30 patients during the follow-up period. There was no difference in age, gender, hypertension, LVEF%, hypertension, and appearance of fluid when the two groups were compared. There was a difference in PNI score and presence of malignancy between the two groups (p: 0.031 and 0.042, respectively). Multivariate logistic regression showed that malignancy and PNI score were independent predictors of recurrence in patients undergoing pericardiocentesis (p: 0.015 and p: 0.014, respectively). In the ROC analysis, PNI < 40.75 predicts recurrent pericardial effusion with 75% sensitivity and 58% specificity (AUC: 0.626, 95% CI: 0.509-0.742, and p=0.042). Conclusion: Predictors of recurrence in patients undergoing pericardiocentesis are important for patient follow-up. PNI is a simple and useful score that can be used to predict recurrent pericardial effusion.

The Naples prognostic score as a new predictive index of severe abdominal aortic calcification: a population-based study

Purpose

Abdominal aortic calcification (AAC) is related to inflammation and nutritional status. The Naples prognostic score (NPS) is an innovative biological marker capable of reflecting systemic inflammation and nutritional status. This research seeks to investigate the correlation of NPS with severe abdominal aortic calcification (SAAC).

Methods

The research evaluated data obtained from the National Health and Nutrition Examination Survey (NHANES) conducted between 2013 and 2014. The variables were filtered utilizing the Least Absolute Shrinkage and Selection Operator (LASSO) regression. Weighted logistic regression models were employed to examine the association of NPS with SAAC. The predictive value of NPS for the risk of SAAC was assessed utilizing the receiver operating characteristic (ROC) curve. A subgroup analysis was conducted to assess the strength and reliability of the research findings.

Results

The research encompassed 2,854 participants, among whom 303 (11.87%) exhibited SAAC. The outcomes of multivariate weighted logistic regression revealed that participants with a NPS of 3-4 points was positively correlated with SAAC in comparison to the control group [odds ratio (OR) = 2.07, 95% confidence interval (95%CI): 1.17-3.67]. The area under the curve (AUC) for predicting the risk of SAAC using NPS was 0.635. The subgroup analysis results indicated that there was no significant difference noted in the association of NPS with SAAC across various population subgroups.

Conclusion

A positive association of NPS with SAAC has been observed in this research. This study offers valuable insights into the prevention and diagnosis of SAAC. Future longitudinal studies are warranted to confirm causative relationships and assess the role of NPS in clinical decision-making for SAAC.

Association of body composition with left ventricular remodeling and outcomes in diabetic heart failure with reduced ejection fraction: assessment of sarcopenic obesity using cardiac MRI

BACKGROUND

Obesity is common in the heart failure (HF) population and is regarded as an important risk factor for developing HF. Greater skeletal muscle mass has shown to be the underlying protective factor against cardiac failure. Since diabetic mellitus (DM) can impair muscle protein metabolism, leading to skeletal muscle wasting, accompanied by adipose tissue accumulation, sarcopenic obesity (SO) may be a high-risk phenotype with poor outcomes in this specific population, especially in HF with reduced ejection fraction (HFrEF). Thus, the aim of this study was to clarify the clinical profiles, left ventricular (LV) remodeling, and prognostic implications of SO in patients with HFrEF and DM.

METHODS

A total of 283 patients who underwent cardiac MRI were included. Thoracic skeletal muscle index (SMI) was served as a surrogate of skeletal muscle mass. Patients were stratified according to the median thoracic SMI (42.75 cm2/m2) and body mass index (25 kg/m2). Obesity in conjunction with a SMI lower than the median is referred to as SO. The LV volume and function, as well as the systolic strain, were measured. The clinical characteristics and cardiovascular outcomes (heart failure readmission, cardiovascular mortality and heart transplantation) were recorded.

RESULTS

Patients with SO had a greater level of amino-terminal pro-B-type natriuretic peptide and were more likely than nonsarcopenic patients with obesity to present with hypoproteinemia. Among patients with obesity, those with sarcopenia displayed greater LV expansion and more profound LV dysfunction, together with an increase in LV mass. During a median follow-up duration of 35.1 months, a total of 73 (25.8%) subjects reached the composite endpoint, with a worst outcome in the group of patients with SO (log-rank P = 0.04). Multivariable Cox analysis revealed that patients with SO had an approximately 3-fold greater risk of experiencing adverse outcomes than did those with neither sarcopenia nor obesity (hazard ratio: 3.03, 95% confidence interval: 1.39 to 6.63; P = 0.005).

CONCLUSIONS

SO is a potentially high-risk phenotype with adverse LV remodeling and poor clinical outcomes in diabetic patients with HFrEF that may require more attention.

Associations of prognostic nutritional index with cardiovascular all-cause mortality among CVD patients with diabetes or prediabetes: evidence from the NHANES 2005-2018

Background

Immunonutritional status is linked to the prognosis of cardiovascular disease (CVD) and diabetes, but the relationship between immunonutritional disorders and clinical outcomes in CVD patients with diabetes is unclear. This study aims to investigate the association of the novel immunonutritional indicator of prognostic nutritional index (PNI) with all-cause and CVD mortality in diabetic and prediabetic CVD patients.

Method

This is an open-cohort study involving 1,509 CVD patients with diabetes or prediabetes collected from The National Health and Nutrition Examination Survey (NHANES) and initially interviewed between 2005 and 2018. Subjects were followed up until on December 31, 2019. Mortality outcomes and causes of death were obtained from National Death Index (NDI) records. We used restricted cubic spline (RCS) and maximally selected rank statistics method (MSRSM) to assess the nonlinearity of the PNI-mortality association and determine the optimal PNI cutoff for survival outcomes. Additionally, weighted multivariable Cox regression models, subgroup analyses, and interaction tests were employed to examine the relationship between PNI and all-cause and CVD mortality. The predictive accuracy of PNI for survival outcomes was evaluated using time-dependent receiver operating characteristic curve (ROC) analysis.

Results

During a median follow-up of 61 months (interquartile range, 33-103 months), 507 of the 1509 (33.60%) diabetic or prediabetic CVD patients died. A negative and nonlinear association between PNI and all-cause/CVD mortality was identified by RCS analysis in all patients. In the fully-adjusted Cox regression model, in the entire cohort, higher PNI (≥46.5) was significantly associated with reduced risks for all-cause and CVD mortality. A consistent association between PNI and all-cause/CVD mortality was observed in diabetic CVD patients, but not in prediabetic CVD patients. No significant interaction between PNI and other covariates was observed (all P interaction >0.05). Time-dependent ROC curve revealed that the areas under the curve (AUC) of PNI for 1-, 3-, 5-, and 10-year survival rates were 0.66, 0.66, 0.66, and 0.67 for all-cause mortality, and 0.72, 0.70, 0.72, and 0.69 for CVD mortality, respectively.

Conclusion

Increased PNI is significantly associated with reduced risks for all-cause and CVD mortality in diabetic or prediabetic CVD patients, especially for diabetic CVD patients.

Interpretable prediction of acute ischemic stroke after hip fracture in patients 65 years and older based on machine learning and SHAP

BACKGROUND

Hip fracture and acute ischemic stroke (AIS) are prevalent conditions among the older population. The prognosis for older patients who experience AIS subsequent to hip fracture is frequently unfavorable.

METHODS

Patients were categorized into the AIS group and the non-AIS group. A predictive model was developed using six different machine learning algorithms. The SHapley Additive exPlanations (SHAP) method was then utilized to provide both local and global explanations. We performed adjusted mediation analyses. Furthermore, a nomogram was created to present the outcomes obtained from the LASSO regression examination. The main objective was to ascertain influential elements that can predict the occurrence of AIS. To alleviate the influence of confounding variables, propensity score matching was utilized to compare the occurrence of additional complications. Survival was compared by Kaplan-Meier methods.

RESULTS

The AUC of 6 ML models ranged from 0.73 to 0.87. The SVM model exhibited the greatest efficacy in forecasting AIS among older individuals with hip fractures. The leading 6 variables in the support vector machines (SVM) model were identified as systemic inflammatory response index (SIRI), carotid atherosclerosis, prior stroke, C-reactive protein (CRP), fibrinogen (FIB), and hypertension. The leading 2 variables in SHAP were identified as FIB at admission and SIRI index. There wasn't potential mediating effect of admission FIB between the SIRI index and AIS. There were statistically significant differences between the two groups in survival (P=0.003).

CONCLUSIONS

The model displayed good performance for prediction of AIS after hip fracture in patients 65 years and older, which might facilitate to establishment of a better clinical assessment plan.

The relationship between neutrophil percentage-to-albumin ratio and slow and normal coronary flow phenomenon

BACKGROUND

The relationship between several inflammatory biomarkers and slow coronary flow phenomenon(SCFP) has been reported. However, the correlation between neutrophil percentage-to-albumin ratio (NPAR) and SCFP is lacking. In this study, we aimed to assess the relationship between NPAR and SCFP.

METHODS

A total of 228 patients were enrolled in this study according to the diagnostic and exclusion criteria. 76 patients were included in the SCFP group, and 152 age-matched patients were included in the normal coronary flow (NCF) group. The baseline data, laboratory parameters and coronary angiography were recorded and compared.

RESULTS

The values of NPAR were significantly higher in the SCFP group than those in the NCF group (1.78[1.58,1.88] vs. 1.42[1.24,1.66], P < 0.001). NPAR elevated as the number of vessels involved SCFP increased. In the multiple logistic regression tests, NPAR was an independent predictor of SCFP (OR: 1.239, 95%CI: 1.124-1.367, p < 0.001). The receiver operating characteristic curve analysis showed that the cutoff value of NPAR for predicting SCFP was > 1.57 with a 76.3% sensitivity and 67.1% specificity [the area under the curve (AUC) = 0.727, 95%CI: 0.659-0.795, p < 0.001]. NPAR had a better predictive value of SCFP than neutrophil percentage, but not albumin.

CONCLUSION

Elevated NPAR may be an independent and valuable predictor of SCFP.

Assessing the Predictive Impact of Preoperative Lactate Dehydrogenase to Albumin Ratio on Outcomes Following Coronary Artery Bypass Graft Surgery

Background: The lactate dehydrogenase to albumin ratio (LAR) is a novel inflammatory marker and a potential predictor of mortality in various conditions. No research has yet examined LAR's impact on mortality in cardiac surgery patients. This study evaluated LAR's role in predicting mortality and complications in isolated coronary artery bypass grafting (CABG) patients. Methods: A retrospective analysis of 377 CABG patients (93 women, 24.7%; 284 men, 75.3%; mean age 65.9 years) from 2020 to 2024 was conducted. Data included demographics, preoperative characteristics, surgical details, and postoperative outcomes, along with ICU and hospital length of stay (LOS). Results: In-hospital mortality was 6.1% (n = 23). Independent predictors were low preoperative ejection fraction (EF) (OR: 0.96, p = 0.024), baseline LAR (OR: 1.08, p = 0.000), LOS-ICU (OR: 1.1, p = 0.000), postoperative ventricular tachycardia (OR: 37.9, p = 0.006), and acute renal failure (OR: 12.1, p = 0.000). Mortality cases had a higher median LAR than survivors (8.6 vs. 5.2, p = 0.000). Elevated LAR correlated with lower preoperative EF (r = -0.227, p = 0.000), longer LOS-ICU (r = 0.17, p = 0.001), and longer LOS-hospital (r = 0.208, p = 0.000). A LAR cut-off of 7.097 predicted mortality (AUC: 0.823, sensitivity 78.3%, specificity 77.1%). Elevated LAR values were observed in all groups with postoperative complications (p < 0.05), indicating its consistent association with negative outcomes. Conclusions: LAR is a valuable predictor of in-hospital mortality and postoperative complications in CABG patients. Elevated LAR is associated with longer ICU/hospital stays and poorer outcomes. Preoperative LAR assessment can guide risk stratification, forecast mortality, and inform surgical planning and treatment strategies.

Association between preoperative serum albumin levels and length of stay in elderly patients with hip fractures: A nonlinear relationship

Previous studies have provided relatively limited evidence in examining the impact of preoperative serum albumin levels on the length of hospital stay (LOS) in patients with hip fractures. This study aimed to elucidate the association between preoperative serum albumin levels and LOS in elderly patients with hip fractures. This retrospective cohort study included 1444 elderly patients undergoing surgical treatment for hip fractures at the Second People's Hospital of Shenzhen from January 2012 to December 2021. The main exposure variable was serum albumin level, and the outcome variable was LOS. A generalized additive model was used to identify the nonlinear relationship between serum albumin levels and LOS, and saturation effects were calculated using a two-piecewise linear regression model. Subgroup analysis was conducted using stratified logistic regression. The median LOS was 10 (8-15) days among all included patients. After adjusting for potential confounding factors (age, sex, comorbidities, hypertension, coronary heart disease, stroke, diabetes, duration of surgery, surgical method, intraoperative blood loss, red cell distribution width, estimated glomerular filtration rate, blood urea nitrogen, postoperative pneumonia, and transfer to ICU), a nonlinear relationship was found between serum albumin levels and LOS, with a turning point at 3.06. On the left side of the turning point, the effect size was not statistically significant (β = 1.84, 95% CI -1.00 to 4.68, P = .2042), while on the right side of the turning point, for every 1 g/dL increase in albumin, LOS decreased by 1.05 days (β = -1.05, 95% CI -1.90 to -0.20, P = .0162). A nonlinear relationship was observed between preoperative serum albumin levels and LOS in elderly patients with hip fractures. When albumin levels were >3.06 g/dL, they were negatively correlated with LOS. This has important implications for clinicians in the development of nutritional improvement strategies.

Antioxidant Properties of Albumin and Diseases Related to Obstetrics and Gynecology

Albumin, the most abundant protein, contributes significantly to various physiological processes, indicating its multifunctional properties. It has drawn the attention of scientists and physicians because of its primary role in maintaining osmotic pressure and involvement in transporting numerous small molecules, including hormones, fatty acids, and drugs. A growing body of evidence has recently illustrated an additional aspect of albumin's antioxidant properties. Therefore, based on recent research findings, this review article delves into the molecular and biochemical aspects of albumin's antioxidative capabilities. We highlight the multifaceted significance of proteins in oxidative stress and their relation to pathologies in obstetrics and gynecology. In particular, we focused on preeclampsia, in which oxidative stress is closely involved in the pathogenesis, and renal dysfunction leads to increased albumin excretion into the urine, resulting in hypoalbuminemia. In addition, we discussed the role of albumin in preeclampsia pathogenesis, diagnosis, and patient prognosis. Understanding the antioxidant properties of albumin opens new avenues for therapeutic intervention and sheds light on novel strategies for combating preeclampsia associated with oxidative damage. In this study, we employed the PubMed database to search for articles that assessed the antioxidant properties of albumin, with a specific focus on obstetric diseases, particularly preeclampsia. The last update of the search was conducted in November 2024.

Risk factors and characteristics of preoperative heart failure in elderly patients with hip fracture and the influence of anemia on prognosis

BACKGROUND

Patients with preoperative acute heart failure (AHF) after hip fracture in the elderly have a worse prognosis. We aim to investigate the characteristics, risk factors and postoperative complications of elderly patients with hip fracture complicated with preoperative AHF. We also looked at the effect of the severity of anemia at admission on the prognosis of the above people.

METHODS

A retrospective study of hip fracture patients (aged ≥ 65) admitted to the Department of Geriatric Orthopaedics, Third Hospital, Hebei Medical University, was conducted from January 2018 to October 2020. We used univariate and multivariate logistic regression to assess risk factors for preoperative AHF. The Kaplan-Meier survival curve shows the relationship between the severity of anemia on admission and all-cause mortality in elderly hip fracture patients with preoperative AHF.

RESULTS

Out of the 1092 patients, 503 had preoperative AHF and the incidence of it in hip fracture patients was 46.1%. Age, coronary artery disease, chronic atrial fibrillation, Age-Adjusted Charlson Comorbidity Index (ACCI), admission anemia, admission albumin < 40 g/dl, and admission C-reactive protein (CRP) were all significantly different between those with AHF and those without. Multivariate logistic regression analysis revealed that age ≥ 80 years (OR 1.740, 95% CI 1.309-2.313), coronary artery disease (OR 1.417, 95% CI 1.017-1.975), chronic atrial fibrillation (OR 4.010, 95% CI 1.757-9.152), admission anemia (OR 1.433, 95% CI 1.051-1.953) are the independent risk factors for preoperative AHF in elderly patients with hip fracture (p < 0.05). The HF group exhibited a higher incidence of postoperative complications, such as anemia, arrhythmia, NOAF (new-onset atrial fibrillation), AIS (acute ischemic stroke), electrolyte disturbance and hypoproteinemia. The moderate-to-severe anemia group had a higher incidence of postoperative complications, including deep vein thrombosis of the lower limbs, NOAF, and hypoproteinemia, as well as all-cause mortality.

CONCLUSION

Older patients combined with admission anemia, coronary artery disease, chronic atrial fibrillation are more likely to have preoperative AHF after hip fracture. For such patients, early and effective identification and strengthening perioperative management can avoid the occurrence of adverse events. For patients with moderate and severe anemia at admission, timely intervention is recommended to reduce postoperative complications and mortality.

Current Strategies for Atrial Fibrillation Prevention and Management: Taming the Commonest Cardiac Arrhythmia

Atrial fibrillation (AF) is the commonest cardiac arrhythmia, constituting a major cause of morbidity and mortality, with an age-dependent incidence and prevalence ranging from 1-2% in the general population to ~10% in persons aged >60 years. The global prevalence of AF is rapidly increasing, mostly due to the aging population. If not properly and timely managed, this arrhythmia adversely affects left ventricular function, increases the risk of stroke five-fold, impairs quality of life, and shortens longevity. There is a genetic, hence non-modifiable, predisposition to the arrhythmia, while several life-style and cardiometabolic inciting factors, such as hypertension, heart failure, coronary disease, metabolic syndrome, alcohol use, and thyroid disorders, can be addressed, attesting to the importance of a holistic approach to its management. Thromboembolism is a serious consequence of AF, which could lead to a disabling stroke or have a lethal outcome. The risk of a thromboembolic complication can be estimated as based on a scoring system that takes into consideration the patient's age, previous thromboembolic events, and clinical comorbidities. In addition, rapid AF could affect cardiac performance, leading to an elusive type of arrhythmia- induced cardiomyopathy and heart failure with grave consequences if undetected and untreated. Furthermore, AF may cause silent brain infarcts and/or its hemodynamic perturbations can account for a type of dementia that needs to be taken into account, emphasizing the need for AF screening and prevention strategies. All these issues are herein detailed, the causes of the arrhythmia are tabulated, and an algorithm illustrates our current approach to its management.

Clinical features and prognostic factors of cardiorenal anemia syndrome in China: a retrospective single-center study

BACKGROUND

There is little research on cardiorenal anemia syndrome (CRAS) in China. This study was to describe the characteristics of patients with CRAS and to explore risk factors of all-cause death.

METHODS

A total of 81,795 patients were hospitalized from August 2012 to August 2021 in the nephrology department and cardiology department, of which 820 patients with CRAS were recruited into this study. The 820 patients were divided into three groups based on New York Heart Association (NYHA) functional class: a NYHA Class II group (n = 124), a NYHA Class III group (n = 492), and a NYHA Class IV group (n = 204). Demographics and laboratory tests were collected and risk factors of all-cause death were analyzed. The primary endpoint of the study was all-cause death.

RESULTS

820 patients were included, with a median age of 65.00 (51.00-75.00) years and 61.2% were men. The median follow-up was 27.0 (13.0-51.0) months. 416 (50.7%) patients died during follow-up. Age, smoking history, cerebral infarction, NYHA functional class, albumin, serum creatinine (SCr), left ventricular end-diastolic diameter (LVEDD), and left ventricular ejection fraction (LVEF) remained independent predictors of all-cause mortality risk in patients with CRAS (P < 0.05) after adjusting to the potential confounders.

CONCLUSIONS

In patients with CRAS, older age, smoking history, and more advanced systolic heart failure and renal failure correlated with worse clinical outcomes at follow-up.

An inflammatory prognostic scoring system to predict the risk for adults with acute coronary syndrome undergoing percutaneous coronary intervention

BACKGROUND

This study aimed to investigate the value of the inflammatory prognostic score (IPS) system for predicting the risk of all-cause major adverse cardiovascular events (MACEs) and cardiac-related MACEs in patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI).

METHODS

Overall, 1384 patients with ACS who underwent PCI between January 2016 and December 2018 were consecutively enrolled. Demographic characteristics and related laboratory results for 11 inflammatory markers were collected. Least absolute shrinkage and selection operator (LASSO)-COX regression, Kaplan- Meier, restricted cubic spline (RCS), receiver operator characteristic curve (ROC), time-dependent ROC, and Cox hazard proportional regression were applied to explore the values of individual and IPS parameters.

RESULTS

Based on the LASSO analysis, albumin (ALB) and monocyte-to-lymphocyte ratio (MLR) were included in the construction of the IPS system. A higher IPS was associated with a significantly worse long-term prognosis in the Kaplan-Meier analysis (log-rank p < 0.001). The Cox proportional hazards model demonstrated that the IPS was an independent risk factor for patients with ACS undergoing PCI. In addition, the IPS remained an independent prognosticator compared to the lowest tertiles. The time-dependent ROC showed satisfactory values for the long-term prognosis of different MACEs. Additionally, RCS showed a linear association with IPS, all-cause MACEs, and cardiac-related MACEs.

CONCLUSIONS

A higher IPS level was associated with an increased risk in patients with ACS undergoing PCI, suggesting that the IPS may be a useful method for risk stratification in the assessment of the long-term prognosis of ACS.

Exploring the link between the Naples prognostic score and the cardio-ankle vascular index

Introduction

Background: the Naples Prognostic Score is a novel scoring system designed to provide a comprehensive assessment of patients' inflammation and nutritional status. Aim: our aim was to investigate the correlation between the Naples Prognostic Score and arterial stiffness, a factor known to be linked with heart failure and acute coronary syndrome. Materials and methods: this prospective study included 142 consecutive patients without a history of cardiovascular disease, inflammatory disease, immunological disease, malignancy, or comorbid conditions other than hypertension. Patients were categorized into two groups based on their Naples Prognostic Scores: Group 1 (score of 0-2) and Group 2 (score of 3 or 4). Arterial stiffness was assessed using the Cardio-Ankle Vascular Index (CAVI) measured with the VaSera VS-1000 device. CAVI values were compared between the groups. Results: the mean age of the patients was 54 ± 9 years. Group 1 comprised 114 (80.3 %) patients, while Group 2 comprised 28 (19.7 %) patients. There were no significant differences in demographic data between the groups (p > 0.005). Additionally, there were no statistically significant differences between Group 1 and Group 2 regarding left CAVI (7.92 ± 1.45 vs. 8.72 ± 1.85; p = 0.295), right CAVI (7.89 ± 1.52 vs. 8.67 ± 1.34; p = 0.332), or left or right ankle brachial index (p > 0.005). Conclusions: despite previous studies indicating a significant association between the Naples Prognostic Score and heart failure or acute coronary syndrome, our study did not observe a significant correlation between this score and arterial stiffness assessed by CAVI.

Postprocedural Contrast-Associated Acute Kidney Injury and Prognosis of Patients Undergoing Recanalization of Chronic Total Occlusions

Introduction: Percutaneous coronary intervention (PCI) for chronic total occlusions (CTOs) requires advanced techniques and prolonged procedural efforts, often necessitating high contrast volumes, which may increase the risk of contrast-associated acute kidney injury (CA-AKI). However, evidence suggests that factors beyond contrast exposure contribute to CA-AKI, though data specific to CTO PCI remain limited. Methods: Patients undergoing contemporary CTO PCI at our university-affiliated tertiary care center were enrolled. CA-AKI was defined according to KDIGO criteria, and patients were stratified based on the presence of postprocedural CA-AKI. Baseline and procedural characteristics, including osmotic factors, were compared between the groups. The primary outcome was all-cause mortality at one year, and the secondary outcome was all-cause mortality at three years. Results: A total of 145 patients were enrolled, with a mean age of 67 years, and 75% were male. Baseline creatinine levels, electrolytes, and osmotic factors did not differ significantly between groups. Lesion parameters and J-CTO scores were also comparable. The contrast volume and procedural duration were numerically higher in patients who developed CA-AKI. Patients with CA-AKI received a higher radiation dose (22.1 vs. 13.2 Gy·cm2, p = 0.041). CA-AKI emerged as an independent predictor of all-cause mortality at one year (adjusted HR 5.3, CI [1.52-18.51], p = 0.009) but not at three years. Conclusions: In this retrospective analysis, CA-AKI was an independent predictor of all-cause mortality at one year following CTO PCI but lost predictive value at three years. Baseline renal function and contrast volume alone did not predict CA-AKI. Instead, procedural complexity, reflected by higher radiation exposure, was associated with an elevated risk of CA-AKI.

Prognostic Value of Four Objective Nutritional Indices in Predicting Long-Term Prognosis in Elderly Patients with Atrial Fibrillation: A Retrospective Cohort Study

Background

Several objective and comprehensive nutritional assessment methods have been used for predicting adverse outcomes in elderly patients with various diseases. However, their predictive value for long-term adverse outcomes in elderly patients with atrial fibrillation (AF) is unclear. This study aimed to explore the prognostic significance of the four nutritional indices, namely Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status (CONUT), and High-Sensitivity Modified Glasgow Prognostic Score (HS-mGPS), in evaluating the long-term prognosis in elderly patients with AF.

Methods

This retrospective study was conducted at a single center and included a total of 261 elderly patients with AF from December 2015 to December 2021. Patients were divided into all-cause death and survival groups based on the follow-up results. Kaplan-Meier analysis and COX regression were conducted to explore the relationship between all-cause mortality and nutritional scores. In addition, Receiver Operating Characteristic (ROC) curves were used to compare the predictive value of the four nutritional screening tools for the endpoint event.

Results

During the follow-up period, 119 cases (45.59%) of all-cause mortality were recorded. The cumulative incidence of all-cause death was significantly higher in participants with a lower PNI, lower GNRI, higher CONUT, and higher HS-mGPS levels. And the low PNI (HR 1.325, 95% CI 1.032-2.857, P=0.025) and the high HS-mGPS (HR 2.166, 95% CI 1.281-4.326, P=0.023) groups were independently and significantly associated with increased risk of all-cause death analyzed by multivariate COX regression. Additionally, PNI showed the best area under the curve value (AUC: 0.696, 95% CI 0.632-0.760 P < 0.001) for the prediction of all-cause mortality compared with the other nutritional indices.

Conclusion

Among the four nutritional risk screening tools, PNI might be a simple and useful indicator in predicting the long-term prognosis of elderly patients with AF.

Is the hemoglobin, albumin, lymphocyte, and platelet (HALP) score a novel biomarker for predicting mortality in patients with middle cerebral artery infarctions undergoing mechanical thrombectomy?

BACKGROUND

The hemoglobin, albumin, lymphocyte, and platelet (HALP) score, easily calculated parameter, indicating systemic inflammation and nutritional status INTRODUCTION: In this study, we used the HALP score in patients with acute ischemic stroke (AIS) undergoing mechanical thrombectomy (MT) to predict 90-day mortality.

METHOD

122 patients with AIS who underwent either MT or MT and tissue plasminogen activator (tPA) for middle cerebral artery (MCA) M1 occlusion. The HALP score was calculated, demographic data, modified Rankin Scale (mRS) score, and mortality status in retrospectively reviewed. The effectiveness of the HALP score in predicting mortality within 90 days was assessed using the receiver operating characteristic ( ROC) curves. The optimal cutoff value for HALP was 13.10.

RESULTS

A HALP score <13.10 increased the risk of death within 90 days and was associated with a higher incidence of large artery thrombosis. Cardioembolism and hyperlipidemia were more common in patients with high (>13) HALP scores. In addition to the HALP score, the length of hospital stay, 24-h National Institutes of Health Stroke Scale score (NIHSS), number of days of intubation, acute physiologic assessment and chronic health evaluation (APACHE) II score, and symptom-to-groin time were statistically significant risk factors for mortality within 90 days.

DISCUSSION

The HALP score is an easily calculated, inexpensive, and noninvasive parameter that can be used to predict mortality in patients with MCA M1 occlusion undergoing reperfusion therapy. Low HALP scores indicate a poor prognosis. Thus, there is a relationship between the HALP score and survival.

Serum Albumin-to-Creatinine Ratio: A Novel Predictor of Pulmonary Infection in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

AIM

In patients with ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI), a low serum albumin-to-creatinine ratio (sACR) is associated with elevated risk of poor short- and long-term outcomes. However, the relationship between sACR and pulmonary infection during hospitalization in patients with STEMI undergoing PCI remains unclear.

METHODS

A total of 4,507 patients with STEMI undergoing PCI were enrolled and divided into three groups according to sACR tertile. The primary outcome was pulmonary infection during hospitalization, and the secondary outcome was in-hospital major adverse cardiovascular events (MACE) including stroke, in-hospital mortality, target vessel revascularization, recurrent myocardial infarction, and all-cause mortality during follow-up.

RESULTS

Overall, 522 (11.6%) patients developed pulmonary infections, and 223 (4.9%) patients developed in-hospital MACE. Cubic spline models indicated a non-linear, L-shaped relationship between sACR and pulmonary infection (P=0.039). Receiver operating characteristic curve analysis indicated that sACR had good predictive value for both pulmonary infection (area under the ROC curve [AUC]=0.73, 95% CI=0.70-0.75, P＜0.001) and in-hospital MACE (AUC=0.72, 95% CI=0.69-0.76, P＜0.001). Kaplan-Meier survival analysis indicated that higher sACR tertiles were associated with a greater cumulative survival rate (P＜0.001). Cox regression analysis identified lower sACR as an independent predictor of long-term all-cause mortality (hazard ratio [HR]=0.96, 95% CI=0.95-0.98, P＜0.001).

CONCLUSIONS

A low sACR was significantly associated with elevated risk of pulmonary infection and MACE during hospitalization, as well as all-cause mortality during follow-up among patients with STEMI undergoing PCI. These findings highlighted sACR as an important prognostic marker in this patient population.

Impact of Baseline Hypoalbuminemia on Long-Term Survival Following Acute Myocardial Infarction According to Body Mass Index

Serum albumin and body mass index (BMI, kg/m2) have been associated with outcomes following acute myocardial infarction (AMI). Aiming to assess whether the mortality risk inflicted by hypoalbuminemia (<3.5 g/dL) in this context is influenced by BMI, we conducted a retrospective analysis of AMI survivors hospitalized during 2004-2017. Stratified by admission-time albumin level and BMI, eligible cases were evaluated for all-cause mortality up to 10 years after discharge. A total of 6283 individuals (74.1% males, mean age 64.1 ± 13.1 years, 44.3% with ST-elevation MI) were included. Of them, 22.7% had hypoalbuminemia and 1.2%, 41.0%, and 28.6% were underweight (BMI < 18.5), overweight (BMI 25-30), and obese (BMI ≥ 30), respectively. Over a median of 7.9 (IQR, 4.8-10.0) years of follow-up, 42.5% of patients died. Hypoalbuminemia was independently associated with a heightened mortality risk overall (AdjHR = 1.54, 95%CI 1.42-1.67, p < 0.001), accounted for by the normal weight (AdjHR = 1.73, 95%CI 1.50-1.99, p < 0.001), overweight (AdjHR = 1.55, 95%CI 1.35-1.79, p < 0.001), and class 1 obesity (BMI 30-35) (AdjHR = 1.37, 95%CI 1.12-1.68, p = 0.002) subgroups. Upon interaction analysis, the mortality risk imposed by hypoalbuminemia was most pronounced among individuals with normal BMI. In conclusion, hypoalbuminemia constituted a negative prognostic marker for long-term survival in AMI patients with normal or mildly elevated but not reduced or severely increased BMI. Pending further research, addressing hypoalbuminemia based on BMI range may prove beneficial.