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Ren L, Li Z, Duan L, Gao J, Qi L. Association between white blood cell-to-haemoglobin ratio and 30 day mortality in heart failure in intensive care unit. ESC Heart Fail 2024; 11:400-409. [PMID: 38016675 PMCID: PMC10804145 DOI: 10.1002/ehf2.14592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/10/2023] [Accepted: 11/07/2023] [Indexed: 11/30/2023] Open
Abstract
AIMS The short-term mortality of heart failure (HF) patients admitted to the intensive care unit (ICU) is reported to be high. This study aims to explore the association between white blood cell-to-haemoglobin ratio (WHR) and 30 day mortality from the admission to the ICU. METHODS AND RESULTS This retrospective cohort study was performed based on the Medical Information Mart for Intensive Care III (MIMIC-III) database (2001-12) and MIMIC-IV database (2008-19). Covariables were selected using the least absolute shrinkage and selection operator regression. Based on the optimal cutoff point selected using the survminer package, WHR was divided into high-ratio group (≥1.6) and low-ratio group (<1.6). The association between WHR and the risk of 30 day mortality was explored using univariate and multivariable Cox regression models. The area under the receiver operating characteristic curve (AUC) was calculated to evaluate the prediction performance of WHR. A total of 13 702 patients were included. After adjusting the potential covariates, high WHR was associated with a greater risk of 30 day mortality compared with low WHR [hazard ratio = 1.16, 95% confidence interval (CI): 1.07-1.27, P < 0.001]. WHR also showed a good performance for the prediction of risk of 30 day mortality (AUC = 0.751, 95% CI: 0.746-0.756). CONCLUSIONS WHR was positively associated with and performed well to predict 30 day mortality, indicating that WHR may be a reliable index to assess the prognosis of HF patients admitted to the ICU.
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Affiliation(s)
- Li Ren
- Cardiovascular Department, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Zhaoling Li
- Cardiovascular Department, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Lian Duan
- Cardiovascular Department, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Jialiang Gao
- Cardiovascular Department, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
| | - Lianfen Qi
- Cardiovascular Department, Guang'anmen HospitalChina Academy of Chinese Medical SciencesBeijingChina
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Lenz M, Krychtiuk KA, Brekalo M, Draxler DF, Pavo N, Hengstenberg C, Huber K, Hülsmann M, Heinz G, Wojta J, Speidl WS. Soluble neprilysin and survival in critically ill patients. ESC Heart Fail 2022; 9:1160-1166. [PMID: 35040286 PMCID: PMC8934932 DOI: 10.1002/ehf2.13787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 11/08/2021] [Accepted: 12/13/2021] [Indexed: 11/30/2022] Open
Abstract
Background Critically ill patients admitted to an intensive care unit (ICU) exhibit a high mortality rate irrespective of the initial cause of hospitalization. Neprilysin, a neutral endopeptidase degrading an array of vasoactive peptides became a drug target within the treatment of heart failure with reduced ejection fraction. The aim of this study was to analyse whether circulating levels of neprilysin at ICU admission are associated with 30 day mortality. Methods and results In this single‐centre prospective observational study, 222 consecutive patients admitted to a tertiary ICU at a university hospital were included. Blood was drawn at admission and soluble neprilysin levels were measured using ELISA. In the total cohort, soluble neprilysin levels did not differ according to survival status after 30 days as well as type of admission. However, in patients after surgery or heart valve intervention, 30 day survivors exhibited significantly lower circulating neprilysin levels as compared to those who died within 30 days (660.2, IQR: 156.4–2512.5 pg/mL vs. 6532.6, IQR: 1840.1–10 000.0 pg/mL; P = 0.02). Soluble neprilysin predicted mortality independently from age, gender, and commonly used scores of risk‐prediction (EuroSCORE II, STS‐score, and SAPS II score). Additionally, soluble neprilysin was markedly elevated in patients with sepsis and septic shock (P < 0.05). Conclusion At the time of ICU admission, circulating levels of neprilysin independently predicted 30 day mortality in patients following cardiac surgery or heart valve intervention, but not in critically ill medical patients. Furthermore, patients suffering from sepsis and septic shock displayed significantly increased circulating neprilysin levels.
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Affiliation(s)
- Max Lenz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Konstantin A Krychtiuk
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria
| | - Mira Brekalo
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Dominik F Draxler
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Noemi Pavo
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Christian Hengstenberg
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Kurt Huber
- Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.,3rd Medical Department, Wilhelminenhospital, Vienna, Austria
| | - Martin Hülsmann
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Gottfried Heinz
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
| | - Johann Wojta
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.,Core Facilities, Medical University of Vienna, Vienna, Austria
| | - Walter S Speidl
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria
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