晚期肺癌炎症指数预测房颤合并心衰患者预后的价值

Value of advanced lung cancer inflammation index in predicting the prognosis of patients with atrial fibrillation and heart failure

摘要:

目的 探讨晚期肺癌炎症指数（advanced lung cancer inflammation index，ALI）对心房颤动（atrial fibrillation，AF）合并心力衰竭（heart failure，HF）患者全因死亡的预测价值。方法 收集重庆医科大学附属第一医院的AF合并HF（AF-HF）患者临床资料，使用受试者工作特征（receiver operating characteristic，ROC）曲线评估ALI对全因死亡预测的能力，采用约登指数算取ALI的截断值，根据患者入院时ALI值分组（ALI>16.99组，ALI≤16.99组），并用Kaplan-Meier曲线对2组生存时间进行检验，最后利用多因素Cox逐步回归，分析ALI对本人群全因死亡的影响，并将样本分为瓣膜性AF及非瓣膜性AF进行亚组分析。结果 共纳入614名AF-HF患者，其中失访49名，对剩余565患者进行统计分析，其中ALI>16.99组370例，ALI≤16.99组195例，ALI≤16.99组共出现全因死亡113例（57.9%），ALI>16.99组出现全因死亡104例（28.1%），ALI≤16.99组的年龄更大，脑钠肽（brain natriuretic peptide，BNP）、D-二聚体、中性粒细胞百分比、尿素氮、肌酐、超敏C反应蛋白（high sensitivity C-reactive protein，hs-CRP）、活化部分凝血活酶时间（activated partial thromboplastin time，APTT）、白细胞、纽约心脏病协会心功能分级（New York Heart Association，NYHA）及心房颤动抗凝治疗出血风险评分系统（HAS-BLED出血风险评分）评分更高，体质指数（body mass index，BMI）、血红蛋白、淋巴细胞计数、白蛋白（albumin，ALB）、总胆固醇、低密度脂蛋白、高密度脂蛋白更低，差异有统计学意义。ALI预测AF-HF患者发生全因死亡的曲线下面积为0.660（95%Cl=0.614~0.705，P<0.001）。多因素Cox回归分析中，ALI≤16.99、肌酐、年龄>65岁、原发性高血压是AF-HF患者全因死亡的独立危险因素。亚组分析中，ALI≤16.99为瓣膜性及非瓣膜性AF-HF患者全因死亡的独立危险因素。结论 ALI与AF-HF患者的全因死亡相关，ALI≤16.99是AF-HF患者全因死亡的独立危险因素。因此，ALI可能有助于评估AF-HF患者的预后。

Abstract:

Objective To investigate the value of advanced lung cancer inflammation index（ALI） in predicting the all-cause mortality of patients with atrial fibrillation（AF） and heart failure（HF）.Methods Related clinical data were collected from the patients with AF and HF in The First Affiliated Hospital of Chongqing Medical University，and the receiver operating characteristic（ROC） curve was used to assess the value of ALI in predicting all-cause mortality. Youden index was used to determine the cut-off value of ALI，and the patients were divided into ALI>16.99 group and ALI≤16.99 group according to the ALI value on admission. The Kaplan-Meier curve was used to analyze survival time，and finally the multivariate Cox stepwise regression analysis was used to investigate the influence of ALI on the all-cause mortality of this population. The samples were divided into valvular and non-valvular AF for subgroup analysis.Results A total of 614 patients with AF and HF were enrolled，among whom 49 patients were lost to follow-up，and a statistical analysis was performed for the remaining 565 patients，with 370 patients in the ALI>16.99 group and 195 patients in the ALI≤16.99 group. There were 113 cases（57.9%） of all-cause mortality in the ALI≤16.99 group and 104 cases（28.1%） of all-cause mortality in the ALI>16.99 group. Compared with the ALI>16.99 group，the ALI≤16.99 group had significantly higher age，brain natriuretic peptide，D-dimer，percentage of neutrophils，blood urea nitrogen，creatinine，high-sensitivity C-reactive protein，activated partial thromboplastin time，white blood cell count，NYHA class，and HAS-BLED score，as well as significantly lower body mass index，hemoglobin，lymphocyte count，albumin，total cholesterol，low-density lipoprotein，and high-density lipoprotein（all P<0.05）. ALI had an area under the ROC curve of 0.660（95%CI=0.614-0.705，P<0.001） in predicting all-cause mortality of patients with AF and HF. The multivariate Cox regression analysis showed that ALI≤16.99，creatinine，age>65 years，and primary hypertension were independent risk factors for all-cause mortality of patients with AF and HF，and the subgroup analysis showed that ALI≤16.99 was an independent risk factor for all-cause mortality in patients with valvular or non-valvular AF-HF.Conclusion ALI is associated with all-cause mortality in patients with AF-HF，and ALI≤16.99 is an independent risk factor for all-cause mortality in such patients. Therefore，ALI may help to assess the prognosis of patients with AF-HF.