Dataset Information

Predictive value of remnant cholesterol level for all-cause mortality in heart failure patients.

ABSTRACT:

Background

Lower cholesterol levels are associated with increased mortality in heart failure (HF) patients. Remnant cholesterol corresponds to all cholesterol not found in high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The prognostic role of remnant cholesterol in HF remains unknown.

Objective

To reveal the relationship between the baseline remnant cholesterol level and all-cause mortality in HF patients.

Methods

This study enrolled 2,823 patients hospitalized for HF. Kaplan-Meier analysis, Cox regression, C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were used to evaluate the prognostic value of remnant cholesterol for all-cause mortality in HF.

Results

The mortality rate was lowest in the fourth quartile of remnant cholesterol, which had an adjusted hazard ratio (HR) for death of 0.56 [HR: 0.39, 95% confidence interval (CI): 0.46-0.68, p < 0.001] relative to the first quartile. After adjustment, a one-unit increase in the level of remnant cholesterol was associated with a 41% decrease in the risk of all-cause mortality (HR: 0.59, 95% CI: 0.47-0.73, p < 0.001). A refinement in risk prediction was observed after adding remnant cholesterol quartile to the original model (ΔC-statistic = 0.010, 95% CI: 0.003-0.017; NRI = 0.036, 95% CI: 0.003-0.070; IDI = 0.025, 95% CI: 0.018-0.033; all p < 0.05).

Conclusion

Low remnant cholesterol levels are associated with increased all-cause mortality in HF patients. The addition of the remnant cholesterol quartile improved the predictive value over traditional risk factors.

Clinical trial registration

ClinicalTrials.gov, Unique Identifier: NCT02664818.

SUBMITTER: Zhao L

PROVIDER: S-EPMC9975541 | biostudies-literature | 2023

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Predictive value of remnant cholesterol level for all-cause mortality in heart failure patients.

Zhao Lang L Zhao Xuemei X Tian Pengchao P Liang Lin L Huang Boping B Huang Liyan L Feng Jiayu J Zhang Yuhui Y Zhang Jian J

Frontiers in cardiovascular medicine 20230215

<h4>Background</h4>Lower cholesterol levels are associated with increased mortality in heart failure (HF) patients. Remnant cholesterol corresponds to all cholesterol not found in high-density lipoprotein (HDL) and low-density lipoprotein (LDL). The prognostic role of remnant cholesterol in HF remains unknown.<h4>Objective</h4>To reveal the relationship between the baseline remnant cholesterol level and all-cause mortality in HF patients.<h4>Methods</h4>This study enrolled 2,823 patients hospita ...[more]

PMID: 36873397

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Project description:ObjectiveNutritional status is closely associated with the prognosis of heart failure. This study aims to assess the relationship between the Controlling Nutritional Status (CONUT) score and in-hospital mortality among patients with acute decompensated heart failure (ADHF) in Jiangxi, China.MethodsA retrospective cohort study was conducted. Multivariable Cox regression models and restricted cubic spline regression were employed to evaluate the relationship between the CONUT score and in-hospital mortality in ADHF patients from Jiangxi, China. The predictive value of the CONUT score for in-hospital mortality in ADHF patients was analyzed using receiver operating characteristic curves. Subgroup analyses were performed to identify risk dependencies of the CONUT score in specific populations.ResultsThe study included 1,230 ADHF patients, among whom 44 (3.58%) mortality events were recorded. After adjusting for confounding factors, a positive correlation was found between the CONUT score and the risk of in-hospital mortality in ADHF patients. Restricted cubic spline regression analysis indicated a non-linear relationship between the CONUT score and the risk of in-hospital mortality in ADHF patients, estimating a rapid increase in mortality risk when the CONUT score exceeded 5. Receiver operating characteristic analysis demonstrated a good predictive value of the CONUT score for all-cause mortality events in ADHF patients [area under the curve = 0.7625, optimal threshold = 5.5]. Additionally, a relatively higher risk associated with the CONUT score was observed in male patients and those with concomitant cerebral infarction.ConclusionThis study reveals a positive correlation between the CONUT score and the risk of in-hospital mortality in ADHF patients. Based on the findings of this study, we recommend maintaining a CONUT score below 5 for patients with ADHF in Jiangxi, China, as it may significantly contribute to reducing the risk of in-hospital all-cause mortality.

Project description:The study aims to examine the predictive value of arterial blood lactic acid concentration for in-hospital all-cause mortality in the intensive care unit (ICU) for patients with acute heart failure (AHF). We retrospectively analyzed the clinical data of 7558 AHF patients in the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. The exposure variable of the present study was arterial blood lactic acid concentration and the outcome variable was in-hospital all-cause death. The patients were divided into those who survived (n = 6792) and those who died (n = 766). The multivariate logistic regression model, restricted cubic spline (RCS) plot, and subgroup analysis were used to evaluate the association between lactic acid and in-hospital all-cause mortality. In addition, receiver operating curve (ROC) analysis also was performed. Finally, we further explore the association between NT-proBNP and lactic acid and in-hospital all-cause mortality. Compared with the lowest quartiles, the odds ratios with 95% confidence intervals for in-hospital all-cause mortality across the quartiles were 1.46 (1.07–2.00), 1.48 (1.09–2.00), and 2.36 (1.73–3.22) for lactic acid, and in-hospital all-cause mortality was gradually increased with lactic acid levels increasing (P for trend <0.05). The RCS plot revealed a positive and linear connection between lactic acid and in-hospital all-cause mortality. A combination of lactic acid concentration and the Simplified Acute Physiology Score (SAPS) II may improve the predictive value of in-hospital all-cause mortality in patients with AHF (AUC = 0.696). Among subgroups, respiratory failure interacted with an association between lactic acid and in-hospital all-cause mortality (P for interaction <0.05). The correlation heatmap revealed that NT-proBNP was positively correlated with lactic acid (r = 0.07) and positively correlated with in-hospital all-cause mortality (r = 0.18). There was an inverse L-shaped curve relationship between NT-proBNP and in-hospital all-cause mortality, respectively. Mediation analysis suggested that a positive relationship between lactic acid and in-hospital all-cause death was mediated by NT-proBNP. For AHF patients in the ICU, the arterial blood lactic acid concentration during hospitalization was a significant independent predictor of in-hospital all-cause mortality. The combination of lactic acid and SAPS II can improve the predictive value of the risk of in-hospital all-cause mortality in patients with AHF.

Dataset Information

Predictive value of remnant cholesterol level for all-cause mortality in heart failure patients.

Background

Objective

Methods

Results

Conclusion

Clinical trial registration

Publications

Predictive value of remnant cholesterol level for all-cause mortality in heart failure patients.

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