Modification, validation and comparison of Naples prognostic score to determine in-hospital mortality in ST-segment elevation myocardial infarction.

IF 4.4 3区医学 Q1 MEDICINE, GENERAL & INTERNAL

European Journal of Clinical Investigation Pub Date : 2024-10-14 DOI:10.1111/eci.14332

Omer Genc, Abdullah Yildirim, Aslan Erdogan, Ersin Ibisoglu, Yeliz Guler, Gazi Capar, M Mert Goksu, Huseyin Akgun, Gamze Acar, G Cansu Ozdogan, Gunseli Uredi, Furkan Sen, Ufuk S Halil, Fahri Er, Murside Genc, Eyup Ozkan, Ahmet Guler, Ibrahim H Kurt

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引用次数: 0

Abstract

Aim: The relationship between inflammatory status and poor outcomes in acute coronary syndromes is a significant area of current research. This study investigates the association between in-hospital mortality and the modified Naples prognostic score (mNPS) as well as other inflammatory biomarkers in STEMI patients.

Methods: This single-centre, cross-sectional study included 2576 consecutive STEMI patients who underwent primary percutaneous coronary intervention between January 2022 and November 2023. Participants were randomly divided into derivation and validation cohorts in a 6:4 ratio. The following inflammatory indices were calculated: pan-immune-inflammation value (PIV), systemic immune-inflammation-index (SII), systemic inflammation-response index (SIRI) and conventional NPS. The mNPS was derived by integrating hs-CRP into the conventional NPS. The performance of these indices in determining in-hospital mortality was assessed using regression, calibration, discrimination, reclassification and decision curve analyses.

Results: Inflammatory biomarkers, including PIV, SII, SIRI, NPS and mNPS, were significantly higher in patients who died during in-hospital follow-up compared to those discharged alive in both the derivation and validation cohorts. Multivariable logistic regression analyses were performed separately for the derivation and validation cohorts. In the derivation cohort, mNPS was associated with in-hospital mortality (aOR = 1.490, p < .001). Similarly, in the validation cohort, mNPS was associated with in-hospital mortality (aOR = 2.023, p < .001). mNPS demonstrated better discriminative and reclassification power than other inflammatory markers (p < .05 for all). Additionally, regression models incorporating mNPS were well-calibrated and showed net clinical benefit in both cohorts.

Conclusion: mNPS may be a stronger predictor of in-hospital mortality in STEMI patients compared to the conventional scheme and other inflammatory indices.

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修改、验证和比较那不勒斯预后评分，以确定 ST 段抬高型心肌梗死的院内死亡率。

目的：急性冠状动脉综合征患者的炎症状态与不良预后之间的关系是当前研究的一个重要领域。本研究调查了 STEMI 患者院内死亡率与改良那不勒斯预后评分（mNPS）及其他炎症生物标志物之间的关系：这项单中心横断面研究纳入了在2022年1月至2023年11月期间连续接受初次经皮冠状动脉介入治疗的2576名STEMI患者。参与者按 6:4 的比例随机分为推导队列和验证队列。计算了以下炎症指数：泛免疫炎症值（PIV）、全身免疫炎症指数（SII）、全身炎症反应指数（SIRI）和传统 NPS。mNPS 是通过将 hs-CRP 纳入传统 NPS 得出的。通过回归、校准、鉴别、再分类和决策曲线分析，评估了这些指数在确定院内死亡率方面的性能：结果：包括PIV、SII、SIRI、NPS和mNPS在内的炎症生物标志物在院内随访期间死亡的患者中明显高于衍生队列和验证队列中活着出院的患者。对衍生队列和验证队列分别进行了多变量逻辑回归分析。在推导队列中，mNPS 与院内死亡率相关（aOR = 1.490，p 结论：与传统方案和其他炎症指数相比，mNPS 可能是 STEMI 患者院内死亡率的更强预测指标。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Journal of Clinical Investigation 医学-医学：内科

CiteScore

9.50

自引率

3.60%

发文量

192

审稿时长

1 months

期刊介绍： EJCI considers any original contribution from the most sophisticated basic molecular sciences to applied clinical and translational research and evidence-based medicine across a broad range of subspecialties. The EJCI publishes reports of high-quality research that pertain to the genetic, molecular, cellular, or physiological basis of human biology and disease, as well as research that addresses prevalence, diagnosis, course, treatment, and prevention of disease. We are primarily interested in studies directly pertinent to humans, but submission of robust in vitro and animal work is also encouraged. Interdisciplinary work and research using innovative methods and combinations of laboratory, clinical, and epidemiological methodologies and techniques is of great interest to the journal. Several categories of manuscripts (for detailed description see below) are considered: editorials, original articles (also including randomized clinical trials, systematic reviews and meta-analyses), reviews (narrative reviews), opinion articles (including debates, perspectives and commentaries); and letters to the Editor.