Development of peripheral biomarker-based prognostic nomograms for short-term and long-term survival in immune checkpoint inhibitor-associated myocarditis.

IF 2.1 3区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular diagnosis and therapy Pub Date : 2025-04-30 Epub Date: 2025-04-23 DOI:10.21037/cdt-24-556

Zhengkun Guan, Tiezhu Yao, Guang Liu, Jing Liu, Ling Guo, Shaoyan Du, Zhenli Li, Ruipu Gao, Yansong Wang, Jingtao Ma

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引用次数: 0

Abstract

Background: Immune checkpoint inhibitor-associated myocarditis (ICI myocarditis) is a rare but highly fatal immune-related adverse reaction. This study aimed to develop nomogram prognostic models for both short-term and long-term survival outcomes in patients with ICI myocarditis based on key biomarkers in peripheral blood.

Methods: In this single-center retrospective study, we included 90 patients with ICI myocarditis at the Fourth Hospital of Hebei Medical University. Critical peripheral biomarkers associated with 40-day and 1-year overall survival (OS) were identified. Two prognostic models were developed and evaluation of the models were performed with receiver operating characteristic (ROC) curves, C-index, calibration curves, and decision curve analysis (DCA).

Results: A total of 24 patients (26.7%) succumbed within 40 days, while 40 patients (44.4%) died within one year. Cardiac troponin-I (cTnI), N-terminal pro-brain natriuretic peptide (NTBNP) and lactic dehydrogenase-to-albumin ratio (LAR) were identified as critical prognostic factors for 40-day OS in patients with ICI myocarditis and utilized to develop a nomogram model. The model demonstrates an area under the curve (AUC) of 0.867 [95% confidence interval (CI): 0.774-0.960] and a C-index of 0.824. Another predictive model for the 1-year OS was developed based on cTnI, NTBNP, LAR and systemic inflammatory response index (SIRI) with an AUC of 0.765 (95% CI: 0.664-0.866) and a C index of 0.742. The calibration curve demonstrates that both models exhibit strong consistency. The results of the DCA further indicate that both nomograms possess substantial clinical utility.

Conclusions: These two prediction models will enable clinicians to more effectively utilize readily available peripheral blood biomarkers for the convenient and efficient identification of high-risk patients with poor prognoses, thereby facilitating early intervention.

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基于外周生物标志物的免疫检查点抑制剂相关心肌炎短期和长期生存预后图的发展

背景：免疫检查点抑制剂相关性心肌炎（ICI心肌炎）是一种罕见但高度致命的免疫相关不良反应。本研究旨在建立基于外周血关键生物标志物的ICI心肌炎患者短期和长期生存预后的nomogram预后模型。方法：在这项单中心回顾性研究中，我们纳入了河北医科大学第四医院的90例ICI心肌炎患者。确定了与40天和1年总生存期（OS）相关的关键外周生物标志物。建立两种预后模型，采用受试者工作特征（ROC）曲线、c指数、校准曲线和决策曲线分析（DCA）对模型进行评价。结果：40天内死亡24例（26.7%），1年内死亡40例（44.4%）。心肌肌钙蛋白- i （cTnI）、n端前脑利钠肽（NTBNP）和乳酸脱氢酶与白蛋白比（LAR）被确定为ICI心肌炎患者40天OS的关键预后因素，并用于建立nomogram模型。该模型显示曲线下面积（AUC）为0.867[95%置信区间（CI）： 0.774-0.960]， c -指数为0.824。另一个基于cTnI、NTBNP、LAR和系统性炎症反应指数（SIRI）的1年OS预测模型，AUC为0.765 (95% CI: 0.664-0.866)， C指数为0.742。标定曲线表明两种模型具有较强的一致性。DCA的结果进一步表明，两种形态图具有实质性的临床应用。结论：这两种预测模型将使临床医生能够更有效地利用现成的外周血生物标志物，方便有效地识别预后不良的高危患者，从而促进早期干预。

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

Cardiovascular diagnosis and therapy Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

4.20%

发文量

期刊介绍： The journal ''Cardiovascular Diagnosis and Therapy'' (Print ISSN: 2223-3652; Online ISSN: 2223-3660) accepts basic and clinical science submissions related to Cardiovascular Medicine and Surgery. The mission of the journal is the rapid exchange of scientific information between clinicians and scientists worldwide. To reach this goal, the journal will focus on novel media, using a web-based, digital format in addition to traditional print-version. This includes on-line submission, review, publication, and distribution. The digital format will also allow submission of extensive supporting visual material, both images and video. The website www.thecdt.org will serve as the central hub and also allow posting of comments and on-line discussion. The web-site of the journal will be linked to a number of international web-sites (e.g. www.dxy.cn), which will significantly expand the distribution of its contents.