{"title":"Alkaline Phosphatase to Albumin Ratio as a Novel Predictor of All-Cause Mortality in Critically Ill Patients With Atrial Fibrillation.","authors":"Haosheng Wu, Xueqian Shen, Yu Xin, Xue Jiang, Caixia Guo","doi":"10.1155/crp/1283547","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Alkaline phosphatase to albumin ratio (APAR) is an emerging prognostic indicator for sepsis, cancer, and coronary artery disease. However, the predictive value of APAR in patients with atrial fibrillation (AF) has not been investigated yet. Therefore, this study aims to explore the association between APAR and the risk of mortality in critically ill patients with AF.</p><p><strong>Methods: </strong>The data of AF patients were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Patients with AF were divided into three groups according to the APAR tertiles. Study outcomes were defined as 28-day and 365-day all-cause mortality. The Kaplan-Meier analysis was conducted to compare the survival rates between groups. Cox proportional hazards regression and restricted cubic spline (RCS) were used to investigate the association between APAR and all-cause mortality. Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the predictive value of APAR for study outcomes.</p><p><strong>Results: </strong>A total of 1105 critically ill patients with AF were enrolled in the study. The Kaplan-Meier analysis demonstrated that patients with the highest APAR had the lowest survival rate. The Cox regression analysis indicated that the highest APAR tertile was significantly associated with 28-day (HR, 1.64 [95% CI 1.20-2.25]; <i>p</i>=0.002) and 365-day (HR, 1.87 [95% CI 1.47-2.39]; <i>p</i> < 0.001) all-cause mortality. Nonlinear relationships between APAR and 28-day and 365-day all-cause mortality were illustrated based on the RCS curves. The areas under the ROC curves for predicting 28-day and 365-day all-cause mortality were 0.617 and 0.642, respectively.</p><p><strong>Conclusions: </strong>Our research suggested that APAR was a simple biomarker for the prognosis in patients with AF.</p>","PeriodicalId":9494,"journal":{"name":"Cardiology Research and Practice","volume":"2025 ","pages":"1283547"},"PeriodicalIF":2.1000,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12614730/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Cardiology Research and Practice","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1155/crp/1283547","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q3","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
Abstract
Background: Alkaline phosphatase to albumin ratio (APAR) is an emerging prognostic indicator for sepsis, cancer, and coronary artery disease. However, the predictive value of APAR in patients with atrial fibrillation (AF) has not been investigated yet. Therefore, this study aims to explore the association between APAR and the risk of mortality in critically ill patients with AF.
Methods: The data of AF patients were extracted from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. Patients with AF were divided into three groups according to the APAR tertiles. Study outcomes were defined as 28-day and 365-day all-cause mortality. The Kaplan-Meier analysis was conducted to compare the survival rates between groups. Cox proportional hazards regression and restricted cubic spline (RCS) were used to investigate the association between APAR and all-cause mortality. Receiver operating characteristic (ROC) curve analysis was utilized to evaluate the predictive value of APAR for study outcomes.
Results: A total of 1105 critically ill patients with AF were enrolled in the study. The Kaplan-Meier analysis demonstrated that patients with the highest APAR had the lowest survival rate. The Cox regression analysis indicated that the highest APAR tertile was significantly associated with 28-day (HR, 1.64 [95% CI 1.20-2.25]; p=0.002) and 365-day (HR, 1.87 [95% CI 1.47-2.39]; p < 0.001) all-cause mortality. Nonlinear relationships between APAR and 28-day and 365-day all-cause mortality were illustrated based on the RCS curves. The areas under the ROC curves for predicting 28-day and 365-day all-cause mortality were 0.617 and 0.642, respectively.
Conclusions: Our research suggested that APAR was a simple biomarker for the prognosis in patients with AF.
背景：碱性磷酸酶与白蛋白比（APAR）是一种新兴的脓毒症、癌症和冠状动脉疾病的预后指标。然而，APAR在房颤（AF）患者中的预测价值尚未得到研究。因此，本研究旨在探讨房颤危重患者APAR与死亡风险的关系。方法：从重症监护医学信息市场- iv （MIMIC-IV）数据库中提取房颤患者数据。根据APAR分值将AF患者分为三组。研究结果定义为28天和365天的全因死亡率。采用Kaplan-Meier分析比较各组之间的生存率。采用Cox比例风险回归和限制性三次样条（RCS）来研究APAR与全因死亡率之间的关系。采用受试者工作特征（ROC）曲线分析评价APAR对研究结果的预测价值。结果：共纳入1105例AF危重患者。Kaplan-Meier分析表明，APAR最高的患者生存率最低。Cox回归分析显示，最高APAR分值与28天（HR, 1.64 [95% CI 1.20-2.25]; p=0.002）和365天（HR, 1.87 [95% CI 1.47-2.39]; p < 0.001）全因死亡率显著相关。根据RCS曲线，APAR与28天和365天全因死亡率之间存在非线性关系。预测28天和365天全因死亡率的ROC曲线下面积分别为0.617和0.642。结论：我们的研究提示APAR是房颤患者预后的一个简单的生物标志物。
期刊介绍：
Cardiology Research and Practice is a peer-reviewed, Open Access journal that publishes original research articles, review articles, and clinical studies that focus on the diagnosis and treatment of cardiovascular disease. The journal welcomes submissions related to systemic hypertension, arrhythmia, congestive heart failure, valvular heart disease, vascular disease, congenital heart disease, and cardiomyopathy.
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