血清乳酸脱氢酶水平作为感染性心内膜炎危重患者28天死亡率的预测因子：来自MIMIC IV数据库的回顾性队列研究

IF 2.4 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart & Lung Pub Date : 2025-04-09 DOI:10.1016/j.hrtlng.2025.04.002

Yuhan Qin , Anhu Wu , Yufei Wang, Xiaohan Qin, Jing Zhang, Xiaoxiao Guo

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引用次数: 0

摘要

摘要感染性心内膜炎（IE）是一种发病率上升、死亡率高的严重传染病。虽然乳酸脱氢酶（LDH）是炎症、组织损伤和代谢改变的一种敏感且容易获得的生物标志物，但其在IE中的预后价值仍未被探索。目的探讨入院时血清LDH水平对危重IE患者28天死亡率的预测价值。方法本回顾性队列研究的数据来自MIMIC-IV数据库。采用限制性三次样条分析、Cox回归分析、Kaplan-Meier生存分析和受试者工作特征分析评价血清LDH对危重IE患者的预测价值。调整Cox模型的主要临床混杂因素通过LASSO回归过滤。结果215例确诊为IE的危重患者首次入住加护病房。LDH是LASSO分析发现的最重要的混杂因素之一。粗Cox模型和调整后的Cox模型显示，高血清LDH与高死亡率之间存在一致的独立的剂量反应关系。完全调整后的模型显示，LDH每增加一个标准差（log2）与2.37的风险比相关(95% CI: 1.51-3.71, p <；0.001)。Kaplan-Meier曲线显示不同LDH水平的生存模式有显著差异（p = 0.0032）。LDH曲线下面积（AUC）高于SOFA评分（AUC=0.637 vs . 0.573, p=0.251）。结论本研究确定血清LDH是危重IE患者死亡率的独立预测因子。

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Serum lactate dehydrogenase level as a predictor of 28-day mortality in critically ill patients with infective endocarditis: a retrospective cohort study from MIMIC IV database

Background

Infective endocarditis (IE) is a serious infectious disease with a rising incidence rate and high mortality rate. While lactate dehydrogenase (LDH) is a sensitive and accessible biomarker of inflammation, tissue damage and metabolic alteration, its prognostic value in IE remains unexplored.

Objective

This study aims to investigate the prognostic value of admission serum LDH levels for 28-day mortality in critically ill IE patients.

Methods

The data used in this retrospective cohort study was extracted from the MIMIC-IV database. Restricted cubic spline analysis, Cox regression, Kaplan-Meier survival analysis, and receiver operating characteristic analysis were performed to evaluate the predictive value of serum LDH in critically ill IE patients. Key clinical confounders for the adjusting Cox models were filtered by LASSO regression.

Results

A total of 215 critically ill patients with diagnosed IE were included during their first intensive care unit admission. LDH was one of the most significant confounders identified by LASSO analysis. The crude and adjusted Cox models revealed a consistently independent and dose-response relationship between high serum LDH and higher mortality. The fully adjusted model showed each standard deviation increase in LDH (log2) was associated with a hazard ratio of 2.37 (95% CI: 1.51–3.71, p < 0.001). Kaplan-Meier curves demonstrated significantly different survival patterns across LDH levels (p = 0.0032). The area under the curve (AUC) of LDH was higher than SOFA score (AUC=0.637 v.s. 0.573, p=0.251).

Conclusion

This study identified serum LDH as an independent predictor of mortality in critically ill IE patients.

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来源期刊

Heart & Lung 医学-呼吸系统

CiteScore

4.60

自引率

3.60%

发文量

184

审稿时长

35 days

期刊介绍： Heart & Lung: The Journal of Cardiopulmonary and Acute Care, the official publication of The American Association of Heart Failure Nurses, presents original, peer-reviewed articles on techniques, advances, investigations, and observations related to the care of patients with acute and critical illness and patients with chronic cardiac or pulmonary disorders. The Journal''s acute care articles focus on the care of hospitalized patients, including those in the critical and acute care settings. Because most patients who are hospitalized in acute and critical care settings have chronic conditions, we are also interested in the chronically critically ill, the care of patients with chronic cardiopulmonary disorders, their rehabilitation, and disease prevention. The Journal''s heart failure articles focus on all aspects of the care of patients with this condition. Manuscripts that are relevant to populations across the human lifespan are welcome.