Apolipoprotein A-I: A favorable prognostic marker in infective endocarditis

Abstract

Decreased apolipoprotein A-I (apoA-I) and high-density lipoprotein cholesterol (HDL-C) are common in inflammation and sepsis. No study with a large sample size has been performed to investigate the prognostic value of apoA-I or HDL-C in infective endocarditis (IE). The present study aimed to explore the prognostic value of apoA-I and HDL-C for adverse outcomes in IE patients. Patients with a definite diagnosis of IE between January 2009 and July 2015 were enrolled and divided into 3 groups according to their apoA-I tertiles at admission. Univariate and multivariate analyses were performed to evaluate the relationship of apoA-I and HDL-C with clinical outcomes. Of the 593 included patients, 40 (6.7%) died in hospital. Patients with lower apoA-I experienced markedly higher rates of in-hospital mortality (10.7%, 7.0%, and 2.5% in tertiles 1-3, respectively; P=.006) and major adverse clinical events (32.5%, 24.1%, and 8.6% in tertiles 1-3, respectively; P<.001). ApoA-I (area under the curve, 0.671; P<.001) and HDL-C (area under the curve, 0.672; P<.001) had predictive values for in-hospital death. Multivariate logistic regression showed that apoA-I <0.90g/L and HDL-C <0.78mmol/L were independent risk predictors for in-hospital death. A multivariate Cox proportional hazard analysis revealed that apoA-I (increments of 1g/L; hazard ratio, 0.36; 95% confidence interval, 0.15-0.87; P=.023) and HDL-C (increments of 1mmol/L; hazard ratio, 0.38; 95% confidence interval, 0.18-0.83; P=.015) were independently associated with long-term mortality. ApoA-I and HDL-C were inversely associated with adverse IE prognosis.