Association between red cell distribution width to albumin ratio and all-cause mortality in critically ill patients with myelodysplastic syndrome: a retrospective cohort study

Background Limited evidence exists regarding the association between remnant cholesterol (RC) and both all-cause and cardiovascular mortality. Also, the effect of age on the association between RC and the risk of mortality in general population has not been studied comprehensively. Therefore, the aim of this study is to investigate how age modifies the relationship between RC and the risk of all-cause and cardiovascular mortality. Methods A total of 21722 participants aged over 18 years were obtained from the National Health and Nutrition Examination Survey (1999–2018) , with follow-up mortality outcomes records linked to the National Death Index (NDI) until December 31, 2019 and divided into two groups (<65 years old and ≥65 years old).Weighted multivariable cox proportional hazards models and weighted restricted cubic spline (RCS) were used to estimate the relationship of RC with the risk of all-cause mortality and cardiovascular mortality among American adults. The age interaction between RC and all-cause mortality and cardiovascular mortality was assessed. Restricted cubic spline (RCS) and sensitivity analysis were also used. Results During a median 110-month follow-up, a total of 3176 (10.77%) all-cause deaths and 1002 (3.22%) cardiovascular related deaths were recorded. A significant age interaction between RC and all-cause or cardiovascular mortality was found. After adjusting for multiple potential confounding factors, higher RC was associated with an increased risk of all-cause mortality[RC per unit increase Hazard Ratio (HR) 1.45, 95% Confidence Interval (CI) 1.16–1.81, p=0.001] and cardiovascular mortality (RC per unit increase HR 1.80, 95% CI 1.15–2.84, p=0.010) specifically in the younger age group but not in the older age group. Consistent findings were observed in restricted cubic spline analyses and sensitivity analyses. Conclusion In our study, we observed that the association between serum RC and all-cause mortality and cardiovascular mortality was modified by age. Specifically, higher RC levels were found to be significantly associated with an increased risk of all-cause mortality and cardiovascular mortality exclusively in patients below 65 years old. This novel finding warrants further confirmation through randomized controlled trials to provide robust evidence.

Cardio-renal-metabolic (CRM) conditions are increasingly recognized as a major public health challenge, with oxidative stress playing a pivotal role in poor prognosis. The oxidative balance score (OBS) is used to assess the body's oxidative stress status, but its link to all-cause and cardiovascular mortality in CRM patients remains unclear. We used data from participants (≥ 20 years old) in the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2018. The patients were divided into four groups based on OBS using the weighted quartiles method. The relationship between OBS and both all-cause and cardiovascular mortality in CRM patients was assessed using multivariable Cox regression and restricted cubic spline (RCS) models. The differences in cumulative survival between groups were examined using Kaplan-Meier analysis and log-rank tests. Sensitivity analysis and subgroup analysis were also performed. During a median follow-up of 7.9 years, there were 3,838 (25.2%) and 1,412 (8.9%) patients who died from all-cause and cardiovascular mortality, respectively. After adjusting for potential confounders, elevated OBS level was negatively related to the risk of all-cause mortality [Q2, Q3, Q4: adjusted hazard ratio (aHR) (95 confidence interval (CI%)) = 0.85 (0.75-0.96), 0.87 (0.77-0.98), 0.74 (0.62-0.88), respectively; P for trend<0.001]. Moreover, Higher OBS quartiles were linked to a decreased risk of cardiovascular mortality, while no significant reduction was observed in the lower quartiles [model 3: Q2, Q3, Q4: aHR (95CI%) = 0.96(0.77-1.19), 0.78 (0.63-0.97), 0.70 (0.53-0.93), respectively; P for trend = 0.003]. Kaplan-Meier survival analysis also indicated that patients in the highest quartile of OBS had the lowest risk of both all-cause mortality and cardiovascular mortality (log-rank test p < 0.001). Furthermore, restricted cubic spline analyses revealed an inverse relationship between OBS levels and the risk of both all-cause and cardiovascular death. The sensitivity analyses confirmed the stability of our findings. Elevated levels of OBS were negatively related to the risk of all-cause and cardiovascular mortality among CRM patients, which may offer valuable information on the role of oxidative stress status for risk stratification of mortality in CRM patients.

ObjectiveThe Triglyceride-glucose (TyG) index, a novel indicator of insulin resistance, has been associated with mortality from coronary artery diseases, ischemic stroke, and heart failure. In recent years, much emphasis has been placed on the relationship between the TyG index and mortality in the general population. However, the impact of age on the association between TyG and all-cause and cardiovascular mortality remains controversial. This study investigated the link between the TyG index and all-cause and cardiovascular mortality, emphasizing differences between older and non-older populations.MethodsData from the National Health and Nutrition Examination Survey (2009–2018), encompassing 20,194 participants, were analyzed. The baseline TyG index was calculated as Ln [fasting triglycerides (mg/dL) × fasting glucose (mg/dL)/2]. Multivariate Cox proportional hazards regression models with restricted cubic splines and trend tests were employed to explore the association between the TyG index and all-cause and cardiovascular mortality, with emphasis on age-specific analysis. Subgroup analysis was conducted to examine whether the TyG index's association with mortality varied across different subgroups. Additionally, receiver operating characteristic curves were used to compare the predictive ability of the TyG index with the homeostasis model assessment of insulin resistance (HOMA-IR) for all-cause and cardiovascular mortality.ResultsOver a median follow-up period of 105 months, all-cause mortality accounted for 13.345% of cases, and cardiovascular mortality accounted for 3.387%. Kaplan–Meier curves showed a significant increase in all-cause and cardiovascular mortality with higher TyG index values (both P for log-rank test < 0.001). However, during Cox proportional hazards regression analysis, no linear trend was observed between the TyG index and all-cause or cardiovascular mortality after adjusting for confounding factors (all-cause mortality: P for trend = 0.424; cardiovascular mortality: P for trend = 0.481). Restricted cubic splines revealed a non-linear association between the baseline TyG index and all-cause and cardiovascular mortality in the overall population (all-cause mortality: Non-linear P = 0.003; cardiovascular mortality: Non-linear P = 0.034). The effect of the TyG index was consistent across most subgroups in terms of all-cause and cardiovascular mortality, with no significant interaction with randomized factors (all-cause mortality: P for interaction = 0.077–0.940, cardiovascular mortality: P for interaction = 0.173–0.987), except for the age subgroup (all-cause mortality: P for interaction < 0.001, cardiovascular mortality: P for interaction < 0.001). Further age-specific analysis revealed that the association between the TyG index and all-cause and cardiovascular mortality remained significant in patients aged < 65 but not in those aged ≥ 65. Interestingly, a non-linear association was observed between the TyG index and all-cause mortality in individuals aged < 65 (Non-linear P = 0.011), while a linear relationship was observed with cardiovascular mortality, showing an upward trend (Non-linear P = 0.742, P for trend = 0.010). Further stratification according to age yielded similar results only in patients aged 45–64 (all-cause mortality: Non-linear P = 0.001 and cardiovascular mortality: Non-linear P = 0.902, P for trend = 0.015). Compared to HOMA-IR, the TyG index demonstrated superior predictive performance for all-cause and cardiovascular mortality (all-cause mortality: 0.620 vs. 0.524, P < 0.001; cardiovascular mortality: 0.623 vs. 0.537, P < 0.001).ConclusionsThis study established a significant association between the TyG index and all-cause and cardiovascular mortality in the general population, particularly among individuals aged < 65. Notably, a non-linear association with all-cause mortality was observed in those aged < 65, while a linear relationship with cardiovascular mortality was found.

The serum uric acid to albumin ratio (UAR) is a recently recognized composite inflammatory biomarker that has not received sufficient attention in relation to sepsis. This study aimed to investigate the association between UAR and the risk of all-cause mortality in critically ill patients with sepsis. We conducted an analysis using a retrospective database of sepsis patients who were admitted to the Affiliated Hospital of Jiangsu University between January 2015 and November 2023. The patients were divided into four groups based on UAR quartiles. The primary outcome was in-hospital all-cause mortality. The Kaplan-Meier curve and log-rank tests were used to evaluate all-cause mortality among the four groups. Cox proportional hazards regression analysis and restricted cubic splines were performed to examine the association between UAR and clinical outcomes in patients with sepsis. Subgroup analyses were conducted to evaluate the impact of other variables on the relationship between UAR and all-cause mortality. A total of 1123 patients (63.0% males) were included in this study. The in-hospital and intensive care unit (ICU) mortality rates were 33.9% and 31.7%, respectively. There was a significant association between higher UAR levels and an increased cumulative incidence of 30-/60-day mortality (log-rank test, P < 0.001). Cox proportional hazards regression analysis demonstrated that the UAR was independently associated with a higher risk of in-hospital mortality [per SD increase in the UAR: hazard ratio (HR) (95%CI): 1.186 (1.067–1.319); P = 0.002] and ICU mortality [per SD increase in the UAR: HR (95%CI): 1.190 (1.068–1.327); P = 0.002]. Restricted cubic spline regression analysis illustrated a linear relationship between UAR and the risks of in-hospital and ICU mortality. Elevated UAR levels were strongly associated with all-cause mortality in critically ill patients with sepsis, suggesting their potential as predictors of poor outcomes. However, further studies are needed to validate our findings and investigate the underlying causal factors that could contribute to sepsis prevention and treatment.

BackgroundThe triglyceride-glucose (TyG) index serves as a reliable proxy for insulin resistance (IR). IR has been linked to heightened incidence, prevalence, or severity of chronic obstructive pulmonary disease (COPD) and asthma. Prior research indicates that critically ill patients are prone to developing IR. Nevertheless, few studies have delved into the correlation between IR and all-cause mortality in critically ill patients with COPD and asthma. Therefore, the aim of this study is to explore the association between the TyG index and all-cause mortality in patients with COPD and asthma, with the goal of assessing the impact of IR on the prognosis of this patient population.MethodsThis is a retrospective study, and all data are from the Medical Information Mart for Intensive Care IV (MIMIC-IV) critical care database. This study included 684 ICU patients with COPD and asthma and divided them into quartiles based on TyG index levels. The primary outcomes of this study were all-cause mortality during follow-up, encompassing mortality at 30 days, 90 days, and 180 days. The Kaplan–Meier analysis was used to compare all-cause mortality among the above four groups. Cox proportional hazards analyses were performed to examine the association between TyG index and all-cause mortality in critically ill patients with COPD and asthma. Restricted cubic spline analysis was used to assess potential nonlinear association between the TyG index and the primary outcome.ResultsA total of 684 patients (53.9% female) were included. The 90-days all-cause mortality rate and 180-days all-cause mortality were 11.7% and 12.3%, respectively. Kaplan-Meier analysis revealed a significant association between the TyG index and both 90-days all-cause mortality (log-rank p = .039) and 180-days all-cause mortality (log-rank p = .017). Cox proportional hazards analysis revealed a significant association between the TyG index and 90-days all-cause mortality in both the unadjusted model (HR, 1.30 [95% CI 1.08–1.57] p = .005) and the model adjusted for age, gender, and diabetes (HR, 1.38 [95% CI 1.15–1.67] p < .001). Similarly, the TyG index was associated with 180-days all-cause mortality in the unadjusted model (HR, 1.30 [95% CI 1.09–1.56] p = .004) and the model adjusted for age, sex, and diabetes (HR, 1.38 [95% CI 1.15–1.66] p < .001). The restricted cubic splines (RCS) regression model indicated a significant nonlinear association between the TyG index and both 90-days and 180-days all-cause mortality. Specifically, TyG index >4.8 was associated with an increased risk of mortality at both 90 days and 180 days.ConclusionsIn summary, our results extend the utility of the TyG index to critically ill patients with COPD and asthma. Our study shows that the TyG index is a potential predictor of all-cause mortality in critically ill patients with COPD and asthma. In addition, in patients with a TyG index exceeding 4.8, there was a heightened risk of mortality. Measuring the TyG index may help with risk stratification and prognosis prediction in critically ill patients with COPD and asthma. Further prospective studies are needed to confirm our findings.

BackgroundThe stress hyperglycemia ratio (SHR) was developed to mitigate the influence of long-term chronic glycemic factors on stress hyperglycemia levels, which are associated with adverse clinical events, particularly cardiovascular events. However, studies examining the SHR index and its prognostic significance in patients with atrial fibrillation (AF) are lacking. This study aims to evaluate the relationship between the SHR index and all-cause mortality in critically ill patients with AF upon Intensive Care Unit admission.MethodsThe patients’ data were extracted from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. All patients were categorized into four groups based on the SHR index. The outcomes include both primary and secondary endpoints, with the primary endpoints being 30-day and 365-day all-cause mortality, and the secondary endpoints being 90-day and 180-day all-cause mortality. The SHR index was analyzed using quartiles, and the Kaplan-Meier curve was employed to compare the outcomes across groups. Cox proportional-hazards regression and restricted cubic splines (RCS) were used to assess the relationship between the SHR index and the outcomes.ResultsOut of a total of 1,685 participants, the average age was 63.12 years (range: 40.17 to 101.49), with 1,004 (59.58%) being male. Higher levels of the SHR index were associated with an increased risk of all-cause mortality at 30 days, 90 days, 180 days, and 365 days, as indicated by the Kaplan-Meier curves (log-rank P < 0.01). Additionally, Cox proportional-hazards regression analysis revealed that the risk of mortality at these time points was significantly higher in the highest quartile of the SHR index. Restricted cubic splines (RCS) analysis demonstrated U-shaped relationships between the SHR index and all-cause mortality, with inflection points at 0.73 for 30-day mortality and 0.76 for 365-day mortality. Compared to patients with SHR levels below these inflection points, those with higher levels had a 69.9% increased risk for 30-day all-cause mortality (hazard ratio [HR] 1.699; 95% confidence interval [CI] 1.336 to 2.159) and a 61.6% increased risk for 365-day all-cause mortality (HR 1.616; 95% CI 1.345 to 1.942).ConclusionIn critically ill patients with AF, higher levels of the SHR index are significantly associated with an increased risk of all-cause mortality at 30 days, 90 days, 180 days, and 365 days. The SHR index may serve as a valid indicator for assessing the severity and guiding the treatment of AF patients in the ICU.

BackgroundThe relationship between triglyceride glucose (TyG) index and long-term prognosis in individuals with heart failure (HF) remains unclear. This study aimed to explore the relationship between the TyG index and both all-cause and cardiovascular mortality in patients with HF.MethodsA total of 709 participants with HF were included from the National Health and Nutrition Examination Survey (1999–2018). The primary endpoints were all-cause mortality and cardiovascular mortality. Participants were classified into three groups (T1, T2, and T3) based on the tertiles of the TyG index, with T1 representing the group having the lowest values, T2 the middle-value group, and T3 the group with the highest values. Multivariate Cox proportional hazards regression model was used to investigate the associations between the TyG index and both all-cause mortality and cardiovascular mortality. The restricted cubic spline (RCS) analysis was used to examine the non-linear associations between TyG index and the endpoint events, and a two-piecewise Cox hazards model was constructed.ResultsDuring a median follow-up period of 74 months, a total of 355 deaths were recorded, with 128 of them attributed to cardiovascular causes. Multivariate Cox regression models showed that compared to the T1 group, the T2 group exhibited a significantly lower risk of cardiovascular mortality (model 1 h: 0.51, 95%CI: 0.28–0.94; model 2 h: 0.55, 95%CI: 0.30-1.00). The RCS analysis revealed a nonlinear relationship between TyG index and all-cause mortality (p-non-linear: 0.014) as well as the cardiovascular mortality (p-non-linear: 0.049) among patients with HF. The inflection points were identified as 8.89 for all-cause mortality and 8.86 for cardiovascular mortality. The risk of all-cause mortality and cardiovascular mortality demonstrated a significantly increase when the TyG index exceeded the corresponding inflection points.ConclusionsJ-shaped associations were observed between TyG index and both all-cause mortality and cardiovascular mortality in patients with HF. TyG index exhibited significant predictive value in this population.

BackgroundNeutrophil-to-lymphocyte ratio (NLR) is considered a biomarker of systemic inflammation and immune activation. However, its relationship with the risk of mortality in patients with chronic obstructive pulmonary disease (COPD) remains unclear. This study aimed to investigate the association between NLR and the risk of all-cause and cardiovascular mortality in patients with COPD.MethodsData were collected from the National Health and Nutrition Examination Survey (NHANES) from January 1999 to December 2018. The calculation method of NLR involves dividing the neutrophil count by the lymphocyte count in the total blood cell count. The optimal NLR threshold associated with survival outcomes was determined using the maximally selected rank statistics method (MSRSM). The relationship between NLR and the risk of all-cause mortality and cardiovascular mortality in COPD was investigated using a weighted multivariable Cox regression model. Additionally, restricted cubic spline (RCS) was employed to discuss the potential relationship between NLR patients in different groups and the risk of mortality.ResultsIn this study, 716 adults with COPD were included using the maximally selected rank statistics method, among whom 208 had higher NLR (≥2.56) and 508 had lower NLR (<2.56). During a median follow-up of 111.5 months, 162 COPD patients died from all causes, and 49 patients died from cardiovascular diseases. After adjusting for demographic, socioeconomic status, and lifestyle factors, the risk of all-cause mortality (HR = 2.07, 95%CI: 1.46–2.94) and cardiovascular mortality (HR = 3.03, 95%CI: 1.63–5.65) in patients with higher NLR was increased by 2–3 times compared to those with lower NLR. Kaplan–Meier analysis revealed significantly lower survival rates in patients with higher NLR for all-cause mortality and cardiovascular mortality (p < 0.05). Restricted cubic spline analysis showed a linear correlation between NLR and the risk of all-cause mortality and cardiovascular mortality.ConclusionNLR has a high value in independently predicting long-term all-cause and cardiovascular mortality risks in community-dwelling COPD patients. Therefore, NLR can serve as a cost-effective and widely available indicator for assessing the prognosis of COPD patients.

Background: The stress-induced hyperglycemic ratio (SHR) is an index that reflects the imbalance between acute stress-induced glucose fluctuations and baseline glucose metabolism levels. Currently, there are few studies on the SHR index and its prognostic significance in heart failure (HF) patients undergoing invasive mechanical ventilation. This study aimed to investigate the relationship of SHR with the risk of death in HF patients requiring invasive ventilation. Methods: Conduct a retrospective cohort study based on the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Include adult heart failure patients who received invasive ventilation and divide them into quartile groups according to the level of the Systemic Heart Rate (SHR). The primary endpoints of the observation are the 30-day all-cause mortality rate and the all-cause mortality rate in the Intensive Care Unit (ICU), while the secondary endpoints are the 365-day all-cause mortality rate and the all-cause mortality rate during hospitalization. The Kaplan-Meier curve is used to compare the survival outcomes between groups. A Cox proportional hazards regression model that adjusts for demographic characteristics, underlying diseases, and the severity of critical illnesses is employed to evaluate the relationship between SHR and the mortality rate. The Restricted Cubic Spline (RCS) is utilized to test the nonlinear association between the two, and subgroup analysis is carried out to verify the consistency of the results across different groups. Results: Among the 1,038 eligible patients, the mean age was 68.50 years (range: 59.46 - 77.48 years), and 639 (61.56%) of them were male. The Kaplan-Meier curve showed that the higher the SHR index, the higher the risk of all-cause mortality in patients at 30 days (log-rank test, p = 0.011) and in the ICU (log-rank test, p = 0.0029). An increase in SHR was independently associated with an increased risk of 30-day and ICU mortality. Compared with the second quartile group Q2, the 30-day mortality rate in the group with the highest SHR was significantly higher (HR = 1.59, 95% CI 1.08, 2.33), and the ICU mortality rate in the group with the highest SHR was significantly higher (HR = 1.86, 95% CI 1.10, 3.14). The restricted cubic spline analysis showed a non-linear dose-response relationship between SHR and 30-day all-cause mortality (p for non-linearity &lt; 0.05), and the risk of 30-day and ICU all-cause mortality gradually increased with the increase of the SHR index. The risks of 30-day and all-cause mortality in the ICU gradually increased. The results of the subgroup analysis confirmed that it remained stable in the subgroup of patients with Coronary Heart Disease (CHD). Conclusion: In critically ill heart failure (HF) patients receiving invasive ventilation, a higher stress hyperglycemia ratio (SHR) index is significantly associated with an increased risk of 30-day and all-cause mortality in the intensive care unit (ICU). Meanwhile, the SHR index is an independent predictor of mortality in critically ill HF patients who require invasive ventilation.

While the U-shaped association between high-density lipoprotein cholesterol (HDL-C) levels and the risk of all-cause and cardiovascular mortality is well-established, the underlying contributions of HDL subclasses remain poorly understood. This study aimed to comprehensively analyze the variations of HDL subclass components across different HDL-C levels and assess their associations with the risk of all-cause and cardiovascular mortality. This study enrolled 1,585 participants aged 35-75 years from China Health Evaluation And risk Reduction through nationwide Teamwork (ChinaHEART) (2014-2023). Lipoprotein parameters were measured by nuclear magnetic resonance, with a focus on triglycerides (TG), cholesterol (CH), free cholesterol (FC), phospholipids (PL), apolipoprotein A1 (Apo-A1) and apolipoprotein A2 (Apo-A2) within four density-separated HDL subclasses (HDL1-HDL4). Between-group comparisons were performed using analysis of variance with post-hoc least significant difference tests. Cox proportional hazards regression models and competing risk models were used to assess the association of HDL subclass components with all-cause and cardiovascular mortality. Potential nonlinear associations were examined using models with restricted cubic splines (RCS). During a median follow-up of 7.6 years, 84 all-cause (5.3%) and 23 (1.5%) cardiovascular deaths were documented. As HDL-C concentration increased, most HDL subclass components (including CH, FC, PL, and Apo-A1) also increased across low (≤ 30mg/dL), intermediate (50-60mg/dL), and high (≥ 100mg/dL) HDL-C groups. Regression models showed that components in larger, more buoyant HDL subclasses (such as H1TG, H2TG, H1CH, H1FC, H1PL, H1A1, H1A2 and H2A2) were positively associated with all-cause mortality, whereas smaller, denser ones (including H4CH, H4FC, H4PL, H4A1 and H4A2) exhibited protective effects. H1PL, H1A1 and H1A2 also emerged as independent risk factors for cardiovascular mortality. The RCS analysis revealed positive linear associations of H1CH and H1A1 with all-cause mortality, while H4CH and H4A1 were inversely associated. Larger, more buoyant HDL subclasses showed a positive association with all-cause mortality, whereas smaller, denser ones were protectively associated. The U-shaped association between HDL-C and mortality may be primarily explained by lower levels of H4CH at very low HDL-C concentrations and higher levels of H1CH at extremely high HDL-C levels. Similar explanations could also account for the association between Apo-A1 and mortality. ClinicalTrials.gov, NCT02536456. Registered 24 August 2015.

Background Although numerous studies have examined the correlation between low-density lipoprotein cholesterol (LDL-C) and mortality, no study has explored these associations in hypertensive populations. This study aims to investigate the relationship between low-density lipoprotein cholesterol and cardiovascular and all-cause mortality in adults with hypertension. Methods Hypertensive participants aged ≥ 18 years old from the National Health and Nutrition Examination Survey (NHANES) 1999–2018 with blood lipid testing data and complete follow-up data until December 31, 2019 were enrolled in the analysis. Univariate and multivariate Cox regression were conducted for the calculation of hazard ratios (HR) and 95% confidence intervals (CI). To visually represent the relationship between LDL-C and mortality, a restricted cubic spline (RCS) curve was created, and stratification analysis was also carried out. Results We analyzed 9,635 participants (49.6% male, mean age of 59.4 years). Following a median of 98 months of follow-up, there were 2,283(23.7%) instances of all-cause fatalities, with 758(7.9%) cases attributed to cardiovascular disease. Multivariate Cox regression analysis showed lower levels of LDL-C groups had a higher risk of all-cause and cardiovascular mortality; the LDL-C group's lowest level (&lt; 2.198 mmol/L) still showed a 19.6% increased risk of all-cause mortality (p = 0.0068) in the the model that has been completely adjusted. Both all-cause mortality and cardiovascular mortality showed a non-linear association with LDL-C concentration in restricted cubic spline regression analysis. Conclusions In individuals with hypertension, LDL-C was linked to cardiovascular and all-cause mortality, and we further demonstrated that this relationship was non-linear.

The study investigated the association between Serum Uric Acid (SUA) levels and all-cause as well as cardiovascular mortality in patients with Obstructive Sleep Apnea (OSA). This prospective cohort study enrolled participants with OSA from four cycles of the National Health and Nutrition Examination Survey (NHANES) conducted between 2005 and 2008, and 2015–2018. A weighted Cox proportional hazards model was used to assess adjusted hazard ratios (aHRs) and their corresponding 95% confidence intervals (CI) for all-cause and cardiovascular mortality. Additionally, multivariable logistic regression and restricted cubic splines (RCS) models were employed to examine nonlinear relationships between SUA and all-cause and cardiovascular mortality. Among the 5,584 OSA participants included in the study, covering the four NHANES cycles and with a median follow-up of 4.333 years, a total of 537 deaths were observed, including 108 deaths attributed to cardiovascular disease. Comparing the fourth quartile (Q4) of uric acid levels, both the fifth quartile (Q5) (aHRs = 1.51, 95% CI [1.08, 2.12]) and the second quartile (Q2) (aHRs = 1.53, 95% CI [1.04, 2.25]) of uric acid levels were independently associated with an increased risk of all-cause mortality. Furthermore, comparing the fourth quartile (Q4) of uric acid levels, the second quartile (Q2) (aHRs = 2.40, 95% CI [1.08, 5.35]) of uric acid levels were independently associated with an increased risk of cardiovascular mortality. The RCS model demonstrated a U-shaped pattern in the association between SUA and all-cause mortality in OSA, with an inflection point observed at 5.83 mg/dl. The findings of this study suggest a U-shaped association between serum SUA levels and all-cause mortality and nonlinearity association between serum SUA levels and all-cause mortality. Further studies are warranted to determine the causal relationship between SUA levels and all-cause and cardiovascular mortality.

Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of mortality worldwide. Dysregulation of glucose metabolism and inflammation are key factors in the development of atherosclerosis. The glucose-to-lymphocyte ratio (GLR) is a comprehensive marker for assessing glucose metabolism and inflammation. This study aims to evaluate the association between GLR and all-cause as well as cardiovascular disease (CVD) mortality in patients with ASCVD within the U.S. population. This retrospective cohort study recruited 1,753 ASCVD patients from the 2003–2018 National Health and Nutrition Examination Survey (NHANES) with a median follow-up of 6.25 years. Mortality outcomes were determined by linkage to the National Death Index (NDI) records up to December 31, 2019. Weighted Cox proportional hazard models were used to assess the independent association between GLR and mortality risk. Restricted cubic spline (RCS) curves were used to display the relationship between GLR and all-cause mortality visually, and two-segment Cox proportional hazards models were constructed on either side of the inflection points. Kaplan-Meier survival curves were further used to assess the relationship between GLR and mortality, and further subgroup analyses were performed. Receiver operating characteristic curve (ROC) analysis was conducted to assess the predictive ability of GLR for survival. During a median follow-up of 6.25 years, 624 deaths from various causes were observed, with 254 deaths from CVD. Cox regression analysis revealed a positive association between GLR and both all-cause and CVD mortality. Based on RCS, a J-shaped nonlinear relationship was observed between GLR and all-cause mortality in ASCVD patients, with an inflection point at 3.13. When the GLR < 3.13, it showed a significant negative association with all-cause mortality (HR 0.65, 95% CI 0.47–0.89). When GLR ≥ 3.13 for all-cause mortality, there was a significant positive correlation with all-cause mortality (HR 1.13, 95% CI 1.09–1.17). Subgroup analysis revealed a positive association between GLR and CVD mortality across most subgroups, but the correlation between GLR and CVD mortality was weaker compared to its association with all-cause mortality. In addition, an interaction was detected between GLR and age in relation to all-cause mortality. Moreover, the predictive performance of GLR on all-cause and CVD mortality seemed superior to that of glucose or lymphocytes. Our findings indicate that elevated GLR was closely associated with an increased risk of all-cause mortality and CVD mortality in ASCVD patients. Notably, the relationship between GLR and all-cause mortality exhibited a J-shaped nonlinear pattern, with an inflection point at 3.13.

BackgroundElevated monocyte-to-high-density lipoprotein-cholesterol ratio (MHR) is relevant to higher all-cause and cardiovascular mortality in patients with coronary artery disease and other comorbidities. However, the predictive values of MHR for mortality in the general population have been underutilized. This study investigated the association of MHR with all-cause and cardiovascular mortality in the adult population of the United States.MethodsThis study included 34,335 participants (≥20 years) from the National Health and Nutrition Examination Survey 1999–2014 that were grouped according to MHR tertiles. Kaplan-Meier plots and long-rank tests were employed to investigate differences in survival among the groups. Moreover, the relationship of MHR with all-cause and cardiovascular mortality was further explored using multivariate Cox regression and restricted cubic spline analysis.ResultsDuring the average follow-up of 93.5 ± 56 months, 4310 (12.6%) participants died, with 754 (2.2%) deaths attributed to cardiovascular diseases. Kaplan-Meier analysis revealed statistically obvious differences in all-cause and cardiovascular mortality among the MHR tertiles (log-rank test: all P < 0.001). In multi-adjusted models, participants in the highest tertile of MHR had an increased risk of all-cause (hazard ratio [HR] = 1.19, 95% confidence interval [CI] 1.10–1.29) and cardiovascular mortality (HR = 1.44, 95% CI 1.17–1.77), compared to those in the lowest tertile. Furthermore, the restricted cubic spline curve indicated that MHR had a non-linear association with all-cause mortality (P < 0.001), and the inflection point of MHR was 0.006. Each 2-fold change in MHR exhibited a 32% decrease (HR = 0.68, 95%CI 0.58–0.82) and a 20% increase (HR = 1.20, 95%CI 1.13–1.27) in the risk of all-cause mortality on the left and right flanks of the inflection point, respectively. Additionally, the risk of cardiovascular mortality increased by 21% per 2-fold change in MHR (HR = 1.21, 95%CI 1.07–1.36) in a linear manner.ConclusionsMHR was significantly related to all-cause and cardiovascular mortality in the general population independent of established risk factors.

Cardiorespiratory fitness: an independent and additive marker of risk stratification and health outcomes.