Nonlinear association of alkaline phosphatase-to-albumin ratio with all-cause and cancer mortality: Evidence from NHANES 2005 to 2016.
Medicine
The relationship between the alkaline phosphatase-to-albumin ratio (APAR) and mortality remains unclear. This research looked into the association between APAR levels and cause-specific mortality in US adults. A cohort of 7561 participants from National Health and Nutrition Examination Survey (2005-2016) was analyzed, with mortality outcomes collected from National Death Index records. Cox proportional hazards models and restricted cubic spline (RCS) analysis were utilized to determine hazard ratio (HR) and reveal the nonlinear relationship between APAR levels and mortality. Inflection points were calculated using a recursive algorithm. Followed for an average 99.41 months, a total of 1048 deaths occurred, including 200 cancer deaths and 348 cardiovascular disease-related deaths. Following multivariate adjustment, significant associations were observed between APAR levels and increased all-cause (HR 1.50, 95% CI 1.28-1.75, P < .001) and cardiovascular disease (HR 1.39, 95% CI 1.06-1.82, P = .018) mortality. Furthermore, nonlinear correlations between APAR levels and all-cause and cancer mortality were revealed, characterized by an L-shaped pattern, with mortality rates stabilizing at 1.289 and 2.167, respectively. Participants with APAR levels above the inflection point exhibited a 29.2% increase in all-cause mortality risk per unit increase in APAR levels (HR 1.292, 95% CI 1.217-1.372, P < .001), and a 38.3% increase in cancer mortality risk (HR 1.383, 95% CI 1.199-1.596, P < .001). This study demonstrated nonlinear associations between APAR levels and all-cause and cancer mortality. Thresholds of 1.289 and 2.167 might serve as potential targets for APAR to reduce all-cause and cancer mortality, respectively. Our findings suggest that APAR can be a valuable prognostic tool for clinical mortality risk assessments, helping to identify individuals at higher risk. Nevertheless, these findings necessitate validation through large-scale clinical trials for further substantiation.
10.1097/MD.0000000000040430
Alkaline phosphatase-to-albumin ratio as a novel predictor of long-term adverse outcomes in coronary artery disease patients who underwent PCI.
Dai Xin-Ya,Zheng Ying-Ying,Tang Jun-Nan,Wang Wei,Guo Qian-Qian,Yin Shan-Shan,Zhang Jian-Chao,Cheng Meng-Die,Song Feng-Hua,Liu Zhi-Yu,Wang Kai,Jiang Li-Zhu,Fan Lei,Yue Xiao-Ting,Bai Yan,Zhang Zeng-Lei,Zheng Ru-Jie,Zhang Jin-Ying
Bioscience reports
BACKGROUND:Alkaline phosphatase (ALP) and albumin (ALB) have been shown to be associated with coronary artery disease (CAD), and it has been reported that alkaline phosphatase-to-albumin ratio (AAR) is associated with the liver damage and poorer prognosis of patients with digestive system malignancy. Moreover, several previous studies showed that there was a higher incidence of malignancy in CAD patients. However, to our knowledge, the relationship between AAR and long-term adverse outcomes in CAD patients after undergoing percutaneous coronary intervention (PCI) has not been investigated. Therefore, we aim to access the relation between AAR and long-term adverse outcomes in post-PCI patients with CAD. METHODS:A total of 3378 post-PCI patients with CAD were enrolled in the retrospective Clinical Outcomes and Risk Factors of Patients with Coronary Heart Disease after PCI (CORFCHD-ZZ) study from January 2013 to December 2017. The median duration of follow-up was 37.59 ± 22.24 months. The primary end point was long-term mortality including all-cause mortality (ACM) and cardiac mortality (CM). The secondary end points were major adverse cardiac events (MACEs) and major adverse cardiac and cerebrovascular events (MACCEs). RESULTS:Kaplan-Meier analyses showed that an increased AAR was positively correlated with incidences of long-term ACM (log-rank, P=0.014), CM (log-rank, P=0.011), MACEs (log-rank, P=0.013) and MACCEs (log-rank, P=0.006). Multivariate Cox regression analyses showed that the elevated AAR was an independent predictor of long-term ACM (adjusted HR = 1.488 [1.031-2.149], P=0.034), CM (adjusted HR = 1.837 [1.141-2.959], P=0.012), MACEs (adjusted HR = 1.257 [1.018-1.551], P=0.033) and MACCEs (adjusted HR = 1.237 [1.029-1.486], P=0.024). CONCLUSION:An elevated AAR is a novel independent predictor of long-term adverse outcomes in CAD patients following PCI.
10.1042/BSR20203904
The neutrophil-lymphocyte ratio predicts all-cause and cardiovascular mortality among U.S. adults with rheumatoid arthritis: results from NHANES 1999-2020.
Frontiers in immunology
Background:The neutrophil-to-lymphocyte ratio (NLR) is recognized as a biomarker for systemic inflammation and immune activation. However, its connection with the mortality risk in individuals with rheumatoid arthritis (RA) is not well understood. This study aimed to investigate the association between NLR and all-cause and cardiovascular mortality risk in U.S. adults with RA. Methods:Data were gathered from the National Health and Nutrition Examination Survey (NHANES) cycles spanning 1999 to March 2020. We included adults aged ≥20 years. The NLR was computed by dividing the neutrophil count by the lymphocyte count from complete blood counts. The maximally selected rank statistics method helped identify the optimal NLR cutoff value associated with significant survival outcomes. Multivariable logistic regression models were performed to investigate the relationship between the NLR and the all-cause and cardiovascular mortality of RA. Restricted cubic spline (RCS) analyses were utilized to detect whether there were linear or non-linear relationships between NLR and mortality. Results:In this study, 2002 adults with RA were included, with 339 having a higher NLR (≥3.28) and 1663 having a lower NLR (<3.28). During a median follow-up of 84 months, 79 RA individuals died. Participants with higher NLR had a 2-fold increased risk of all-cause (HR = 2.02, 95% CI: 1.53-2.66) and cardiovascular mortality (HR = 2.48, 95% CI: 1.34-4.57) versus lower NLR, after adjusting for demographics, socioeconomic status, and lifestyle factors. Kaplan-Meier analysis revealed that the survival rate for the higher NLR group was significantly lower than the lower NLR group, in terms of both all-cause and cardiovascular mortality (both P<0.0001). The RCS curve demonstrated a positive linear association between the NLR and all-cause and cardiovascular mortality. Conclusion:A higher NLR was independently predictive of elevated long-term mortality risk in U.S. adults with RA. The NLR may serve as an inexpensive, widely available prognostic marker in RA.
10.3389/fimmu.2023.1309835
Association of inflammation and nutrition status with all-cause and cardiovascular mortality in individuals with osteoarthritis: NHANES, 1999-2018.
Frontiers in nutrition
Background:Osteoarthritis (OA) is the most prevalent form of arthritis worldwide. Inflammation and nutrition status play crucial roles in the development and progression of OA. The advanced lung cancer inflammation index (ALI) serves as a composite indicator for evaluating inflammation and nutritional status, while the systemic immune inflammation index (SII) is a novel marker for assessing immune-related inflammation. The study aimed to investigate the associations of the ALI and SII with all-cause and cardiovascular mortality among US adults with OA. Methods:A total of 2,602 individuals aged 20 years and above with OA were included in the study from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2018. Participants were categorized into higher or lower ALI and SII groups using cut-off values determined by the maximally selected rank statistics method. The Kaplan-Meier analysis, Cox proportional hazards models, and Fine Gray competing risk regression models were employed to assess the associations between the ALI/SII and mortality in OA patients. Additionally, stratified and subgroup analyses were conducted to enhance the robustness of the findings. Furthermore, time-dependent receiver operating characteristic (ROC) analysis was used to evaluate the predictive capacity of ALI and SII for mortality. Results:Higher SII levels were associated with a 2-fold increase in the risk of all-cause mortality (HR: 2.00, 95% CI: 1.59-2.52, < 0.001), whereas individuals with higher ALI in the OA group exhibited a significantly reduced risk of all-cause mortality (HR: 0.49, 95% CI: 0.39-0.60, < 0.001). Notably, in Model 3, individuals with higher ALI demonstrated a substantially lower risk of cardiovascular mortality (HR: 0.60, 95% CI: 0.44-0.82, < 0.001). Conversely, in fully adjusted models, those with higher SII experienced a significantly higher risk (HR: 1.83, 95% CI: 1.29-2.60, < 0.001). The RCS analysis revealed a J-shaped non-linear relationship between SII levels and all-cause mortality ( overall < 0.001; non-linear < 0.001), and an L-shaped non-linear association between ALI levels and all-cause mortality ( overall < 0.001; non-linear = 0.002). The time-dependent ROC curves illustrated that ALI and SII displayed a reasonably good and consistent predictive performance for both short- and long-term mortality in OA patients. Conclusions:Lower ALI and higher SII values were correlated with increased risks of all-cause and cardiovascular mortality among US adults with OA.
10.3389/fnut.2024.1464414
Association of serum folate concentrations with cancer mortality among patients with arthritis: a prospective cohort study.
BMC public health
BACKGROUND:Patients with arthritis exhibit abnormal serum folate concentrations and have a higher incidence of cancer. The aim of this study was to investigate the association of serum folate concentrations with cancer mortality among individuals with arthritis. METHODS:This cohort study included 7,514 patients with arthritis from National Health and Nutrition Examination Survey (NHANES) 1999 to 2016 and NHANES III (1988-1994). Death outcomes were ascertained by linkage to National Death Index records through 31 December 2019. Serum folate concentrations were categorized into 4 groups, group 1 (≤ 17 nmol/L); group 2 (17-≤34 nmol/L); group 3 (34-≤51 nmol/L); and group 4 (> 51 nmol/L). Cox regression models were used to calculate hazard ratios and 95% confidence intervals for the associations between folate concentrations and the risk of mortality. RESULTS:During a median follow-up of 9.75 [interquartile range, IQR, 5.75-14.5] years, there were 2,602 all-cause deaths, 949 deaths due to cardiovascular disease, and 478 deaths due to cancer. A non-linear association was observed for folate concentrations with the risk of cancer mortality (P < 0.001) among arthritis patients. Compared with the reference group 2, the hazard ratios for cancer mortality were 1.75 (95% CI, 1.15-2.69) in group 1, 1.70 (95% CI, 1.17-2.46) in group 3, and 1.60 (95% CI, 1.13-2.25) in group 4. CONCLUSIONS:This study shows that both low and high levels of serum folate are associated with an increased risk of cancer mortality among individuals with arthritis, indicating a potential beneficial role of maintaining moderate serum folate concentrations in decreasing the risk of cancer mortality among this population.
10.1186/s12889-024-21004-8
Red cell distribution width/albumin ratio and mortality risk in rheumatoid arthritis patients: Insights from a NHANES study.
International journal of rheumatic diseases
BACKGROUND:Despite the established negative regulatory effects observed in various diseases like cardiovascular disease and diabetes, the distinct impact of red cell distribution width (RDW) to albumin ratio (RAR) on mortality within the realm of rheumatoid arthritis (RA) remains obscure. This study sought to explore the relationship between RAR and mortality in RA patients. METHODS:A cohort of 2151 adults with RA from the National Health and Nutrition Examination Survey (NHANES) spanning 2003-2016 was analyzed for RAR levels derived from red cell distribution width and albumin concentrations. Utilizing Cox regression analysis, Kaplan-Meier curves, and Restricted Cubic Spline (RCS) models, we assessed the association between RAR levels and RA mortality while adjusting for potential confounding variables. RESULTS:Participants with higher RAR had a twofold to threefold increased risk of all-cause (HR = 3.10, 95% CI: 2.26-4.24) and cardiovascular mortality (HR = 2.46, 95%CI: 1.26-4.79) versus lower RAR. Kaplan-Meier analysis revealed that the higher RAR group had a significantly lower survival rate compared to the lower RAR group for both all-cause and cardiovascular mortality (both p < .0001), with a more pronounced effect observed for all-cause mortality. Furthermore, the RCS-fitted Cox regression model illustrated a nonlinear positive correlation between RAR levels and RA mortality. CONCLUSION:Overall, a higher RAR was associated with an increased risk mortality in RA patients. These findings underscore the potential of RAR as a prognostic biomarker in predicting outcomes in RA.
10.1111/1756-185X.15335
Association of prognostic nutritional index with the presence and all-cause mortality of rheumatoid arthritis: the National Health and Nutrition Examination Survey 2003-2018.
BMC public health
BACKGROUND:The prognostic nutritional index (PNI) is a comprehensive measure of individual immune and nutritional status. This study aimed to evaluate the role of PNI in the presence and mortality of rheumatoid arthritis (RA). METHODS:This study used data of participants aged ≥ 40 years from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. PNI was calculated using serum albumin and lymphocyte count. The relationship between PNI and the prevalence of RA and mortality among RA patients was assessed using logistic and Cox regression models. Nonlinear associations were explored using restricted cubic splines (RCS). RESULTS:Of 18,245 participants (mean 55.4 years, 49% female), 1901 had RA, among whom (480/1899, 25%) died during a median follow-up period of 84 months. PNI was inversely associated with the likelihood of having RA (odds ratio = 0.97, 95% confidence interval [CI]: 0.95-0.98). Compared to participants whose PNI was in the lowest quartile, those in other quartiles had a reduced likelihood of having RA by 21-38% (P <0.01). Cox regression analysis revealed an inverse association between PNI and all-cause mortality (hazard ratio = 0.95, 95%CI: 0.91-0.99). An L-shaped association was observed between PNI and the presence and all-cause mortality of RA, with turning points occurring around the mean value of PNI. The presence and all-cause mortality of RA was significantly reduced before the turning points of PNI and plateaued afterwards. CONCLUSION:In middle-aged and older adults, there is an inverse association between PNI and the presence and all-cause mortality of RA.
10.1186/s12889-024-20795-0
Association between the dietary inflammatory index and all-cause mortality in osteoarthritis.
BMC musculoskeletal disorders
BACKGROUND:To investigate the association between the Dietary Inflammatory Index (DII) and all-cause mortality in patients with osteoarthritis (OA). METHODS:In this retrospective cohort study, data on OA patients were obtained from the National Health and Nutrition Examination Survey (NHANES) 2003-2018. OA diagnosis was self-reported. The study population was divided into low and high DII groups based on the DII's median. All-cause mortality was the outcome, which was determined via linkage to the National Death Index (NDI) until 31 December 2019. Multivariable Cox regression analyses were employed to investigate the association between the DII and all-cause mortality. The survival of the low and high DII groups was exhibited by Kaplan-Meier curves. Furthermore, subgroup analyses were carried out in terms of age and comorbidity. RESULTS:A total of 3804 patients with OA were included, with 1902 (50%) in the low DII group and 1902 (50%) in the high DII group. Patients with a high DII had a significantly greater risk of all-cause mortality than those with a low DII (HR = 1.21, 95%CI: 1.02-1.44, P = 0.025). A high DII was associated with a significantly increased risk of all-cause mortality compared with a low DII in patients aged ≥ 65 years [hazard ratio (HR) = 1.28, 95% confidence level (CI): 1.07-1.53, P = 0.006). Hypertensive patients with a high DII had a significantly greater risk of all-cause mortality than those with a low DII (HR = 1.25, 95%CI: 1.03-1.52, P = 0.025). For patients with cardiovascular disease (CVD), a high DII was associated with a significantly higher risk of all-cause mortality than a low DII (HR = 1.43, 95%CI: 1.17-1.75, P < 0.001). A high DII was associated with a significantly greater risk of all-cause mortality, as compared with a low DII in patients with chronic kidney disease (CKD) (HR = 1.22, 95%CI: 1.02-1.45, P = 0.026). CONCLUSION:The DII was positively associated with the risk of all-cause mortality in patients with OA. This association differed by age, hypertension, CVD, and CKD. Adherence to diet with a low DII may be beneficial in prognosis improvement.
10.1186/s12891-024-07506-x