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Apolipoprotein A-I: A favorable prognostic marker in infective endocarditis
Xue-Biao Wei1, Xiao-Jin Chen2, Yuan-Ling Li1
1Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong General Hospital, Guangdong Academic of Medical Sciences, Guangzhou, China.
Insights
Lower levels of apolipoprotein A-I (apoA-I) and high-density lipoprotein cholesterol (HDL-C) predict worse outcomes in infective endocarditis (IE). These biomarkers are valuable for assessing prognosis in IE patients.
Area of Science:
- Cardiology
- Biochemistry
- Infectious Diseases
Background:
- Decreased apolipoprotein A-I (apoA-I) and high-density lipoprotein cholesterol (HDL-C) are observed in inflammatory conditions like sepsis.
- The prognostic significance of apoA-I and HDL-C in infective endocarditis (IE) has not been extensively studied in large cohorts.
Purpose of the Study:
- To investigate the prognostic value of apoA-I and HDL-C for adverse clinical outcomes in patients diagnosed with IE.
- To determine if apoA-I and HDL-C levels can predict mortality and major adverse events in IE.
Main Methods:
- A cohort of 593 patients with confirmed IE between 2009 and 2015 was analyzed.
- Patients were stratified into tertiles based on admission apoA-I levels.
- Univariate and multivariate analyses, including logistic regression and Cox proportional hazard models, were used to assess the association of apoA-I and HDL-C with outcomes.
Main Results:
- Lower apoA-I levels correlated with significantly higher in-hospital mortality and major adverse clinical events.
- Both apoA-I and HDL-C demonstrated predictive value for in-hospital death (AUC > 0.67).
- Low apoA-I (<0.90 g/L) and low HDL-C (<0.78 mmol/L) were identified as independent predictors of in-hospital death and long-term mortality.
Conclusions:
- Apolipoprotein A-I and HDL-C levels are inversely associated with adverse prognosis in patients with infective endocarditis.
- These biomarkers serve as important indicators for predicting both short-term and long-term adverse outcomes in IE.
Background:
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).
Objective:
The present study aimed to explore the prognostic value of apoA-I and HDL-C for adverse outcomes in IE patients.
Methods:
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.
Results:
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 <0.90 g/L and HDL-C <0.78 mmol/L were independent risk predictors for in-hospital death. A multivariate Cox proportional hazard analysis revealed that apoA-I (increments of 1 g/L; hazard ratio, 0.36; 95% confidence interval, 0.15-0.87; P = .023) and HDL-C (increments of 1 mmol/L; hazard ratio, 0.38; 95% confidence interval, 0.18-0.83; P = .015) were independently associated with long-term mortality.
Conclusions:
ApoA-I and HDL-C were inversely associated with adverse IE prognosis.
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