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Prognostic value of atherogenic index of plasma in pulmonary hypertension
Meng-Qi Chen1, An Wang1, Chuan-Xue Wan1
1Department of Cardiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Background:
The atherogenic index of plasma (AIP) is a brand-new lipid parameter that has been used to assess various cardiovascular events. This study aimed to investigate the prognostic value of AIP in patients with pulmonary hypertension (PH).
Methods:
This retrospective study was conducted at Shanghai Jiao Tong University School of Medicine affiliated Renji Hospital, and included data from 125 PH patients treated during 2014-2018. The endpoint events of this study were clinical worsening outcomes. PH patients include those from group 1 and group 4. AIP was determined as the logarithm of the blood triglycerides ratio to high-density lipoprotein cholesterol.
Results:
The 1-year, 3-year, and 5-year incidence rates of clinical worsening outcomes in PH patients in this study were 20.0, 44.8, and 54.4%, respectively. The median age of the PH patients was 38.00 years, with females accounting for 90.4%. After controlling for multivariable factors, the results of Cox regression analysis indicated that AIP was an independent predictor of adverse outcomes with a hazard ratio and 95% confident interval (CI) of 2.426 (1.021-5.763). The positive linear relationship of AIP was evaluated using restricted cubic spline analysis. Kaplan-Meier curves showed a significantly higher events rate in patients with AIP ≥ 0.144 compared to those with AIP < 0.144 (p = 0.002). Four potential prognostic variables, including AIP, were identified by LASSO regression to construct a nomogram. Compared to the model minus AIP, the AUC of the nomogram displayed a non-significant improvement (0.749 vs. 0.788, p = 0.298). In contrast, the results of net reclassification improvement (0.306, 95% CI: 0.039-0.459, p < 0.001) and integrated discrimination improvement (0.049, 95% CI: 0.006-0.097, p = 0.020) demonstrated significant enhancements in the predictive ability of the model when AIP was added to the clinical model.
Conclusion:
AIP is an independent predictor of long-term clinical worsening in PH patients, and its inclusion in prognostic models could improve risk stratification and management.
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