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Association Between CBC-Derived Inflammatory Indicators and 28-Day Mortality in Patients With Coronary Heart Disease
Guang Tu1, Zhonglan Cai1, Shengnan Xue2
1Department of Cardiology, Lichuan People's Hospital, No. 2 Rifeng Road, Rifeng Town, Lichuan County, Fuzhou, 344600, Jiangxi, China.
Insights
Complete blood count inflammatory indices like the neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) can predict mortality in critically ill patients with coronary heart disease and diabetes. These simple blood tests offer rapid, cost-effective risk stratification at the bedside.
Area of Science:
- Critical Care Medicine
- Cardiology
- Endocrinology
Background:
- Coronary heart disease (CHD) is a leading cause of death globally.
- Diabetes mellitus (DM) exacerbates CHD mortality, primarily via chronic inflammation.
- The predictive value of complete blood count (CBC)-derived inflammatory indices in comorbid CHD-DM patients remains unclear.
Purpose of the Study:
- To evaluate the utility of six CBC-derived inflammatory indices (NLR, MLR, PLR, SII, SIRI, AISI) in predicting 28-day mortality in critically ill patients with CHD and DM.
- To identify the most potent predictive indices for risk stratification in this patient population.
Main Methods:
- Retrospective cohort study using the MIMIC-IV database (2008-2022).
- Patients were divided into training (n=1607) and validation (n=1145) sets.
- Cox regression, ROC curves, and SHAP analysis were employed to assess the predictive performance of CBC indices for 28-day mortality.
Main Results:
- All six CBC-derived indices demonstrated independent, dose-dependent associations with 28-day mortality.
- The indices exhibited good discrimination (AUC ~0.76) and excellent calibration.
- SHAP analysis identified the Platelet-to-Lymphocyte Ratio (PLR) and Monocyte-to-Lymphocyte Ratio (MLR) as the most significant predictors.
Conclusions:
- CBC-derived inflammatory indices, particularly PLR and MLR, are valuable tools for predicting 28-day mortality in critically ill CHD-DM patients.
- These indices enable rapid, inexpensive, and effective bedside risk stratification.
Background:
Coronary heart disease (CHD) remains the leading global cause of death; concomitant diabetes mellitus (DM) doubles short-term mortality, largely through chronic low-grade inflammation. Inexpensive, bedside complete blood count (CBC)-derived inflammatory indices (NLR, MLR, PLR, SII, SIRI, and AISI) predict outcomes in CHD or DM alone, but their utility in comorbid patients is unclear.
Methods:
Retrospective cohort study of CHD-DM patients from Medical Information Mart for Intensive Care-IV (MIMIC-IV; 2008-2022), split into training (2017-2022, n = 1607) and validation (2008-2016, n = 1145) sets. Six indices (NLR, MLR, PLR, SII, SIRI, and AISI) were calculated from initial ICU CBC (48-h mean for sensitivity analysis). Primary outcome: 28-day mortality, Cox regression, restricted cubic splines (RCSs), receiver operating characteristic (ROC) curves, calibration plots, and SHAP-based variable importance were used.
Results:
Mortality was 10.6% (training) and 11.9% (validation). All indices showed independent, dose-dependent associations with mortality (e.g., training MLR per 1-SD: HR = 1.49, 95% CI = 1.37-1.61), discrimination was good (training AUC 0.767, C-index 0.752; validation AUC 0.755, C-index 0.746), and calibration was excellent. Spearman correlation showed moderate-to-strong interindex correlations (e.g., MLR-SIRI: r = 0.84). SHAP analysis ranked PLR and MLR as top predictive indices. Sensitivity analysis confirmed robustness.
Conclusions:
Six CBC-derived indices independently predict 28-day mortality in critically ill CHD-DM patients, with PLR and MLR showing superior predictive weight, and can be used for rapid, cost-free bedside risk stratification.
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