Background: Early risk stratification in acute decompensated heart failure with reduced ejection fraction (ADHF-rEF) remains challenging. The Endothelial Activation and Stress Index (EASIX)—a composite of lactate dehydrogenase, creatinine, and platelet count—reflects endothelial dysfunction, a pathophysiological contributor to early deterioration in ADHF-rEF. This study evaluated the prognostic utility of admission-based EASIX for in-hospital mortality. Methods: In this retrospective single-center cohort, 850 consecutive patients hospitalized with ADHF-rEF between January 2022 and June 2025 were analyzed. EASIX was calculated from first-day laboratory values. Logistic regression, ROC analysis, restricted cubic splines, and Kaplan–Meier survival methods were used to assess the association between EASIX and in-hospital mortality, and to evaluate its incremental value beyond established clinical and laboratory predictors. Results: In-hospital mortality was 12.4%. Higher EASIX values were significantly associated with mortality in both univariable and multivariable models (adjusted OR 1.273; p < 0.001). EASIX demonstrated moderate discriminative performance among evaluated biomarkers (AUC 0.751) and showed a clear dose–response risk gradient, with mortality rising from 1.4% in the lowest tertile to 26.2% in the highest. Incorporating EASIX into clinical and laboratory prediction models yielded substantial continuous net reclassification improvement (0.59 and 0.38, respectively). Survival curves diverged early and remained distinctly separated across EASIX strata. Conclusions: Admission EASIX is an independent predictor of in-hospital mortality in ADHF-rEF and provides complementary prognostic information beyond conventional models. This is the first study to demonstrate the prognostic value of EASIX in the ADHF-rEF setting, supporting its potential utility as an accessible endothelial stress biomarker for early risk stratification.
Objective: Nondipper blood pressure pattern plays an important role in cardiovascular events even in normotensive individuals. The relationship between CRP (C-reactive protein)/albumin ratio (CAR), a valuable marker of inflammation and cardiovascular diseases, has been studied for a long time. We aimed to investigate the relationship between CAR and dipper/nondipper pattern in normotensive subjects. Methods: A total of 78 dipper and 78 nondipper participants, based on ambulatory blood pressure monitoring (ABPM), were retrospectively included in our study. CAR and other parameters of all participants were collected from blood samples taken at the time of monitoring. Results: CAR was significantly higher in the nondipper group than dipper group (P = 0.001). CAR was negatively and significantly correlated with nocturnal SBP fall ratio and nocturnal DBP fall ratio (P < 0.001). CRP/albumin ratio was found significantly and independently associated with the nondipper pattern (P = 0.002). Conclusion: We found that normotensive individuals with nondipping pattern tend to have increased CAR. Increased inflammatory response could contribute to increase in the atherosclerotic risk in nondippers compared with dippers even in a normotensive profile.
Background and Objectives: Conventional risk models may not adequately capture key biological determinants of mortality following transcatheter aortic valve implantation (TAVI), such as inflammation, malnutrition, and immune dysfunction. The Osaka Prognostic Score (OPS), incorporating CRP, albumin, and lymphocyte count, may address this gap. We aimed to evaluate the prognostic value of OPS for predicting in-hospital and one-year all-cause mortality after TAVI. Materials and Methods: In this retrospective single-center cohort study, 244 patients who underwent transfemoral TAVI between December 2022 and January 2024 were analyzed. OPS was calculated at baseline (range: 0–3), and its prognostic value for in-hospital and one-year all-cause mortality was evaluated using multivariable Cox regression, ROC analysis, and restricted cubic spline (RCS) modeling. Results: In-hospital and one-year mortality rates were 11.5% and 21.7%, respectively. Higher OPS scores were significantly associated with mortality in both periods. OPS independently predicted in-hospital mortality (HR: 2.018; 95% CI: 1.632–2.521; p = 0.017) and one-year mortality (HR: 2.125; 95% CI: 1.300–3.473; p = 0.003). ROC analysis yielded AUC values of 0.776 and 0.859 for in-hospital and one-year mortality, respectively. Kaplan–Meier curves revealed significantly reduced survival in patients with higher OPS (log-rank p < 0.001), and RCS analysis demonstrated a significant nonlinear association between increasing OPS values and mortality risk (p < 0.001). Conclusions: OPS is a simple, cost-effective, and biologically relevant prognostic index that independently predicts both in-hospital and one-year mortality following TAVI. By integrating markers of inflammation, nutrition, and immune competence, OPS may offer additional value in risk stratification and support clinical decision-making in this high-risk population.
1 March 2022 in e-Journal of Cardiovascular Medicine