Novel Risk Biomarker for Infective Endocarditis Patients With Normal Left Ventricular Ejection Fraction　― Monocyte to High-Density Lipoprotein Cholesterol Ratio

• Published in: Circulation Journal Vol. 82; no. 1; pp. 283 - 288
• Main Authors: Wei, Xue-biao, Chen, Feng, Huang, Jie-leng, He, Peng-cheng, Wei, Yan-xing, Tan, Ning, Chen, Ji-yan, Yu, Dan-qing, Liu, Yuan-hui
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 01.01.2018
• Subjects: Adult; Biomarkers; Cholesterol, HDL - blood; Endocarditis - complications; Endocarditis - diagnosis; Endocarditis - mortality; Endocarditis - physiopathology; Female; High-density lipoprotein; Hospital Mortality; Humans; Infective endocarditis; Inflammation; Kaplan-Meier Estimate; Male; Middle Aged; Monocytes; Monocytes - cytology; Outcomes; Predictive Value of Tests; Prognosis; Stroke Volume; Infective endocarditis; Monocytes; High-density lipoprotein; Outcomes
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-17-0427

Background:The monocyte to high-density lipoprotein cholesterol ratio (MHR) appears to be a newly emerging inflammatory marker. However, its prognostic value in patients with infective endocarditis (IE) and normal left ventricular ejection fraction (LVEF) has been unclear.Methods and Results:We enrolled consecutive patients with IE and normal LVEF and divided into 3 groups based on the tertiles of MHR. Of 698 included patients, 44 (6.3%) died while in hospital. The occurrence of in-hospital death (3.9%, 4.3%, and 10.8%, P=0.003) and of major adverse clinical events (MACEs) (15.6%, 20.9%, and 30.6%, P<0.001) increased from the lowest to the highest MHR tertiles, respectively. Receiver-operating characteristic analysis demonstrated that MHR had good predictive value for in-hospital death (area under the curve [AUC] 0.670, 95% confidence interval [CI] 0.58–0.76, P<0.001) and was similar to C-reactive protein (AUC 0.670 vs. 0.702, P=0.444). Furthermore, MHR >21.3 had a sensitivity of 74.4% and specificity of 57.6% for predicting in-hospital death. Multiple analysis showed that MHR >21.3 was an independent predictor of both in-hospital (odds ratio 3.98, 95% CI 1.91–8.30, P<0.001) and long-term death (hazard ratio 2.29, 95% CI 1.44–3.64, P<0.001) after adjusting for age, female, diabetes mellitus, estimated glomerular filtration rate <90 mL/min/1.73 m2, and surgical treatment. Kaplan-Meier survival curves showed that patients with MHR >21.3 had an increased rate of long-term death compared to those without (P=0.002).Conclusions:Elevated MHR was independently associated with in-hospital and long-term death in patients with IE and normal LVEF.