Association between Endothelial Activation and Stress Index and mortality in diabetic nephropathy ICU patients: A retrospective cohort study

• Published in: PloS one Vol. 20; no. 8; p. e0329233
• Main Authors: Chen, Sheng, Guo, Lin, Ma, Xiaohan, Wang, Shuaikang, Wu, Junchao, Wu, Lingling, Zhang, Ting, Gao, Hongjun
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 14.08.2025; Public Library of Science (PLoS)
• Subjects: Age; Aged; Biology and Life Sciences; Biomarkers; Blood platelets; Cardiac arrhythmia; Cardiovascular disease; Care and treatment; Comorbidity; Creatinine; Critical Illness - mortality; Dehydrogenases; Diabetes; Diabetes mellitus; Diabetic nephropathies; Diabetic Nephropathies - mortality; Diabetic Nephropathies - pathology; Diabetic Nephropathies - physiopathology; Diabetic nephropathy; Diagnosis; Endothelium; Endothelium, Vascular - physiopathology; Female; Health aspects; Heart failure; Hemoglobin; Hospital Mortality; Hospital patients; Hospitals; Human subjects; Humans; Inflammation; Intensive care; Intensive Care Units; Kaplan-Meier Estimate; Kinases; Male; Medical research; Medicine and Health Sciences; Medicine, Experimental; Middle Aged; Mortality; Nephropathy; Oxidative stress; Paralysis; Patient outcomes; Physiological aspects; Physiology; Prognosis; Proportional Hazards Models; Regression analysis; Respiratory failure; Retrospective Studies; Sepsis; Sodium; Statistical models; Subgroups; Survival; Therapeutic applications; Type 2 diabetes; Variables; China; United States > US; Massachusetts
• DOI: 10.1371/journal.pone.0329233
• ISSN: 1932-6203

Diabetic nephropathy (DN) is a serious complication of diabetes mellitus, often leading to poor outcomes in critically ill patients. Endothelial Activation and Stress Index (EASIX), a marker of endothelial dysfunction and systemic stress, has been associated with adverse outcomes in various diseases, but its role in predicting mortality in DN patients remains unclear. A retrospective cohort study was conducted using the MIMIC-IV database. A total of 1,260 critically ill DN patients were included and stratified into tertiles based on their EASIX scores. Kaplan-Meier survival analysis, Cox proportional hazard models, and restricted cubic spline regression were applied to evaluate the association between EASIX and 30- and 60-day all-cause mortality. Subgroup analyses were also performed to assess interactions with key patient characteristics. Patients with higher EASIX scores had significantly increased ICU and in-hospital mortality rates. Cox regression analyses revealed that EASIX was an independent predictor of mortality after adjusting for age, sex, and comorbidities (HR: 1.14; 95% CI: 1.03-1.26; p = 0.01). Kaplan-Meier analysis showed significantly worse survival rates in the highest EASIX tertile. Subgroup analysis showed that higher EASIX scores were still associated with short-term survival in patients with DN in the presence of older age, male gender, and severe complications. Higher EASIX scores are associated with increased short-term mortality in critically ill DN patients, highlighting its value as a prognostic biomarker for risk stratification and personalized management. Further studies are needed to validate these findings and explore therapeutic interventions targeting endothelial dysfunction.