What question did this study set out to answer?

This research explores the association between elevated EASIX levels and mortality risk in critically ill patients with atrial fibrillation.

February 19, 2026Open Access

Association between endothelial activation and stress index and mortality in critically ill patients with atrial fibrillation: In MIMIC database: A Retrospective Cohort Study

Key Result

Elevated EASIX levels independently increased in-hospital mortality risk by HR 1.09 and ICU mortality risk by HR 1.10 in critically ill AF patients.

Key Points

This research explores the association between elevated EASIX levels and mortality risk in critically ill patients with atrial fibrillation.
Utilized MIMIC-IV database for data extraction
Conducted Kaplan-Meier survival analysis
Applied Cox proportional hazards models for mortality correlation
Performed subgroup and sensitivity analyses
Elevated EASIX levels linked to higher in-hospital and ICU mortality
Adjusted HR for in-hospital mortality was 1.09 (95% CI 1.03, 1.15)
Adjusted HR for ICU mortality was 1.10 (95% CI 1.04, 1.17)
In highest EASIX group, HR for in-hospital death was 2.08 (95% CI: 1.51–2.85)
Interaction observed with sepsis and respiratory failure concerning mortality.

Structured PICO

Does an elevated Endothelial Activation and Stress Index (EASIX) predict higher mortality in critically ill patients with atrial fibrillation?

Population

3,193 critically ill patients diagnosed with atrial fibrillation from the MIMIC-IV database

Intervention

Elevated Endothelial Activation and Stress Index (EASIX)

Comparator

Lower EASIX levels

Outcome

All-cause mortality (in-hospital and ICU mortality)hard clinical

Elevated EASIX levels are significantly associated with increased in-hospital and ICU mortality in critically ill patients with atrial fibrillation.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background Evidence indicates that the Endothelial Activation and Stress Index (EASIX) is a predictor of mortality in endothelium-related conditions; however, its association with mortality risk in atrial fibrillation (AF) remains uncertain. Accordingly, this study examines the relationship between EASIX and mortality risk among patients with AF. Methods This retrospective analysis utilized data from the Medical Information Marketplace in Intensive Care IV (MIMIC-IV) database, which includes critically ill patients diagnosed with AF. To examine the association between EASIX scores and mortality, Kaplan–Meier survival analysis, Cox proportional hazards models, and restricted cubic spline regression were applied to evaluate the relationship between EASIX and all-cause mortality. Subgroup analyses were conducted to explore potential interactions with key patient characteristics, and sensitivity analyses were performed to further confirm the robustness of the results. Results A total of 3,193 patients were included in the analysis. KM survival analysis showed that elevated EASIX levels were associated with a higher risk of both in-hospital and ICU mortality. After adjusting for potential confounders, increased EASIX levels remained significantly associated with in-hospital mortality HR, 1.09 (95% CI 1.03, 1.15), P = 0.0002 and ICU mortality HR, 1.10 (95% CI 1.04, 1.17), P = 0.0002. Stratified analyses revealed a significant interaction between sepsis, respiratory failure, and EASIX in relation to both in-hospital and ICU mortality. To evaluate the robustness of the findings, a sensitivity analysis was performed. After additionally adjusting for metoprolol and heparin as covariates, patients in the highest EASIX group continued to demonstrate the greatest mortality risk: the HR for in-hospital death was 2.08 (95% CI: 1.51–2.85), and the HR for ICU death was 1.83 (95% CI: 1.21–2.65). Conclusion Elevated EASIX levels correlate with higher mortality rates, underscoring its potential as an accessible tool for identifying high-risk patients and informing clinical decisions. However, further studies are needed to explore the underlying mechanisms and validate its applicability across diverse patient populations.