The role of endothelial injury in worsening congestive heart failure (CHF) remains unquantified. This study evaluates the Endothelial Activation and Stress Index (EASIX) for predicting short-term mortality in patients with critical CHF. This was a retrospective cohort study using the Medical Information Mart for Intensive Care-IV (2008–2022). Adults with CHF admitted to the intensive care unit were stratified by ln(EASIX) quartiles. The primary endpoint was 30-day all-cause mortality. Multivariable Cox regression, restricted cubic splines, and subgroup analyses were performed. Among 4556 patients (median age 72.1 years, 42.8% female), the highest EASIX quartile (Q4) had a 44.2% 30-day mortality rate versus 19.2% in Q1 (adjusted hazard ratio HR = 1.6, 95% confidence interval CI: 1.27–2.02, P < .001). A nonlinear association was observed (nonlinearity P = .008) with an inflection point at ln(EASIX) = 0.05. Beyond this threshold, each unit increase in ln(EASIX) conferred a 14.2% higher mortality risk (HR = 1.142, 95% CI: 1.062–1.227). Ln(EASIX) remained predictive after full adjustment for severity scores and treatments, with the highest quartile (Q4) exhibiting a 60% increased mortality risk (adjusted HR = 1.60, 95% CI: 1.27–2.02). EASIX is a robust predictor of short-term mortality in patients with critical CHF, particularly valuable in nonsepsis populations. Its simple calculation (lactate dehydrogenase/creatinine/platelets) that refines risk stratification beyond conventional severity scores.
Dong et al. (Fri,) studied this question.