Advanced lung cancer inflammation index and mortality risk in patients with cardiovascular disease

Reliable prognostic markers are essential for optimizing risk stratification and clinical management in patients with cardiovascular disease (CVD). The advanced lung cancer inflammation index (ALI), an integrated measure of systemic inflammatory and nutritional status, has shown promise as a predictor of cardiovascular outcomes. This study aimed to examine the association of ALI with the risk of all-cause and cardiovascular mortality in patients with CVD. In this prospective cohort study, we utilized data from the National Health and Nutrition Examination Survey (NHANES) between 1999 and 2018, linked to mortality records from the National Death Index (NDI). A total of 4,247 adult CVD patients were included. The association of ALI with mortality risk was evaluated using Kaplan–Meier survival analysis with log-rank tests and Cox proportional hazards regression models. To examine the nonlinear association, restricted cubic spline (RCS) analysis was performed. Additionally, Time-dependent receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive performance of ALI for survival outcomes. During a median follow-up period of 84 months, 1,795 deaths were recorded, including 741 were cardiovascular-related. Kaplan–Meier survival analysis demonstrated significantly improved survival for participants in the highest ALI tertile compared to those in lower tertiles, for both all-cause and cardiovascular mortality. Weighted Cox proportional hazards models revealed that patients with high ALIs had significantly lower risks of all-cause and cardiovascular mortality than did those with low ALIs. RCS analysis further supported a nonlinear, inverse dose-response relationship between ALI and all-cause and cardiovascular mortality. The ROC demonstrated moderate discriminative performance for short- and long-term mortality risk, with AUCs of 0.727, 0.728 at 1 year and 0.638, 0.639 at 10 years, for all-cause and cardiovascular mortality, respectively. ALI is independently associated with mortality in patients with CVD, and low ALI levels are significantly correlated with an elevated risk of mortality. Therapeutic interventions focused on mitigating inflammation and optimizing nutritional status may have important clinical implications for reducing mortality risk in this patient population, given the observed association between ALI and mortality outcomes.