Endothelial activation and stress index predicts 28-day mortality in patients undergoing CRRT

TL;DR

This study shows that the endothelial activation and stress index (EASIX) can predict 28-day mortality in patients receiving CRRT, improving on existing models.

Contribution

The study demonstrates EASIX's independent predictive value for mortality in CRRT patients, enhancing the SOFA score's performance.

Findings

Higher EASIX scores were significantly linked to lower 28-day survival in CRRT patients.

EASIX improved the predictive accuracy of the SOFA score for mortality.

The association between EASIX and mortality was linear and consistent across subgroups.

Abstract

The endothelial activation and stress index (EASIX) is recognized as a prognostic indicator across various diseases; however, its utility in patients undergoing continuous renal replacement therapy (CRRT) is limited. This study aimed to investigate the relationship between EASIX and prognosis in individuals receiving CRRT. Data from patients receiving CRRT were extracted from the Medical Information Mart for Intensive Care IV database. EASIX was calculated and log2-transformed. Kaplan–Meier survival analysis was conducted based on log2(EASIX) quartiles. Cox proportional hazards regression was utilized to estimate the relationship between EASIX and 28-day all-cause mortality. Potential nonlinear associations were evaluated through restricted cubic splines (RCS) analysis, and subgroup analyses were performed to assess the robustness of EASIX’s impact on all-cause mortality. A total of 2873 intensive care unit patients treated with CRRT were enrolled. Kaplan–Meier analysis revealed that higher EASIX scores were significantly associated with lower 28-day survival (log-rank P < 0.001). After adjusting for confounding factors, EASIX remained significantly associated with the risk of 28-day all-cause mortality among CRRT patients (HR: 1.066; 95% CI: 1.026–1.107; P ═ 0.001). The area under the curve of the SOFA+EASIX model was 0.694 (95% CI: 0.673–0.714; P < 0.001), slightly higher than that of the Sequential Organ Failure Assessment (SOFA) scores alone. These results suggest that EASIX may enhance the predictive performance of SOFA scores. RCS analysis indicated a linear association between log2(EASIX) and 28-day all-cause mortality (P for overall = 0.001; P for nonlinear = 0.224). Subgroup analyses confirmed the robustness of this association across various patient groups. In conclusion, EASIX is independently associated with mortality in patients undergoing CRRT. Prospective studies are warranted to further explore its therapeutic and prognostic significance.

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