Background: The neutrophil-to-lymphocyte ratio (NLR) has been linked as a marker of systemic inflammation to adverse outcomes in various metabolic diseases. However, the association of the NLR with mortality risk among patients with hyperlipidemia remains inconclusive. Thus, this research aimed to investigate whether the NLR is associated with mortality risk among individuals with hyperlipidemia and to examine how glycemic status influences this relationship. Methods: Weighted Cox regression, restricted cubic splines (RCS), and subgroup analyses were employed to evaluate the association between the NLR and mortality risk in patients with hyperlipidemia. Time-dependent receiver operating characteristic (ROC) analysis was conducted to assess the predictive accuracy for mortality risk. Results: In Model 3, individuals in the highest NLR quartile had a 40% higher risk of all-cause mortality (95% confidence interval (CI): 1.19–1.65; p for trend <0.001) and an 86% higher risk of cardiovascular mortality (95% CI: 1.28–2.68; p for trend <0.001) compared with those in the lowest quartile. Time-dependent ROC analysis confirmed the superior performance of the NLR in predicting cardiovascular mortality risk. A significant interaction between the NLR and diabetes mellitus (DM) was observed for both all-cause and cardiovascular mortality in the subgroup analyses. Given this finding, we further examined the association between the NLR and mortality, stratified by glycemic status. The results indicated that the association between the NLR and mortality was stronger among individuals with DM. Conclusions: An elevated NLR is closely associated with an increased risk of mortality among individuals with hyperlipidemia, and the presence of DM significantly strengthens this association.
Background: Sodium–glucose cotransporter 2 (SGLT2) inhibitors, a novel class of oral antihyperglycemic medications prescribed for type 2 diabetes mellitus, play a beneficial role in slowing the progression of heart failure. However, debate persists regarding the potential link of these inhibitors to acute kidney injury (AKI) in specific clinical conditions. Methods: This study was a retrospective analysis of consecutive patients receiving off-pump coronary artery bypass grafting (OPCABG) at our institution between January 2018 and July 2023. A group of patients who had been administered SGLT2 inhibitors was systematically compared with non-users in a 1:3 ratio using propensity score matching. The principal endpoint was postoperative AKI after OPCABG. In addition, we performed a comprehensive meta-analysis of the associations between SGLT2 inhibitor therapy and AKI risk. The analytical approach combined institutional data with aggregated findings from existing literature. Results: The analysis encompassed 403 patients who administered SGLT2 inhibitors and 1209 non-users. AKI developed in 54 cases (13.4%) post-OPCABG among individuals who received SGLT2 inhibitors, compared to 373 cases (30.9%) in the control cohort. Statistical analysis demonstrated significantly reduced AKI prevalence in the SGLT2 inhibitor cohort compared to non-users (p < 0.001). The meta-analysis results confirmed a protective association between SGLT2 inhibitor therapy and AKI risk reduction (odds ratio (OR) = 0.525, 95% confidence interval (CI) 0.437–0.631; p < 0.001). Conclusion: In this study, SGLT2 inhibitor administration was associated with a decreased incidence of postoperative AKI in OPCABG patients. Clinical Trial Registration: NCT05888168, https://clinicaltrials.gov/study/NCT05888168?cond=NCT05888168&rank=1.
Background: The controlling nutritional status (CONUT) and allostatic load (AL) indices indicate significant correlations with heart failure (HF). Given that depressive status associated with metabolic dysregulation may influence these associations, this research aimed to explore whether depressive status modulates the associations between these two indices and HF. Methods: Data were analyzed from 4632 participants aged ≥20 years in the National Health and Nutrition Examination Survey (NHANES), 2005–2018. After applying weighting (WTINT2YR) to the included data, samples with missing data and those without weighted processing were excluded. Binary logistic regression analysis was then employed to investigate the relationships between CONUT, AL, and HF. Subgroup analysis was performed with depressive status as a stratifying factor, and a restricted cubic spline (RCS) model was used to investigate the presence of linear or non-linear relationships between the two clinical indices and HF. Receiver operating characteristic (ROC) curves, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) were employed to evaluate the predictive performance of the different models for HF. Results: Both CONUT and AL were positively correlated with HF in Model 1 (CONUT: odds ratio (OR) = 1.43, 95% confidence interval (CI): 1.25–1.63, p < 0.001; AL: OR = 1.23, 95% CI: 1.14–1.32, p < 0.001) and Model 2 (CONUT: OR = 1.29, 95% CI: 1.12–1.48, p < 0.001; AL: OR = 1.14, 95% CI: 1.05–1.24, p = 0.002). Depressive status was shown to moderate the positive association between CONUT and HF (p for interaction = 0.035). AL was associated with HF in the depressive subgroup (area under the curve (AUC) = 0.6048, 95% CI: 0.5162–0.6934), indicating limited predictive performance of the model. The NRI and IDI values revealed no significant difference in the predictive performance of CONUT and AL in Model 4. Conclusions: The CONUT and AL indices demonstrated positive associations with HF in the general population. Depressive status is a moderating factor that attenuates the association between CONUT and HF. Meanwhile, CONUT and AL are not effective predictors of HF risk under conditions of depressive status. Therefore, screening for depressive status in individuals with high CONUT and AL indices is important for predicting HF.
Background: Cardiovascular-kidney-metabolic (CKM) syndrome represents a progressive disorder characterized by the interplay of cardiovascular pathologies, chronic renal impairment, and metabolic dysregulation. Therefore, this study aimed to examine the relationship between the dietary index for gut microbiota (DI-GM) and mortality outcomes, including both all-cause and cardiovascular-specific mortality, in individuals classified with CKM syndrome stages 0–3. Methods: Our study cohort consisted of 7884 adult participants aged 30–79 years from the National Health and Nutrition Examination Survey (NHANES) conducted between 2007 and 2018. Dietary intake data obtained through 24-hour dietary recalls and food frequency questionnaires were used to calculate the DI-GM scores, incorporating both components beneficial to the microbiota and those with potentially detrimental nutritional effects. The primary and secondary endpoints were all-cause mortality and cardiovascular-related mortality, respectively. The Kaplan–Meier survival analysis, Cox proportional hazards regression models, and restricted cubic spline (RCS) techniques were employed in the statistical analyses. Results: The participants had a median age of 50 years, with females comprising 52.97% of the cohort. Over a median follow-up period of 77 months, we documented 469 all-cause deaths (4.56%) and 105 cardiovascular fatalities (1.02%). Elevated beneficial scores for the DI-GM demonstrated significant inverse associations with both all-cause (p < 0.001) and cardiovascular mortality (p = 0.017). However, while the total DI-GM scores showed correlation with decreased all-cause mortality (p < 0.001), no significant association emerged for cardiovascular mortality. Following the employment of a comprehensive adjustment, the hazard ratio (HR) for the total DI-GM score and all-cause mortality was 0.90 (95% confidence interval (CI): 0.82–0.98). For the beneficial components, the HR was 0.88 (95% CI: 0.79–0.98) for all-cause mortality and 0.87 (95% CI: 0.77–0.99) for cardiovascular mortality. RCS modeling revealed a U-shaped correlation between the total DI-GM scores and all-cause mortality, which was in contrast to a linear association for the beneficial scores. The systemic inflammation index (SII) accounted for 5.29% and 8.45% of the observed associations between the total and beneficial DI-GM scores and all-cause mortality, respectively. Conclusions: Elevated DI-GM dietary scores, particularly those emphasizing food components beneficial to the gut microbiota, demonstrate protective associations against both all-cause and cardiovascular mortality in individuals with CKM syndrome in stages 0–3. These protective effects appear partially influenced by systemic inflammatory pathways.
