Frontiers in cardiovascular medicine · 2026
Association of the inflammatory burden index with 1-year major adverse cardiovascular events in patients with HFpEF after myocardial infarction: a single-center retrospective cohort study.
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Yin Xiaoyan, Chen Pan, Liu Boshi, Ren Lei
Аннотация
BACKGROUND: Inflammatory activation may contribute to adverse remodeling and recurrent cardiovascular events after myocardial infarction (MI), but its prognostic value in patients with heart failure with preserved ejection fraction (HFpEF) remains uncertain. This study evaluated whether the Inflammatory Burden Index (IBI) was associated with 1-year major adverse cardiovascular events (MACE) in patients with HFpEF and documented MI.
METHOD: In this single-centre retrospective cohort study, 625 patients hospitalized at Fuyang People's Hospital from January 2018 to December 2023 were screened. After 33 patients with incomplete follow-up or unavailable baseline data were excluded, 592 patients were included. IBI was calculated as C-reactive protein multiplied by the neutrophil-to-lymphocyte ratio. The Youden-derived IBI cutoff of 7.70 was used only for descriptive grouping and sensitivity analysis. The primary Cox model treated log-transformed IBI (logIBI) as a continuous predictor and adjusted for age, sex, hypertension, diabetes mellitus, LDL-C and soluble ST2. Discrimination, calibration and clinical usefulness were assessed using the C-index, 365-day AUC, Brier score, calibration slope, Hosmer-Lemeshow test and decision curve analysis.
RESULTS: During 1-year follow-up, 74 patients experienced MACE (12.5%). Higher logIBI was independently associated with 1-year MACE (HR 1.828, 95% CI 1.529-2.186, P < 0.001). In the sensitivity model, high IBI was also associated with increased MACE risk (HR 4.126, 95% CI 2.512-6.776, P < 0.001). Adding logIBI improved the 365-day AUC from 0.790 to 0.832 and increased the C-index from 0.776 to 0.817. The expanded model showed generally acceptable calibration, with a Brier score of 0.075, calibration slope of 0.938 and Hosmer-Lemeshow P value of 0.202. Decision curve analysis suggested higher net benefit after adding logIBI.
CONCLUSION: In patients with HFpEF and documented MI, higher logIBI was independently associated with 1-year MACE and improved risk discrimination when added to a base clinical model. IBI may provide a practical admission-level measure of residual inflammatory burden, but external validation and prospective assessment are needed before clinical use.
METHOD: In this single-centre retrospective cohort study, 625 patients hospitalized at Fuyang People's Hospital from January 2018 to December 2023 were screened. After 33 patients with incomplete follow-up or unavailable baseline data were excluded, 592 patients were included. IBI was calculated as C-reactive protein multiplied by the neutrophil-to-lymphocyte ratio. The Youden-derived IBI cutoff of 7.70 was used only for descriptive grouping and sensitivity analysis. The primary Cox model treated log-transformed IBI (logIBI) as a continuous predictor and adjusted for age, sex, hypertension, diabetes mellitus, LDL-C and soluble ST2. Discrimination, calibration and clinical usefulness were assessed using the C-index, 365-day AUC, Brier score, calibration slope, Hosmer-Lemeshow test and decision curve analysis.
RESULTS: During 1-year follow-up, 74 patients experienced MACE (12.5%). Higher logIBI was independently associated with 1-year MACE (HR 1.828, 95% CI 1.529-2.186, P < 0.001). In the sensitivity model, high IBI was also associated with increased MACE risk (HR 4.126, 95% CI 2.512-6.776, P < 0.001). Adding logIBI improved the 365-day AUC from 0.790 to 0.832 and increased the C-index from 0.776 to 0.817. The expanded model showed generally acceptable calibration, with a Brier score of 0.075, calibration slope of 0.938 and Hosmer-Lemeshow P value of 0.202. Decision curve analysis suggested higher net benefit after adding logIBI.
CONCLUSION: In patients with HFpEF and documented MI, higher logIBI was independently associated with 1-year MACE and improved risk discrimination when added to a base clinical model. IBI may provide a practical admission-level measure of residual inflammatory burden, but external validation and prospective assessment are needed before clinical use.