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Monocyte to high density lipoprotein cholesterol ratio (MHR) was a newly emerged inflammatory marker. However, its prognostic value in patients with infective endocarditis (IE) and normal left ventricular ejection fraction (LVEF) was unclear.
We enrolled consecutive patients with IE and normal LVEF. The association of MHR with in-hospital and long-term mortality was evaluated. A receiver operator characteristic (ROC) curve analysis was performed to evaluate the predictive value of MHR for clinical outcomes. Multivariate logistic regression was used to determine the independent risk of MHR for adverse outcomes.
Of 698 patients included, 44 (6.3%) developed in-hospital mortality. The occurrence of in-hospital death (3.9, 4.3 and 10.8%, p=0.003) and major adverse clinical events (MACEs) (15.6, 20.9 and 30.6%, p<0.001) were increased from the lowest to the highest MHR tertiles. ROC analysis demonstrated that MHR had good predictive value for in-hospital mortality (AUC=0.670, 95%CI=0.58-0.76, P<0.001), and was similar to C-reactive protein (AUC: 0.670 vs. 0.702, P=0.444). Furthermore, MHR>21.3 had a sensitivity of 74.4% and specificity of 57.6% for predicting in-hospital mortality. Multiple analysis showed that MHR>21.3 was an independent predictor of in-hospital (OR=3.21, 95%CI=1.38-7.47, P=0.007) and one-year death (HR=2.24, 95%CI=1.21-4.17, P=0.011). Kaplan-Meier survival curves showed that patients with MHR>21.3 had an increased one-year mortality relative to those without (P<0.001).
Elevated MHR was independently associated with in-hospital and long-term mortality in patients with IE and normal LVEF.