背景:新描述的炎症负担指数(IBI)反映了患者的炎症负担。本研究旨在估计IBI,骨关节炎(OA),以及OA患者的全因死亡率。
方法:我们从1999年至2018年的国家健康和营养调查数据库中提取了成年人的数据。在使用适当的调查权重校正样本偏差后,我们进行了多变量逻辑回归分析,以探索IBI和OA在三个模型之间的关联:在未调整模型中,部分调整模型(调整年龄,性别,种族,教育水平,婚姻状况,PIR,BMI,吸烟状况,饮酒状况,中风,CVD,DM,和高血压)和完全调整模型(包括其他变量:HBA1C,ALT,AST,BUN,TC,和HDL)。计算比值比(OR)和95%置信区间(CI)。同样,使用可比的调查权重和协变量调整,我们采用Cox比例风险回归分析来研究其他3个模型中IBI与全因死亡率之间的关系.拟合Cox比例风险回归模型以计算IBI与全因死亡率之间关联的风险比(HR)和95%CI。使用受限三次样条(RCS)来探索关联效应之间的非线性关系。进行亚组分析以验证其效果的可靠性。
结果:总计,包括22,343名合格参与者。多元逻辑回归模型显示,IBI最高的参与者的OA风险是模型1中IBI最低的参与者的2.54倍(95CI,2.23,2.90),而模型2中的OR为1.21(95CI,1.03,1.42),模型3中的OR为1.23(95CI,1.05,1.45)。多重Cox回归模型显示,IBI最高的参与者发生全因死亡的风险是模型1中IBI最低的参与者的186%(95CI,1.50,2.31)倍。这一趋势在模型2中保持稳定(HR,1.54;95CI,1.22,1.95)和3(HR,1.41;95CI,1.10,1.80)。RCS显示IBI和OA风险之间存在显著正相关。关于IBI和全因死亡率之间的关联,从IBI的最低四分位数到第二四分位数观察到死亡率略有下降,死亡风险随着IBI的增加而增加。亚组分析显示,年龄,心血管疾病,高血压在IBI与全因死亡率的关系中至关重要,而IBI与OA的关联在性别等其他因素分层后保持稳定,种族,教育水平,婚姻,吸烟,和饮酒状况,高血压,和大多数血清学指标。
结论:这项研究提供了IBI,OA,和全因死亡率。IBI可能是评估OA患者炎症负担的一个有希望的标志,which,反过来,有利于高危人群识别的精确参考,抗炎指导,减少死亡率干预。
BACKGROUND: The newly described inflammatory burden index (IBI) reflects a patient\'s inflammatory burden. This study aimed to estimate the association between IBI, osteoarthritis (OA), and all-cause mortality in patients with OA.
METHODS: We extracted the data of adults from the National Health and Nutrition Examination Survey database between 1999 and 2018. After using appropriate survey weights to correct for sample bias, we conducted multivariate logistic regression analyses to explore the association between IBI and OA across three models: in the unadjusted model, partially adjusted model (adjusting age, sex, race, education level, marital status, PIR, BMI, smoking status, drinking status, stroke, CVD, DM, and hypertension) and fully adjusted model (which included additional variables: HBA1C, ALT, AST, BUN, TC, and HDL). And the odds ratios (OR) and 95% confidence intervals (CI) were calculated. Similarly, using comparable survey weights and covariates adjustments, we employed Cox proportional hazards regression analysis to investigate the association between IBI and all-cause mortality in the other 3 models. The Cox proportional hazards regression models were fitted to calculate the hazard ratios (HR) and 95% CI of the association between IBI and all-cause mortality. A restricted cubic spline (RCS) was used to explore the nonlinear relationships between association effects. Subgroup analysis was performed to validate the reliability of their effects.
RESULTS: In total, 22,343 eligible participants were included. Multiple logistic regression models revealed that participants with the highest IBI had 2.54 times (95%CI, 2.23, 2.90)) higher risk of OA than those with the lowest IBI in Model 1, whereas the OR was 1.21 (95%CI, 1.03, 1.42) in Model 2 and 1.23 (95%CI,1.05, 1.45) in Model 3. Multiple Cox regression models showed participants with the highest IBI had 186% (95%CI, 1.50, 2.31) times risk of developing all-cause death than those with the lowest IBI in Model 1. This trend remained stable in Models 2 (HR,1.54; 95%CI,1.22, 1.95) and 3 (HR, 1.41; 95%CI, 1.10, 1.80). The RCS revealed a significant positive association between IBI and OA risk. With respect to the association between IBI and all-cause mortality, a slight decrease in mortality was observed from the lowest quartile to the second quartile of IBI, and the mortality risk increased with increasing IBI. Subgroup analyses showed that age, cardiovascular disease, and hypertension were pivotal in the association of IBI with all-cause mortality, whereas the association of IBI with OA remained stable after stratification by other factors such as sex, race, education level, marital, smoking, and drinking status, hypertension, and most serological indices.
CONCLUSIONS: This study provides evidence of a positive association between IBI, OA, and all-cause mortality. IBI may be a promising signature for assessing the inflammatory burden in patients with OA, which, in turn, is conducive to precise references for high-risk population recognition, anti-inflammatory guidance, and reducing mortality intervention.