Inflammatory and Clinical Predictors of In-Hospital Mortality in Acute Coronary Syndrome: A Retrospective Cohort Study

Abstract

Background: This study aims to retrospectively analyze in-hospital mortality rates in patients diagnosed with acute coronary syndrome (ACS) and to identify independent risk factors contributing to increased mortality. Materials and Methods: This Retrospective Single-Center Cohort Study was conducted at the Cardiolo-gy Clinic of Aktif International Hospital between January 1, 2023, and December 30, 2024. A total of 694 ACS patients were included in the study. Demographic, clinical, laboratory, and imaging data were collected. Independent risk factors for in-hospital mortality were assessed using multivariate logistic regression analysis. Results: The in-hospital mortality rate was 2.4%. Age (p = 0.02), the frequency of diabetes mellitus (p = 0.03) and hyperlipidemia (p = 0.04), creatinine (p = 0.002) and troponin-I (p < 0.001) were significant-ly higher, whereas left ventricular ejection fraction (LVEF) was significantly lower (p = 0.04) in non-survivors compared to the survivors. In addition, hematological parameters such as neutrophil-to-lymphocyte ratio (NLR) (p = 0.005) and platelet-to-lymphocyte ratio (PLR) (p = 0.01) were significantly elevated in non-survivors. Multivariate logistic regression analysis demonstrated that age (odds ration [OR] = 1.05, p = 0.003), presence of diabetes mellitus (OR=1.37, p = 0.002), hypertension (OR=1.42, p = 0.001) and hyperlipidemia (OR= 1.28, p = 0.03), increased troponin-I (OR = 2.34, p < 0.001), ele-vated creatinine levels (OR = 1.75, p = 0.002), lower LVEF (OR = 0.89, p = 0.04), NLR (OR = 1.56, p = 0.005) and PLR (OR = 1.42, p = 0.01) were independent predictors of in-hospital mortality. Conclusions: Our study suggests that older age, the presence of hypertension, diabetes mellitus, hy-perlipidemia, renal dysfunction, elevated inflammatory markers (NLR, PLR), and reduced LVEF are independent predictors of in-hospital mortality in ACS patients. Our findings further emphasize the critical role of early revascularization in reducing mortality rates in ACS patients. Keywords: Acute coronary syndrome, In-hospital mortality, Risk factors, Neutrophil-to-lymphocyte ratio, Platelet-to-lymphocyte ratio

Keywords

• Acute coronary syndrome
• in-hospital mortality
• risk factors
• troponin
• inflammatory markers
• neutrophil-to-lymphocyte ratio
• platelet-to-lymphocyte ratio

Akut Koroner Sendromda Hastane İçi Mortalitenin İnflamatuar ve Klinik Tahmin Edicileri: Retrospektif Bir Kohort Çalışması

Abstract

Amaç: Bu çalışmanın amacı, akut koroner sendrom (AKS) tanısı alan hastalarda hastane içi mortalite oranlarını retrospektif olarak analiz etmek ve mortaliteyi artıran bağımsız risk faktörlerini belirlemek-tir. Materyal ve Metod: 01 Ocak 2023 - 30 Aralık 2024 tarihleri arasında Aktif International Hospital Kardi-yoloji Kliniği’nde yürütülen retrospektif kohort çalışmasına 694 AKS hastası dahil edilmiştir. Hastaların demografik, klinik, laboratuvar ve görüntüleme verileri retrospektif olarak analiz edilmiştir. Hastane içi mortaliteyi etkileyen bağımsız risk faktörleri çok değişkenli lojistik regresyon analizi ile değerlendiril-miştir. Bulgular: Hastane içi mortalite oranı %2,4 olarak bulundu. Yaş (p = 0.02), diyabetes mellitus (p = 0.03) ile hiperlipidemi (p = 0.04) sıklığı, kreatinin (p = 0.002) ve troponin-I (p < 0.001) mortalite grubunda anlamlı olarak daha yüksek iken, sol ventrikül ejeksiyon fraksiyonu (LVEF) ise daha düşük (p = 0.04) olarak tespit edildi. Ek olarak, hematolojik parametreler arasında yer alan nötrofil-lenfosit oranı (NLR) (p = 0.005) ve trombosit-lenfosit oranı (PLR) da (p = 0.01) mortalite grubunda anlamlı derecede yüksek bulundu. Çok değişkenli lojistik regresyon analizinde, yaş (OR = 1.05, p = 0.003), diabetes mellitus (OR=1.37, p = 0.002), hipertansiyon (OR=1.42, p = 0.001) and hiperlipidemi varlığı (OR= 1.28, p = 0.03), artmış troponin-I (OR = 2.34, p < 0.001), yükselmiş kreatinin seviyeleri (OR = 1.75, p = 0.002), düşük LVEF (OR = 0.89, p = 0.04), NLR (OR = 1.56, p = 0.005) ve PLR (OR = 1.42, p = 0.01) hastane içi mortalitenin bağımsız prediktörleri olarak belirlendi. Sonuç: Çalışmamız ileri yaşın, hipertansiyon, diabetes mellitus, hiperlipidemi, renal disfonksiyon, yükselmiş inflamatuar belirteçlerin (NLR, PLR) ve azalmış LVEF'nin ACS hastalarında hastane içi mortali-tenin bağımsız öngörücüleri olduğunu ileri sürmektedir. Bulgularımız ayrıca ACS hastalarında mortalite oranlarını azaltmada erken revaskülarizasyonun kritik rolünü vurgulamaktadır. Anahtar Kelimeler: Akut koroner sendrom, Hastane içi mortalite, Risk faktörleri, Nötrofil-lenfosit oranı, Trombosit-lenfosit oranı

Keywords

• Akut koroner sendrom
• hastane içi mortalite
• risk faktörleri
• troponin
• inflamatuvar belirteçler
• nötrofil-lenfosit oranı
• trombosit-lenfosit oranı

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