Evidence mapPaperPMID 42299547Full record

ArticleMedicine2026

Endothelial Activation Stress Index and risk of all-cause and cardiovascular mortality in early-stage cardio-renal-metabolic syndrome: A nationwide retrospective cohort study.

Rui Han, Yuting Ouyang, Shanshan Zhou

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Article in Medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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1 · What the graph read from it

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2 · The registry

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3 · Its place in the literature

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4 · The record

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5 · Who and what money

Authors and funding

3 authors.

Rui HanDepartment of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, Jilin Province, China.ORCID 0009-0006-8915-7822
Yuting OuyangDepartment of Cardiovascular Diseases, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.
Shanshan ZhouDepartment of Cardiovascular Diseases, The First Hospital of Jilin University, Changchun, Jilin Province, China.ORCID 0000-0003-2033-2099

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Endothelial dysfunction plays a central role in the pathophysiology of cardiovascular, renal, and metabolic diseases. The Endothelial Activation Stress Index (EASIX) has emerged as a promising prognostic marker in endothelial-related disorders. This study aimed to evaluate the association between EASIX and the risks of all-cause and cardiovascular mortality in individuals with cardio-renal-metabolic (CKM) syndrome stages 0 to 3. Data were obtained from the National Health and Nutrition Examination Survey 2005 to 2010 and 2015 to 2018 cycles. A total of 7046 participants with CKM stages 0 to 3 were included. EASIX was calculated as lactate dehydrogenase × creatinine/platelet count. The primary outcome was cardiovascular mortality, and the secondary outcome was all-cause mortality, ascertained through linkage to the National Death Index. The optimal cutoff value of EASIX was determined using maximally selected rank statistics. Associations were assessed using survey-weighted Cox proportional hazards models, restricted cubic splines, and subgroup analyses. Predictive performance was evaluated using time-dependent receiver operating characteristic curves. Mediation analysis and competing risk models were also performed. Higher EASIX (≥0.64) was significantly associated with increased risks of cardiovascular mortality (adjusted hazard ratio = 1.65, 95% confidence interval = 1.11-2.46) and all-cause mortality (adjusted hazard ratio = 1.45, 95% confidence interval = 1.16-1.81). Restricted cubic spline analysis revealed a significant nonlinear relationship between EASIX and mortality (P < .001). Kaplan-Meier curves showed lower survival probabilities in the high-EASIX group (log-rank P < .0001). The association remained consistent across subgroups. EASIX demonstrated good predictive performance for 1-, 3-, and 5-year mortality. Mediation analysis indicated that chronic kidney disease accounted for approximately 30% to 35% of the observed associations. Competing risk analysis confirmed the independent association between EASIX and cardiovascular mortality. EASIX is a simple and robust predictor of all-cause and cardiovascular mortality in patients with CKM stages 0 to 3, and may facilitate early risk stratification and personalized management.

Indexed as

Cardio-Renal SyndromeCardiovascular DiseasesEndothelium, VascularMetabolic SyndromeAdultAgedBiomarkersCause of DeathFemaleHumansMaleMiddle AgedNutrition SurveysPrognosisProportional Hazards ModelsRetrospective StudiesBiomarkerscardio-renal-metabolic syndromeEndothelial Activation Stress Indexendothelial dysfunctionmortalityrisk stratification

Identifiers

PMID42299547
PMCPMC13268516

What Socratic holds

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.