Endothelial activation and stress index predicts 28-day mortality in patients undergoing CRRT

Jinjin Hu; Junjun  Wei; Weiwei Feng; Ling Shi; Chunying Li; Ning Cui; Junxiu Dong; Wei Zhang

doi:10.17305/bb.2025.13231

Authors

Jinjin Hu Hemopurification Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China https://orcid.org/0009-0006-6677-3585
Junjun Wei Hemopurification Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China
Weiwei Feng Hemopurification Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China
Ling Shi Hemopurification Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China
Chunying Li Hemopurification Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China
Ning Cui Hemopurification Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China
Junxiu Dong Hemopurification Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China
Wei Zhang Hemopurification Center, Ningbo Yinzhou No.2 Hospital, Ningbo, Zhejiang, China

DOI:

https://doi.org/10.17305/bb.2025.13231

Keywords:

Endothelial activation and stress index, EASIX, continuous renal replacement therapy, all-cause mortality, MIMIC-IV

Abstract

The endothelial activation and stress index (EASIX) is recognized as a prognostic indicator across various diseases; however, its utility in patients undergoing continuous renal replacement therapy (CRRT) is limited. This study aimed to investigate the relationship between EASIX and prognosis in individuals receiving CRRT. Data from patients receiving CRRT were extracted from the Medical Information Mart for Intensive Care IV database. EASIX was calculated and log₂-transformed. Kaplan–Meier survival analysis was conducted based on log₂(EASIX) quartiles. Cox proportional hazards regression was utilized to estimate the relationship between EASIX and 28-day all-cause mortality. Potential nonlinear associations were evaluated through restricted cubic splines (RCS) analysis, and subgroup analyses were performed to assess the robustness of EASIX's impact on all-cause mortality. A total of 2,873 ICU patients treated with CRRT were enrolled. Kaplan-Meier analysis revealed that higher EASIX scores were significantly associated with lower 28-day survival (log-rank p < 0.001). After adjusting for confounding factors, EASIX remained significantly associated with the risk of 28-day all-cause mortality among CRRT patients (HR: 1.066; 95% CI: 1.026–1.107; p = 0.001). The area under the curve (AUC) of the SOFA+EASIX model was 0.694 (95% CI: 0.673–0.714; p < 0.001), slightly higher than that of the SOFA scores alone. These results suggest that EASIX may enhance the predictive performance of SOFA scores. RCS analysis indicated a linear association between log₂(EASIX) and 28-day all-cause mortality (p for overall = 0.001; p for nonlinear = 0.224). Subgroup analyses confirmed the robustness of this association across various patient groups. In conclusion, EASIX is independently associated with mortality in patients undergoing CRRT. Prospective studies are warranted to further explore its therapeutic and prognostic significance.

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