Abstract
BACKGROUND: Asthma poses a significant global health challenge, representing a chronic respiratory disorder marked by airway inflammation. The advanced lung cancer inflammation index (ALI) served as a comprehensive index to assess inflammation. However, few studies have investigated the association between ALI and both all-cause and cardiovascular mortality in US patients with asthma. METHODS: We used data from the National Health and Nutrition Examination Survey (NHANES) to explore the association of ALI with all-cause and cardiovascular mortality in US patients with asthma. This study used Kaplan-Meier curves to examine the ALI index's impact on asthma patients' survival. We applied weighted Cox models and restricted cubic splines (RCS) analysis to assess the ALI-mortality link, identifying non-linear thresholds with a recursive algorithm. Subgroup analyses and sensitivity analyses were conducted, excluding those with missing covariates and cancer patients. RESULTS: A total of 6,211 asthma patients were enrolled and categorized into three groups based on ALI tertiles. The risk of all-cause mortality decreased as ALI increased in the fully adjusted multivariate Cox regression analysis; the hazard ratio (HR) is 0.95 (95% CI: 0.91-0.99, P = 0.01). Compared with the lowest ALI group, T1, the fully adjusted HR values for ALI and all-cause mortality in T2, T3 were 0.68 (95% CI: 0.55-0.85, P < 0.001), 0.53 (95% CI: 0.41-0.68, P < 0.001). The risk of cardiovascular mortality was also lower in the groups of T2 (HR: 0.84, 95% CI: 0.55-1.28) and T3 (HR: 0.47, 95% CI: 0.31-0.71, P for trend < 0.001), respectively. In addition, the results of the subgroup analyses were robust. CONCLUSIONS: This cohort study demonstrated the higher accuracy of ALI in predicting mortality in asthma patients, highlighting its important clinical value of ALI in risk assessment and prognosis evaluation.