Xiaozhou Su,1,* Huiqing Rao,2,* Chunli Zhao,1 Xianwei Zhang,1 Donghua Li1 

1Department of Cardiology, Minzu Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, People’s Republic of China; 2Department of Internal Medicine, Guangxi Medical University Cancer Hospital, Nanning, Guangxi, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Xiaozhou Su, Department of Cardiology, Minzu Affiliated Hospital of Guangxi Medical University, No. 232, Mingxiu Road, Nanning, Guangxi, 530001, People’s Republic of China, Email suxiaozhou@minzucardiac.cn

Purpose: Identifying reliable prognostic markers is critical for improving chronic obstructive pulmonary disease (COPD) management. The advanced lung cancer inflammation index (ALI) is a novel marker reflecting inflammation and nutritional status. This study evaluated the association between ALI and all-cause and cause-specific mortality in COPD patients.
Patients and Methods: Data from 4616 adults with COPD in the National Health and Nutrition Examination Survey (1999– 2018) were analyzed. Mortality outcomes were obtained from the National Death Index. Multivariable Cox proportional hazards models and restricted cubic splines assessed the association between the natural logarithm of ALI (lnALI) and mortality. Time-dependent receiver operating characteristic (ROC) curves evaluated the predictive performance of lnALI at 3, 5, and 10 years. Mediation analysis examined whether estimated glomerular filtration rate (eGFR) mediated these associations.
Results: During a median 80-month follow-up, 1202 participants died: 349 from cardiovascular disease, 263 from cancer, and 194 from chronic lower respiratory diseases (CLRD). Higher lnALI was significantly associated with lower risks of all-cause, cardiovascular, and CLRD mortality. L-shaped associations were observed for all-cause and cardiovascular mortality, with inflection points at 4.04 and 3.64, respectively. The AUCs for predicting all-cause mortality were 0.670, 0.646, and 0.634; for cardiovascular mortality, 0.659, 0.653, and 0.629; and for CLRD mortality, 0.770, 0.751, and 0.739 at 3, 5, and 10 years. eGFR partially mediated the associations between lnALI and both all-cause and cardiovascular mortality.
Conclusion: Higher lnALI values were significantly associated with lower risks of all-cause, cardiovascular, and CLRD mortality in COPD patients.

Keywords: advanced lung cancer inflammation index, chronic obstructive pulmonary disease, mortality, cohort study, NHANES