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已发表论文
慢性阻塞性肺疾病患者单核细胞与高密度脂蛋白比值与死亡率之间的非线性关联：来自美国国家健康与营养调查的证据
Authors Tian T, She T, Qu X, Li R
Received 25 August 2025
Accepted for publication 27 November 2025
Published 12 December 2025 Volume 2025:20 Pages 4005—4018
DOI https://doi.org/10.2147/COPD.S563173
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Jill Ohar
Tulei Tian,1,* Tianyu She,2,* Xiangkun Qu,1 Rui Li3
1Department of Respiratory and Critical Care Medicine, the Affiliated Bozhou Hospital of Anhui Medical University, Bozhou, Anhui, People’s Republic of China; 2Department of Medical Imaging Function, Xi’an Electric Power Central Hospital, Xi’an, Shaanxi, People’s Republic of China; 3Traditional Chinese Medicine Internal Medicine, The Third Affiliated Hospital of Liaoning University Traditional Chinese Medicine, Shenyang, Liaoning, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Rui Li, Email m13940538976@163.com Tulei Tian, Email tiantulei2010@126.com
Background: Chronic Obstructive Pulmonary Disease (COPD) represents a leading cause of mortality worldwide, with systemic inflammation being a key pathological feature. The association between the emerging inflammatory marker monocyte to high-density lipoprotein cholesterol ratio (MHR) and the risk of all-cause mortality in COPD patients remains unclear.
Methods: Data from COPD patients in the 1999– 2018 NHANES database were analyzed using Cox regression models to assess the association between MHR and all-cause mortality risk. Restricted cubic spline (RCS) modeling was used to explore nonlinear associations and identify inflection points. Time-dependent ROC curves were utilized to evaluate the predictive accuracy of MHR. Subgroup and sensitivity analyses were performed to ensure the robustness of the results.
Results: This study included 1768 COPD patients and observed 606 all-cause deaths during a mean follow-up of 92 months. After adjusting for confounding factors, MHR level was significantly and positively associated with all-cause mortality risk (HR = 2.10, 95% CI: 1.53– 2.89). RCS analysis revealed a nonlinear relationship between MHR and all-cause mortality risk (non-linear P = 0.004). A turning point analysis indicated a threshold effect of MHR at 0.29: mortality risk increased significantly above this value (HR = 2.52, P < 0.001) and decreased significantly below it (HR = 0.02, P = 0.006). Sex-stratified analysis showed that the association between MHR and mortality risk tended to be linear in men, while it was nonlinear in women. Time-dependent ROC analysis showed AUC values for MHR at 12, 36, 72, and 120 months were 0.73, 0.79, 0.78, and 0.81, respectively.
Conclusion: Elevated MHR serves as an important risk marker for all-cause mortality in COPD patients. This association exhibits nonlinear characteristics with threshold effects, suggesting that MHR has potential value in prognostic assessment of COPD patients.
Keywords: chronic obstructive pulmonary disease, monocyte to HDL-C ratio, MHR, mortality, nonlinear association, NHANES
1Department of Respiratory and Critical Care Medicine, the Affiliated Bozhou Hospital of Anhui Medical University, Bozhou, Anhui, People’s Republic of China; 2Department of Medical Imaging Function, Xi’an Electric Power Central Hospital, Xi’an, Shaanxi, People’s Republic of China; 3Traditional Chinese Medicine Internal Medicine, The Third Affiliated Hospital of Liaoning University Traditional Chinese Medicine, Shenyang, Liaoning, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Rui Li, Email m13940538976@163.com Tulei Tian, Email tiantulei2010@126.com
Background: Chronic Obstructive Pulmonary Disease (COPD) represents a leading cause of mortality worldwide, with systemic inflammation being a key pathological feature. The association between the emerging inflammatory marker monocyte to high-density lipoprotein cholesterol ratio (MHR) and the risk of all-cause mortality in COPD patients remains unclear.
Methods: Data from COPD patients in the 1999– 2018 NHANES database were analyzed using Cox regression models to assess the association between MHR and all-cause mortality risk. Restricted cubic spline (RCS) modeling was used to explore nonlinear associations and identify inflection points. Time-dependent ROC curves were utilized to evaluate the predictive accuracy of MHR. Subgroup and sensitivity analyses were performed to ensure the robustness of the results.
Results: This study included 1768 COPD patients and observed 606 all-cause deaths during a mean follow-up of 92 months. After adjusting for confounding factors, MHR level was significantly and positively associated with all-cause mortality risk (HR = 2.10, 95% CI: 1.53– 2.89). RCS analysis revealed a nonlinear relationship between MHR and all-cause mortality risk (non-linear P = 0.004). A turning point analysis indicated a threshold effect of MHR at 0.29: mortality risk increased significantly above this value (HR = 2.52, P < 0.001) and decreased significantly below it (HR = 0.02, P = 0.006). Sex-stratified analysis showed that the association between MHR and mortality risk tended to be linear in men, while it was nonlinear in women. Time-dependent ROC analysis showed AUC values for MHR at 12, 36, 72, and 120 months were 0.73, 0.79, 0.78, and 0.81, respectively.
Conclusion: Elevated MHR serves as an important risk marker for all-cause mortality in COPD patients. This association exhibits nonlinear characteristics with threshold effects, suggesting that MHR has potential value in prognostic assessment of COPD patients.
Keywords: chronic obstructive pulmonary disease, monocyte to HDL-C ratio, MHR, mortality, nonlinear association, NHANES