High EASIX Scores Linked to Greater Mortality in ICU Patients with Atrial Fibrillation: Study Shows
China: A recent retrospective study using the MIMIC-IV database has highlighted the prognostic value of the Endothelial Activation and Stress Index (EASIX) in critically ill patients diagnosed with atrial fibrillation (AF). The findings, published in the European Journal of Medical Research, reveal that EASIX is closely linked with the likelihood of death during hospitalization, as well as within 28 days and one year of ICU admission.
Atrial fibrillation is a common cardiac arrhythmia seen in intensive care settings and is often associated with poor clinical outcomes. The EASIX score, originally developed to reflect endothelial dysfunction and stress, was evaluated in this study to determine its potential as a mortality predictor in AF patients requiring intensive care.
Yu Xia, Department of Burn and Trauma Medicine, First Naval Hospital of Southern Theater Command, Zhanjiang, China, and colleagues analyzed data from 4,896 adult patients with AF sourced from the MIMIC-IV critical care database. The EASIX score was calculated based on three routine laboratory markers: lactate dehydrogenase (LDH), creatinine, and platelet count. To strengthen the statistical rigor, advanced methods like the Boruta algorithm and LASSO regression were employed to identify key variables, while Cox regression and logistic models assessed the predictive value of EASIX.
The key findings of the study were as follows:
- Higher EASIX scores were significantly linked to increased all-cause mortality during hospitalization at 28 days and one year.
- Patients in the higher EASIX quartiles had markedly lower survival rates than those in the lowest quartile.
- Kaplan-Meier survival analysis visually confirmed the inverse relationship between EASIX scores and survival outcomes.
- The prognostic performance of EASIX was comparable to the SOFA score.
- EASIX outperformed the CHA₂DS₂–VASc score in predicting mortality risk in critically ill patients with atrial fibrillation.
- EASIX may be a practical and focused prognostic tool for clinicians managing critically ill AF patients.
What sets EASIX apart is its ability to capture the burden of endothelial dysfunction, which plays a critical role in the pathophysiology of AF and multi-organ failure. The strength of its association with mortality remained consistent even when accounting for various comorbidities and clinical interventions, highlighting its robustness as a risk stratification tool.
The study’s authors advocate for prospective studies to validate EASIX’s broader use in other patient groups and settings. Nevertheless, their findings support the integration of EASIX into clinical assessments of critically ill AF patients, offering a simple yet powerful method for the early identification of individuals at heightened risk of poor outcomes.
"EASIX emerges as a dependable indicator for predicting both short- and long-term mortality in critically ill patients with atrial fibrillation. However, further prospective studies are warranted to validate its utility across broader patient populations," the authors wrote.
Reference:
Xia, Y., Liang, A., Wang, M. et al. Risk analysis of the association between EASIX and all-cause mortality in critical ill patients with atrial fibrillation: a retrospective study from MIMIC-IV database. Eur J Med Res 30, 344 (2025). https://doi.org/10.1186/s40001-025-02621-4
