A baseline model incorporating elevated eosinophil ratio, reduced lymphocyte ratio, and elevated myoglobin predicted the occurrence of ICI-associated myocarditis with an AUC of 0.699.
Case-Control (n=196)
No
Does a baseline hematological profile and combined ECG/enzymatic signature predict the occurrence and severity of ICI-associated myocarditis in patients receiving immune checkpoint inhibitors?
A baseline hematological profile and an onset ECG/enzymatic signature can help predict the occurrence and severity of ICI-associated myocarditis, enabling a two-stage risk stratification approach.
Estimación del efecto: AUC 0.699 (95% CI 0.626-0.772)
valor p: p=<0.001
Background Immune checkpoint inhibitor-associated myocarditis (ICI-associated myocarditis) is a rare but fatal immune-related adverse event. Early identification of high-risk patients remains challenging. This study aimed to identify risk factors and develop models for predicting both the occurrence and severity of ICI-associated myocarditis. Methods This retrospective unmatched case-control study stratified patients receiving ICIs into ICI-associated myocarditis (stratified into mild and severe subgroups) and controls. Comparative analysis of baseline and onset-phase data was performed, with logistic regression used to identify risk factors for the development of ICI-associated myocarditis and the severe myocarditis. Results In this cohort of 196 patients (98 myocarditis cases vs. 98 controls), a two-tiered risk stratification was established. Patients with myocarditis were further stratified into mild (n=71) and severe (n=27) subgroups. For predicting the occurrence of ICI-associated myocarditis, a baseline model incorporating elevated eosinophil ratio, reduced lymphocyte ratio, and elevated myoglobin demonstrated an area under the ROC curve (AUC) of 0.699 (95% CI, 0.626-0.772, P 0.001). Upon onset, for predicting severe myocarditis, a model combining electrocardiographic abnormalities (T-wave changes, bundle branch blocks) and marked CK elevation (10× ULN) achieved a higher AUC of 0.769 (95% CI, 0.655-0.882, P 0.0001). Severe cases presented significantly earlier than mild cases (33 vs . 63 days, P = 0.043) and had higher rates of symptoms and concurrent immune-related adverse events. Conclusion A baseline profile of elevated eosinophil ratio, reduced lymphocyte ratio, and elevated myoglobin collectively may help identify patients at risk for ICI-associated myocarditis. At myocarditis onset, a combination of specific electrocardiographic abnormalities and marked CK elevation may predict severe cases. These findings suggest a two-stage approach for early risk stratification and targeted management.
Zheng et al. (Tue,) conducted a case-control in ICI-associated myocarditis (n=196). Baseline hematological profile (elevated eosinophil ratio, reduced lymphocyte ratio, elevated myoglobin) vs. Controls (patients receiving ICI therapy without myocarditis) was evaluated on Occurrence of ICI-associated myocarditis (AUC 0.699, 95% CI 0.626-0.772, p=<0.001). A baseline model incorporating elevated eosinophil ratio, reduced lymphocyte ratio, and elevated myoglobin predicted the occurrence of ICI-associated myocarditis with an AUC of 0.699.