Predictive power of the Lact/Chol ratio in the validation cohort.

<p>Patients of the validation cohort were included (n = 74) in this analysis: with favorable outcome (n = 57) and with 30-day mortality outcome (n = 17). (A) Receiver Operating Characteristic (ROC) curve analysis of lactate, cholesterol and lactate to cholesterol ratio in relation with 30-day mortality), AUC  =  0.76 (95% CI, 0.65−0.85, p<0.0001). (B) Kaplan–Meier curve estimation of the survival rate of the patients according to the cholesterol to lactate ratio at the cutoff value. Bold and dashed lines are for lactate/cholesterol ratio <0.4 and ≥ 0.4, respectively. Number at risk indicates over time the number of survival patients within each group based on lactate to cholesterol ratio (<0.4 and ≥ 0.4).</p

¹H NMR signals intensities of lactate and cholesterol in plasmas.

<p><b>(A)</b> Contribution of a ¹H NMR characteristic signal of lactate at 1.36 ppm to the spectrum of aqueous fraction of the plasma extract (Aq spectrum). <b>(B)</b> Contribution of a ¹H NMR characteristic signal of cholesterol at 0.68 ppm to the spectrum of lipid fraction of the plasma extract (Org spectrum). Values are expressed as arbitrary unit (AU). Lines at the middle for medians, boxes extend from 25^th to 75^th percentile, error bars for max and min values. Boxes: white, plasma from patients with favorable outcome; grey plasma from patients with 30-day mortality outcome. <b>*</b> is for Student’s <i>t</i> test p <0.05.</p

Flow-chart of the study.

<p>Flow-chart of the study.</p

Cox regression analysis for 30-day mortality in the validation cohort.

*<p>HRs of 30-day mortality outcomes adjusted for age and sex. ⁼ Cox proportional-hazards stepwise regression with clinical presentation CS, Lact/Chol ratio, MAP and serum sodium as predictor variables, significance level of the model P  =  0.002. <i>CS</i>, cardiogenic shock. <i>HR</i>, hazard ratio. <i>CI</i>, confident interval. Figures in bold are statistically significant.</p

Survival analysis of the patients according to the cholesterol to lactate ratio.

<p>Kaplan−Meier curve estimation of the survival rate of the patients according to the cholesterol to lactate ratio at the cutoff value. A total of 126 AHF patients (training cohort) were included in this analysis based on <b>Cobas Mira+ automated enzymatic detection</b> of venous plasma lactate and cholesterol. Bold and dashed lines are for lactate/cholesterol ratio <0.4 and ≥ 0.4, respectively. Number at risk indicates over time the number of survival patients within each group based on lactate to cholesterol ratio (<0.4 and ≥ 0.4).</p

Characteristics of the patients of the validation cohort.

<p><i>ACE</i> angiotensin-converting enzyme, <i>LDL</i> low density lipoproteins, <i>HDL</i> high density lipoproteins, <i>TG</i> triglycerides, <i>BMI</i> body mass index, <i>LVEF</i> left ventricular ejection fraction, <i>LV</i> left ventricular, <i>BNP</i> B-type Natriuretic Peptide concentration. Numbers in parenthesis indicate number of patients.</p

Receiver Operating Characteristic (ROC) curve analysis.

<p>ROC curves analysis of lactate, cholesterol and lactate to cholesterol ratio in relation with 30-day mortality in the training cohort.</p

PLS-DA analysis of ¹H NMR spectral data.

<p><b>(A)</b> PLS-DA t1/t2 score plot derived from ¹H NMR spectral data correlating to 86% of the Y-variance. The plot shows how well individuals separate whether it is a survivor (blue spot) or a deceased (red spot) individual (number is for the identification of individual). <b>(B)</b> PLS-DA weight plot (w*c₁/w*c₂). This plot of the X- and Y-weights (w* and c) shows how the ¹H NMR spectral data correlate with class belonging i.e. the survival or 30-day mortality classes. Variables corresponding to the 6 first higher variable influence parameters have a colored box; red when there are positively correlated with 30-day mortality class and blue when there are positively correlated with survival class. The triangles were labeled by spectral data identification. List of these discriminating variables is in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0060737#pone-0060737-t002" target="_blank">Table 2</a>.</p

Univariate and multivariate Cox regression analysis of variables associated with 30-day mortality.

<p><i>CS</i> cardiogenic shock; <i>MAP</i> Mean blood pressure, <i>ADCHF</i> acute decompensation of CHF, <i>HR</i> hazard ratio, <i>CI</i> confident interval, <i>Lact/Chol</i> Lactate/cholesterol, <i>LDL</i> low density lipoproteins, <i>HDL</i> high density lipoproteins, <i>APACHE II</i> acute physiology and chronic health evaluation II scoring system.</p>*<p>HRs of 30-day mortality outcomes adjusted for age and sex.</p> = <p>stepwise regression, significance level of the model P < 0.0001.</p>†<p>HR of patients in the highest quartile of Lact/Chol ratio (4^th quartile Lact/Chol  =  0.80 (95%CI, 0.66−1.90, n = 29); HR = 1, 1^st −3^rd quartile Lact/Chol  =  0.33 (95%CI, 0.29−0.36, n = 97)).</p><p>Statistically significant values are in bold.</p

Baseline characteristics of CHF patients.

<p>Baseline characteristics of CHF patients.</p