Abstract: Objective  To assess the risk factors associated with major adverse cardiovascular events (MACE) in patients diagnosed with stages 3-5 chronic kidney disease (CKD), and to evaluate the predictive value of plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) for MACE within this specific patient population.  Methods  In this retrospective study, we enrolled a total of 212 patients diagnosed with CKD stages 3-5 at Dongguan Tungwah Hospital between November 2017 and December 2022. Among the two groups: 106 patients with confirmed MACE and an equal number of patients without MACE. We compared the differences in Lp-PLA2 levels and various clinical indicators between the two groups, employing logistic regression analysis to identify the risk factors associated with MACE. Additionally, we utilized ROC curve analysis to evaluate the predictive accuracy of Lp-PLA2 for MACE events.  Results  The Lp-PLA2 levels were significantly elevated in the MACE group compared to the non-MACE group (252.769±138.053 vs. 128.984±37.499，t=8.909，F=81.964，Z=-8.331， P＜0.001) among CKD stages 3-5 patients. Logistic regression analysis revealed that, besides age and sex, Lp-PLA2 independently contributed as a risk factor for MACE in CKD stages 3-5 patients with an odds ratio of 1.026. The analysis of age subgroups (elderly OR=1.027，95% CI:(1.009～1.045), P=0.003; non-elderly OR=1.025, 95% CI:(1.013～1.037), P＜0.001), gender subgroups [male OR=1.019, 95% CI: (1.009～1.029), P＜0.001; female OR=1.052, 95% CI:(1.021～1.084), P=0.001], and diabetes subgroup [diabetes OR=1.027, 95% CI: (1.012～1.043), P＜0.001; non-diabetes OR=1.025, 95% CI:(1.012～1.037), P＜0.001] revealed that Lp-PLA2 served as an independent risk factor for MACE. ROC curve analysis demonstrated that a cutoff value of 189 ng/ml for Lp-PLA2 predicted MACE with a sensitivity of 60.4% and specificity of 95.3%. Conclusions  The Lp-PLA2 enzyme is an independent risk factor for MACE in CKD stages 3-5 patients, and it holds significant clinical value in predicting the occurrence of MACE in this patient population.

Key words: Plasma lipoprotein-associated phospholipase A2, Chronic kidney disease, Major adverse cardiovascular events, Risk factors