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Background <p>Existing biomarker studies profile plasma during acute illness, leaving pre-illness proteomic susceptibility to critical care largely uncharacterised. We mapped the baseline proteomic architecture of critical-care outcomes in UK Biobank and tested for sex differences.</p> Methods <p>We performed a proteome-wide association study of 2923 plasma proteins in 53,000 UK Biobank participants linked to Hospital Episode Statistics critical-care records, analysing three outcomes: ever critical-care exposure, prolonged critical care, and in-hospital death during a critical-care hospitalisation. Primary analyses used logistic regression; sensitivity analyses included Cox models, cross-validated LASSO, sex-interaction testing, and reverse-causation proxy analyses.</p> Results <p>Of 53,000 participants, 2986 had at least one critical-care episode. For ever critical-care exposure, 545 proteins survived Bonferroni correction, led by GDF15 (OR per SD 1.37, 95% CI 1.33–1.42, <i>P</i> = 2.82 × 10⁻<sup>68</sup>). In-hospital death yielded 18 Bonferroni-significant proteins, again led by GDF15. Prolonged critical care showed a markedly attenuated signal. Sex-interaction effects were predominantly stronger in women. An exploratory reverse-causation analysis yielded null estimates, indicating unresolved residual confounding.</p> Conclusions <p>Baseline plasma proteins measured a median of more than 10&#xa0;years before any critical-care episode were associated with later critical-care exposure and in-hospital death during a critical-care hospitalisation, with a biologically coherent pattern spanning stress-response, renal, epithelial, inflammatory, and tissue-remodelling pathways and a secondary female-predominant interaction signal among the leading proteins. The incremental discrimination over demographics (ΔAUC 0.040 on a 0.672 baseline) was modest but detectable over a &gt; 10-year horizon. We interpret the signal as a cumulative-morbidity proteomic axis of critical-illness susceptibility rather than as validated isolated pre-morbid biomarkers; reverse-causation risk could not be excluded and external-cohort validation is required.</p>

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A cumulative-morbidity plasma proteomic architecture of critical-illness susceptibility: a UK biobank proteome-wide study of critical-care exposure, in-hospital death, and sex-specific signals

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  • 发表日期：

    2026年5月13日

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  • Xingxing Ren,
  • Qingxia Dai,
  • Chaoyuan Jin

摘要

Background

Existing biomarker studies profile plasma during acute illness, leaving pre-illness proteomic susceptibility to critical care largely uncharacterised. We mapped the baseline proteomic architecture of critical-care outcomes in UK Biobank and tested for sex differences.

Methods

We performed a proteome-wide association study of 2923 plasma proteins in 53,000 UK Biobank participants linked to Hospital Episode Statistics critical-care records, analysing three outcomes: ever critical-care exposure, prolonged critical care, and in-hospital death during a critical-care hospitalisation. Primary analyses used logistic regression; sensitivity analyses included Cox models, cross-validated LASSO, sex-interaction testing, and reverse-causation proxy analyses.

Results

Of 53,000 participants, 2986 had at least one critical-care episode. For ever critical-care exposure, 545 proteins survived Bonferroni correction, led by GDF15 (OR per SD 1.37, 95% CI 1.33–1.42, P = 2.82 × 10⁻68). In-hospital death yielded 18 Bonferroni-significant proteins, again led by GDF15. Prolonged critical care showed a markedly attenuated signal. Sex-interaction effects were predominantly stronger in women. An exploratory reverse-causation analysis yielded null estimates, indicating unresolved residual confounding.

Conclusions

Baseline plasma proteins measured a median of more than 10 years before any critical-care episode were associated with later critical-care exposure and in-hospital death during a critical-care hospitalisation, with a biologically coherent pattern spanning stress-response, renal, epithelial, inflammatory, and tissue-remodelling pathways and a secondary female-predominant interaction signal among the leading proteins. The incremental discrimination over demographics (ΔAUC 0.040 on a 0.672 baseline) was modest but detectable over a > 10-year horizon. We interpret the signal as a cumulative-morbidity proteomic axis of critical-illness susceptibility rather than as validated isolated pre-morbid biomarkers; reverse-causation risk could not be excluded and external-cohort validation is required.