背景心血管疾病(CVD)是腹膜透析(PD)患者死亡的主要原因,而营养不良是PD患者发生CVD及死亡的重要危险因素之一。预后营养指数(PNI)作为一种综合评估患者免疫、炎症和营养状态的指标,因其具有便利性与可靠性等优点,在肿瘤等多种疾病的预...背景心血管疾病(CVD)是腹膜透析(PD)患者死亡的主要原因,而营养不良是PD患者发生CVD及死亡的重要危险因素之一。预后营养指数(PNI)作为一种综合评估患者免疫、炎症和营养状态的指标,因其具有便利性与可靠性等优点,在肿瘤等多种疾病的预后评估中得到了广泛应用。然而,不同时间点的营养状态与PD患者预后之间的关系仍有待进一步探究。目的探讨PD患者首年PNI与CVD死亡之间的关系。方法本研究为多中心、回顾性观察性队列研究,纳入2000-01-01—2019-07-01在南方医科大学南方医院、南方医科大学顺德医院、佛山市第一人民医院以及赣州市人民医院4所中心置管并开始接受PD治疗的1640例PD患者作为研究对象。对患者进行随访,随访截止时间为2021-07-01,终点事件为CVD死亡并记录患者生存时间及具体死亡原因。应用限制性立方条图(RCS)分析PNI与PD患者CVD死亡风险之间的非线性关联;采用Kaplan-Meier法绘制PD患者的生存曲线,绘制PNI预测PD患者CVD死亡的受试者工作特征(ROC)曲线,并根据最佳截断值(cut-off=40.46)将患者分为低PNI组703例与高PNI组937例;采用Log-rank检验和Cox风险回归模型分析探讨PNI对PD患者CVD死亡的影响。结果本研究中位随访时间为30个月,随访期间共148例患者死亡,其中CVD死亡73例(49.32%)。RCS结果表明,PNI与CVD死亡事件呈线性关联(P for Nonlinear=0.655)。ROC曲线显示,PNI预测PD患者CVD死亡的曲线下面积(AUC)为0.717(95%CI=0.659~0.775,P<0.001),灵敏度为74.0%,特异度为58.6%。Kaplan-Meier生存分析结果显示,低PNI组CVD生存率低于高PNI组(χ^(2)=26.685,P<0.001)。多因素Cox风险回归模型分析,校正性别、年龄及CVD病史等混杂因素后,低PNI组仍是CVD死亡的独立预测因素(HR=7.76,95%CI=1.72~35.06,P=0.008),亚组分析结果仍稳健,无明显交互作用。结论PNI降低是PD患者CVD死亡的独立影响因素,PD首年PNI评分在评估PD患者预后有一定的指导意义。展开更多
目的:探讨预后营养指数(Prognostic Nutritional Index, PNI)与急诊ICU老年脓毒症患者死亡相关性及对老年脓毒症患者死亡的评估价值。方法:采用回顾性分析方法,分析2021年1月至2024年7月康复大学青岛医院东院区急诊ICU收治的老年脓毒症...目的:探讨预后营养指数(Prognostic Nutritional Index, PNI)与急诊ICU老年脓毒症患者死亡相关性及对老年脓毒症患者死亡的评估价值。方法:采用回顾性分析方法,分析2021年1月至2024年7月康复大学青岛医院东院区急诊ICU收治的老年脓毒症患者(年龄 ≥ 65岁)的基本信息和实验室检查数据。根据患者的住院结局将其分为生存组和死亡组,比较两组的一般资料和实验室数据。单因素和多因素Logistic回归分析PNI与老年脓毒症患者死亡的关系。绘制受试者工作曲线(Receiver operating characteristic, ROC)和计算曲线下面积(area under the curve, AUC)评估PNI的预测效能。结果:共纳入133例患者,生存组92例,死亡组41例,病死率为30.8%。生存组白蛋白、PNI、总蛋白、血小板均显著高于死亡组,具有统计学意义(P Objectives: To explore the correlation between Prognostic Nutritional Index (PNI) and mortality in elderly sepsis patients in the emergency department, as well as its evaluation value for mortality in elderly sepsis patients. Method: A retrospective analysis was conducted to analyze the basic information and laboratory test data of elderly sepsis patients (aged ≥ 65 years) admitted to the Emergency ICU of the East Campus of Qingdao Hospital of Rehabilitation University from January 2021 to July 2024. According to the hospitalization outcome, they were divided into a survival group and a death group, and their general information and laboratory data were compared between the two groups. Single-factor and multi-factor logistic regression analyses were used to assess the relationship between PNI and the death of elderly patients with sepsis. Receiver operating characteristic (ROC) and calculate area under the curve (AUC) are drawn to evaluate the predictive performance of PNI. Result: A total of 133 patients were included, with 92 in the survival group and 41 in the death group, resulting in a mortality rate of 30.8%. The survival group had significantly higher levels of albumin, PNI, total protein, and platelets than the death group, with statistical significance (P < 0.05). The SOFA, APACHE II scores, and urea nitrogen levels in the death group were significantly higher than those in the survival group, and the differences were statistically significant (P < 0.05). Univariate logistic regression analysis showed that PNI, SOFA score, APACHE II score, total protein, albumin, and lactate were related factors leading to death in elderly sepsis patients. According to the results of multiple logistic regression analysis, PNI is an independent risk factor for in-hospital mortality in sepsis patients. The ROC curve analysis results showed that the area under the curve (AUC) for predicting in-hospital mortality in sepsis patients using PNI, lactate, SOFA, and APACHE II scores was 0.625, 0.604, 0.644, and 0.649, respectively. The area under the four joint prediction curves is 0.697, with a sensitivity of 63.4% and a specificity of 78.3%. Conclusion: Low PNI is an independent risk factor for the prognosis of elderly sepsis patients, with good sensitivity and specificity. When combined with lactate, SOFA, and APACHE II scores for prediction, PNI can improve the specificity of predicting mortality in elderly sepsis patients.展开更多
文摘背景心血管疾病(CVD)是腹膜透析(PD)患者死亡的主要原因,而营养不良是PD患者发生CVD及死亡的重要危险因素之一。预后营养指数(PNI)作为一种综合评估患者免疫、炎症和营养状态的指标,因其具有便利性与可靠性等优点,在肿瘤等多种疾病的预后评估中得到了广泛应用。然而,不同时间点的营养状态与PD患者预后之间的关系仍有待进一步探究。目的探讨PD患者首年PNI与CVD死亡之间的关系。方法本研究为多中心、回顾性观察性队列研究,纳入2000-01-01—2019-07-01在南方医科大学南方医院、南方医科大学顺德医院、佛山市第一人民医院以及赣州市人民医院4所中心置管并开始接受PD治疗的1640例PD患者作为研究对象。对患者进行随访,随访截止时间为2021-07-01,终点事件为CVD死亡并记录患者生存时间及具体死亡原因。应用限制性立方条图(RCS)分析PNI与PD患者CVD死亡风险之间的非线性关联;采用Kaplan-Meier法绘制PD患者的生存曲线,绘制PNI预测PD患者CVD死亡的受试者工作特征(ROC)曲线,并根据最佳截断值(cut-off=40.46)将患者分为低PNI组703例与高PNI组937例;采用Log-rank检验和Cox风险回归模型分析探讨PNI对PD患者CVD死亡的影响。结果本研究中位随访时间为30个月,随访期间共148例患者死亡,其中CVD死亡73例(49.32%)。RCS结果表明,PNI与CVD死亡事件呈线性关联(P for Nonlinear=0.655)。ROC曲线显示,PNI预测PD患者CVD死亡的曲线下面积(AUC)为0.717(95%CI=0.659~0.775,P<0.001),灵敏度为74.0%,特异度为58.6%。Kaplan-Meier生存分析结果显示,低PNI组CVD生存率低于高PNI组(χ^(2)=26.685,P<0.001)。多因素Cox风险回归模型分析,校正性别、年龄及CVD病史等混杂因素后,低PNI组仍是CVD死亡的独立预测因素(HR=7.76,95%CI=1.72~35.06,P=0.008),亚组分析结果仍稳健,无明显交互作用。结论PNI降低是PD患者CVD死亡的独立影响因素,PD首年PNI评分在评估PD患者预后有一定的指导意义。
文摘目的:探讨预后营养指数(Prognostic Nutritional Index, PNI)与急诊ICU老年脓毒症患者死亡相关性及对老年脓毒症患者死亡的评估价值。方法:采用回顾性分析方法,分析2021年1月至2024年7月康复大学青岛医院东院区急诊ICU收治的老年脓毒症患者(年龄 ≥ 65岁)的基本信息和实验室检查数据。根据患者的住院结局将其分为生存组和死亡组,比较两组的一般资料和实验室数据。单因素和多因素Logistic回归分析PNI与老年脓毒症患者死亡的关系。绘制受试者工作曲线(Receiver operating characteristic, ROC)和计算曲线下面积(area under the curve, AUC)评估PNI的预测效能。结果:共纳入133例患者,生存组92例,死亡组41例,病死率为30.8%。生存组白蛋白、PNI、总蛋白、血小板均显著高于死亡组,具有统计学意义(P Objectives: To explore the correlation between Prognostic Nutritional Index (PNI) and mortality in elderly sepsis patients in the emergency department, as well as its evaluation value for mortality in elderly sepsis patients. Method: A retrospective analysis was conducted to analyze the basic information and laboratory test data of elderly sepsis patients (aged ≥ 65 years) admitted to the Emergency ICU of the East Campus of Qingdao Hospital of Rehabilitation University from January 2021 to July 2024. According to the hospitalization outcome, they were divided into a survival group and a death group, and their general information and laboratory data were compared between the two groups. Single-factor and multi-factor logistic regression analyses were used to assess the relationship between PNI and the death of elderly patients with sepsis. Receiver operating characteristic (ROC) and calculate area under the curve (AUC) are drawn to evaluate the predictive performance of PNI. Result: A total of 133 patients were included, with 92 in the survival group and 41 in the death group, resulting in a mortality rate of 30.8%. The survival group had significantly higher levels of albumin, PNI, total protein, and platelets than the death group, with statistical significance (P < 0.05). The SOFA, APACHE II scores, and urea nitrogen levels in the death group were significantly higher than those in the survival group, and the differences were statistically significant (P < 0.05). Univariate logistic regression analysis showed that PNI, SOFA score, APACHE II score, total protein, albumin, and lactate were related factors leading to death in elderly sepsis patients. According to the results of multiple logistic regression analysis, PNI is an independent risk factor for in-hospital mortality in sepsis patients. The ROC curve analysis results showed that the area under the curve (AUC) for predicting in-hospital mortality in sepsis patients using PNI, lactate, SOFA, and APACHE II scores was 0.625, 0.604, 0.644, and 0.649, respectively. The area under the four joint prediction curves is 0.697, with a sensitivity of 63.4% and a specificity of 78.3%. Conclusion: Low PNI is an independent risk factor for the prognosis of elderly sepsis patients, with good sensitivity and specificity. When combined with lactate, SOFA, and APACHE II scores for prediction, PNI can improve the specificity of predicting mortality in elderly sepsis patients.
