预后营养指数联合NLR、PLR在腹膜透析患者全因死亡中的预测价值

Predictive value of prognostic nutritional index combined with NLR and PLR in all-cause mortality of patients with peritoneal dialysis

目的探讨预后营养指数(PNI)、中性粒细胞与淋巴细胞比值(NLR)和血小板与淋巴细胞比值(PLR)预测腹膜透析(PD)患者死亡的临床价值。方法选取接受腹膜透析治疗的患者189例,根据随访期间是否死亡分为死亡组(71例)和生存组(118例),比较2组临床指标的差异,采用受试者工作特征(ROC)曲线分析PNI评分、NLR、PLR预测PD患者死亡的临床价值,多因素Cox回归模型分析患者死亡的危险因素,Kaplan-Meier法比较不同PNI评分、NLR、PLR水平患者的生存差异。结果与存活组相比,死亡组年龄偏大,合并高血压和糖尿病比例升高,NLR和PLR升高,PNI下降(P<0.05)。ROC曲线结果显示,NLR、PLR、PNI预测腹膜透析患者全因死亡的ROC曲线下面积(AUC)分别为0.684、0.689、0.729,敏感度分别为57.75%、67.61%、57.75%,特异度分别为79.66%、68.64%、80.51%,最佳临界值分别为NLR=4.91、PLR=152.92,PNI=43.74,联合指标对患者全因死亡的预测价值优于单独检测。Cox回归分析发现,NLR升高(HR=2.271,95%CI:1.375~3.753)、PLR升高(HR=2.846,95%CI:1.672~4.844)、PNI下降(HR=2.802,95%CI:1.701~4.616)是腹膜透析患者全因死亡的危险因素。生存分析结果显示,NLR≥4.91、PLR≥152.92和PNI≤43.74患者的累积生存率明显下降(Log rankχ^(2)分别为23.299、20.625、28.183,P<0.01)。结论PNI联合NLR和PLR对腹膜透析患者预后转归有较好的预测效果。

Objective To investigate the clinical value of prognostic nutritional index(PNI),neutrophil to lymphocyte ratio(NLR)and platelet to lymphocyte ratio(PLR)in all-cause mortality of patients with peritoneal dialysis(PD).Methods A total of 189 patients who received PD were divided into the death group(n=71)and the survival group(n=118)according to whether they died during follow-up.The differences of clinical indicators between the two groups were compared.The clinical value of PNI score,NLR and PLR in predicting the death of PD patients was analyzed by receiver operating characteristic(ROC)curve.Multivariate Cox regression model was used to analyze the risk factors for death.Kaplan-Meier method was used to compare the survival differences of patients with different PNI scores,NLR and PLR levels.Results Compared with the survival group,patients were older,the proportion of patients with hypertension and diabetes increased,the NLR and PLR were increased,and the PNI was decreased in the death group(P<0.05).The ROC curve results showed that the area under the ROC curve(AUC)of NLR,PLR and PNI in predicting all-cause death in peritoneal dialysis patients were 0.684,0.689 and 0.729,respectively,and the sensitivity were 57.75%,67.61%and 57.75%,respectively.The specificity were 79.66%,68.64%,80.51%,and the optimal cut-off values were NLR=4.91,PLR=152.92,PNI=43.74,respectively.Cox regression analysis showed that increased NLR(HR=2.271,95%CI:1.375-3.753),increased PLR(HR=2.846,95%CI:1.672-4.844)and decreased PNI(HR-2.802,95%CI:1.701-4.616)were risk factors for all-cause mortality in PD patients.Survival analysis showed that the cumulative survival rates of patients with NLR≥4.91,PLR≥152.92 and PNI≤43.74 were significantly decreased(Log rankχ^(2)=23.299,20.625,28.183,P<0.01).Conclusion PNI combined with NLR and PLR has a good predictive effect on the prognosis of PD patients.