预后营养指数与慢性阻塞性肺疾病患者预后的关系

Relationship between prognostic nutritional index and prognosis of patients with chronic obstructive pulmonary disease

目的探讨预后营养指数(prognostic nutritional index,PNI)与慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者90d预后的相关性。方法回顾性分析美国重症监护医学信息数据库Ⅲ中1415例COPD患者的临床资料,根据90d随访时的生存情况将其分为死亡组(n=484)和存活组(n=931)。生存分析使用Kaplan-Meier法,并建立Cox比例风险模型探索PNI和COPD患者预后间的关联。结果两组患者的年龄、序贯器官衰竭评估(sequential organ failure assessment,SOFA)评分、阴离子间隙、白细胞计数、肌酐、PNI、白蛋白、淋巴细胞计数、血红蛋白、入住重症监护病房(intensive care unit,ICU)时间及合并脓毒症休克、急性呼吸衰竭和急性心肌梗死比例比较,差异均有统计学意义(P<0.05)。多因素Cox比例风险模型结果显示,低水平PNI(<31.20)、年龄、SOFA评分、阴离子间隙、白细胞计数、低血红蛋白水平及合并急性呼吸衰竭均是影响COPD患者90d全因死亡的独立危险因素(P<0.05)。结论入住ICU时低水平PNI(<31.20)与COPD患者预后密切相关,是此类患者90d全因死亡的独立影响因素。

Objective To investigate the correlation between prognostic nutritional index(PNI)and 90 days prognosis in patients with chronic obstructive pulmonary disease(COPD).Methods The clinical data of 1415 COPD patients in Medical Information Mart for Intensive CareⅢwere retrospectively analyzed,and they were divided into death group(n=484)and survival group(n=931)according to their survival at 90 days of follow-up.Kaplan-Meier method was used for survival analysis,and Cox proportional hazards model was established to explore the association between PNI and the prognosis in COPD patients.Results There were significant differences in age,sequential organ failure assessment(SOFA)score,anion gap,white blood cell count,creatinine,PNI,albumin,lymphocyte count,hemoglobin,length of stay in intensive care unit(ICU)and the proportion of patients with septic shock,acute respiratory failure and acute myocardial infarction between the two groups(P<0.05).Multivariate Cox proportional risk model showed that low PNI(<31.20),age,SOFA score,anion gap,white blood cell count,low hemoglobin,and combined acute respiratory failure were independent risk factors for 90-day all-cause death in COPD patients(P<0.05).Conclusion Low PNI(<31.20)at ICU admission is closely related to the prognosis of COPD patients and is an independent influencing factor of 90-day all-cause death in such patients.