基于MIMIC数据库探讨预后营养指数与重症肝硬化患者预后的相关性

The correlation between prognostic nutritional index and the prognosis of patients with severe liver cirrhosis: analyses based on the MIMIC database

目的:探讨预后营养指数(PNI)与重症肝硬化患者预后的相关性。方法:回顾性收集2008至2019年美国重症监护数据库2.0版本(MIMIC-IV,v2.0)中在重症医学科(ICU)符合要求的重症肝硬化患者。根据90 d预后,将患者分为存活组和死亡组,比较两组患者基本资料的差异。根据限制性立方样条(RCS)分析中90 d预后风险比(HR)为1时的PNI值,将患者分为高PNI组(≥34.46)和低PNI组(<34.46)。应用Kaplan-Meier法绘制两组肝硬化患者90 d时累积生存率曲线,并建立Cox回归模型以分析PNI与患者90 d预后之间的相关性。结果:死亡组PNI值更低(P<0.05)。RCS显示,PNI与90 d全因死亡风险整体呈非线性趋势关系(χ^(2)=20.800,P<0.001)。在一定范围内,随着PNI值的降低,重症肝硬化患者90 d全因死亡风险升高。生存率曲线分析显示,与高PNI组相比,低PNI组患者90 d的累积生存率更低(P<0.001)。多因素Cox回归分析显示,低PNI是重症肝硬化患者90 d全因死亡的独立危险因素(P<0.05)。结论:入ICU时PNI水平降低(<34.46)是重症肝硬化患者90 d全因死亡的独立危险因素,可作为重症肝硬化患者预后风险分层的一项工具。

Objective:To explore the correlation between prognostic nutritional index(PNI)and the prognosis of patients with severe liver cirrhosis.Methods:Retrospectively collected critically ill patients with liver cirrhosis from the Medical Information Mart for Intensive Care(MIMIC-IV)database,version 2.0,covering the years 2008 to 2019.Based on the 90-day prognosis,patients were divided into survival and death groups,and the differences in baseline characteristics were compared.Using restricted cubic spline(RCS)analysis,the PNI value at which the hazard ratio(HR)for 90-day prognosis was 1 was identified,and patients were categorized into high PNI(≥34.46)and low PNI(<34.46)groups.Kaplan-Meier method was used to plot cumulative survival curves for the two groups of patients with liver cirrhosis at 90 days,and a Cox regression model was established to analyze the correlation between PNI and the 90-day prognosis.Results:The PNI value was significantly lower in the death group(P<0.05).RCS analysis showed a nonlinear trend between PNI and the risk of 90-day all-cause mortality(P<0.001).Within a certain range,as the PNI value decreased,the risk of 90-day all-cause mortality in critically ill patients with liver cirrhosis increased.Survival analysis showed that compared to the high PNI group,the cumulative survival rate at 90 days was significantly lower in the low PNI group(P<0.001).Multivariate Cox regression analysis indicated that low PNI was an independent risk factor for 90-day all-cause mortality in patients with severe liver cirrhosis(P<0.05).Conclusion:A decreased PNI level(<34.46)upon ICU admission was an independent risk factor for 90-day all-cause mortality in patients with severe liver cirrhosis.This highlighted the practicality of the PNI as a predictive tool in risk stratification for patient prognosis.