老年营养风险指数联合肌少症指数预测腹膜透析患者预后的价值

Geriatric nutritional risk index and sarcopenia index in peritoneal dialysis patients

目的:分析老年营养风险指数(GNRI)联合肌少症指数(SI)判断维持性腹膜透析(PD)患者预后的价值。方法:本文为单中心回顾性研究,基线截取2020年7月至2021年6月于国家肾脏疾病临床医学研究中心规律透析≥1年PD患者。利用体质量与血液生化指标分别计算GNRI和SI。经胸心脏超声测量左心室舒张末期内径(LVEDd)、后壁厚度(PWT)、室间隔厚度(IVST)。计算左心室质量(LVM)和左心室质量指数(LVMI)。完善螺旋CT和腹部侧位X线片检测,获得冠状动脉钙化评分(CACS)与腹主动脉钙化评分(AACS)。纳入对象随访至2023年7月,以全因死亡或PD技术失败定义复合事件。利用受试者曲线曲线下面积(AUC)比较GNRI联合SI判断预后价值。结果:296例PD患者年龄51.2±15.2岁,其中男性141例(47.6%),日间不卧床腹膜透析(DAPD)247例(83.4%),透析龄60.5±32.7月,总尿素清除指数(Kt/V)1.79±0.62,血清白蛋白水平37.4±4.1 g/L,GNRI 92.6±7.7,SI 0.77±0.22。单因素分析显示,GNRI(r=-0.26,P<0.01)和SI(r=-0.20,P=0.01)水平分别与CACS呈显著负相关,但与LVMI相关性均无统计学意义。随访发生复合事件196例(66.2%),其中死亡29例,转血液透析167例。多因素Logistic回归分析显示,标准蛋白分解率(nPCR)、LVMI及SI均是发生复合事件独立预测因素。AUC显示,GNRI与SI预测复合事件能力差异有统计学意义(AUC 0.70 vs 0.77,P<0.01),两者联合预测能力进一步提高(AUC 0.81,与两者比较均P<0.01)。结论:GNRI与SI均与PD患者冠状动脉钙化风险相关,SI是发生不良事件独立预测因素,两者联合预测不良事件能力显著提高。

Objective:To evaluate the feasibility of geriatric nutritional risk index(GNRI)combined with sarcopenia index(SI)in assessment of clinical events in peritoneal dialysis(PD)patients.Methodology:In this retrospective cohort study,patients underwent maintained PD at Jinling hospital were enrolled from July 2020 to June 2021.We collected baseline clinical characteristics of the participants.Serum albumin(Alb),creatinine(Cr),cystatin C(CysC)were measured by standard laboratory techniques.The GNRI was calculated with weight and Alb.All patients were examined by transthoracic echocardiography to measure the diameter of the left ventricle.Left ventriclar mass index(LVMI)was obtained by calculation.Abdominal lateral plain radiograph and multi-slice spiral CT were used to detect the calcification of abdominal aorta and coronary artery,respectively.Kauppila score was used to assess the degree of abdominal aortic calcification score(AACS),and Agatston score for the degree of coronary artery calcification score(CACS).Pearson correlation coefficient was used to analyze the relationship between GNRI,SI and CACS,LVMI.We also used receiver operator characteristic(ROC)curves to assess the accuracy and sensitivity of GNRI,SI score for the diagnosis of clinical events(mortality,technique failure).Results:A total of 296 PD patients were enrolled in the final analysis.The mean age of our participants was 51.2 years.Among them,141(47.6%)were males.PD treatment modality was mainly DAPD,and mean PD vintage was 60.5 months.Dialysis adequacy data shown with total(renal+peritoneal)Kt/V was 1.79±0.62.Mean SI was 0.77 and GNRI was 92.6.Correlation analysis showed that GNRI(r=-0.26,P<0.01)or SI(r=-0.20,P<0.01)score was negatively correlated with CACS,respectively.A total of 196 composite outcomes occurred:29 all-cause of deaths and 155 technique failure occurred during a median follow-up of 2 years.Logistic regression analyses showed that nPCR,LVMI and SI were related to the prevalence of composite outcomes.The area under the receiver-operating characteristic curve(AUC)of GNRI or SI score for diagnosing composite outcomes was 0.70 or 0.77,respectively.When GNRI combined with the SI score,the prediction of composite outcomes became more powerful for PD patients.Conclusion:GNRI or SI score was significantly correlated with coronary artery calcification.GNRI can be combined with SI score to predict the composite outcomes in PD patients.