预后营养指数在心脏瓣膜病术后肺部感染预测价值研究

Prognostic Value of Onodera s Prognostic Nutrition Index in Predicting Postoperative Pulmonary Infection of Cardiac Valve Surgery

目的探讨预后营养指数(OPNI)对心脏瓣膜病(HVD)术后肺部感染的预测价值。方法回顾性分析2019年3月至2023年3月我院391例择期HVD手术患者。根据患者术后肺部感染情况,分为感染组(n=142)和非感染组(n=249)。收集患者临床资料,以NRS2002量表为标准,获取OPNI的截止值。采用Lasso回归分析筛选混杂因素,通过多因素二元Logistic回归分析HVD术后肺部感染的影响因素。绘制受试者工作特征(ROC)曲线分析OPNI预测HVD患者术后肺部感染的价值。结果142例(36.3%)心脏瓣膜置换手术的患者发生术后肺部感染;两组年龄、OPNI、吸烟史、血清白蛋白、淋巴细胞计数、纽约心功能分级、射血分数、肺动脉高压、术中输血、手术时间、体外循环时间、主动脉阻断时间、瓣膜置换或成形合并其他手术方式组间比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,OPNI、射血分数、术中输血、吸烟史、淋巴细胞计数是HVD患者术后肺部感染的独立危险因素(P<0.05);OPNI取值45.925,区分营养不良的约登(Youden)指数最大值为0.731,曲线下面积(AUC)为0.914,敏感度和特异度分别为84.0%和89.1%;OPNI预测肺部感染的AUC为0.706,Youden指数最大0.412,敏感度和特异度分别为64.1%和77.1%。结论术前OPNI是简单有效的预测HVD术后肺部感染的临床指标,以45.925为界值有良好的预测价值。

Objective To explore predictive values of Onodera s prognostic nutrition index(OPNI)in postoperative pulmonary infection in patients with valvular heart disease(HVD).Methods 391 patients undergoing elective HVD surgery in our hospital from March 2019 to March 2023 were analyzed retrospectively.According to postoperative pulmonary infection,patients were divided into infection group(n=142)and non-infection group(n=249),and clinical data of patients were collected.The amount of NRS2002 was taken as the standard to obtain the cutoff value of OPNI.Lasso regression analysis was used to screen confounding factors,and multivariate Logistic regression was used to analyze influencing factors of pulmonary infection after HVD.The receiver operating characteristic(ROC)curve was drew to analyze OPNI value in predicting postoperative pulmonary infection in patients with HVD.Results 142(36.3%)patients with cardiac valve replacement developed postoperatire pulmonary infection.There were significant differences in age,OPNI,smoking history,serum albumin,lymphocyte count,New York cardiac function grade,ejection fraction,pulmonary hypertension,intraoperative blood transfusion,operation time,cardiopulmonary bypass time,aortic clamping time,valve replacement or valvuloplasty combined with other surgical methods(P<0.05).Multivariate Logistic regression analysis showed that OPNI,preoperative ejection fraction,intraoperative blood transfusion,smoking history and lymphocyte count were independent risk factors for postoperative pulmonary infection in patients with HVD(P<0.05).The OPNI value was 45.925,the maximum value of Youden index to distinguish malnutrition was 0.731,the area under the curve(AUC)was 0.914,the sensitivity and specificity were 84.0%and 89.1%,respectively.The AUC of OPNI for predicting pulmonary infection was 0.706.The largest Youden index was 0.412.and the sensitivity and specificity were 64.1%and 77.1%,respectively.Conclusions Preoperative OPNI would be a simple and effective clinical index for predicting pulmonary infection after HVD,and the cutoff value of 45.925 would be of good predictive value.