预后营养指数对新疆喀什地区糖尿病足患者全因死亡的预测价值

Prognostic nutritional index in predicting survival for patients with diabetic foot ulcer in kashgar District of Xinjiang

目的评估预后营养指数(prognostic nutritional index,PNI)对新疆喀什地区糖尿病足患者全因死亡的预测价值。方法采用回顾性队列研究方法,收集2018年1月—2019年12月新疆喀什地区第二人民医院内分泌科收治的132例糖尿病足患者临床资料,以患者出院之日作为起点进行电话随访(每年1次),以死亡或满3年为随访终点。根据3年随访时的生存情况分为生存组78例和死亡组54例。根据PNI最佳截断值分为高PNI组86例(PNI≥41.62)和低PNI组46例(PNI<41.62),采用Kaplan-Meier法进行生存分析比较两组生存率,采用Cox比例风险模型探索PNI和糖尿病足患者全因死亡的关系。结果本研究最终纳入132例糖尿病足患者,平均年龄(60.5±10.02)岁,其中男性89例(67.4%),随访期间共54例(40.9%)患者死亡。ROC曲线分析显示,PNI预测糖尿病足患者全因死亡的曲线下面积为0.798(95%CI:0.7210.875,P<0.0001),最佳截断值41.62,灵敏度为61.1%,特异度为83.3%。Log-rank检验表明,低PNI组总生存率较低(P<0.001)。多因素Cox回归分析显示,PNI、冠心病、重型溃疡与糖尿病足患者全因死亡独立相关(P<0.05)。结论在新疆喀什地区,PNI高的糖尿病足患者死亡率较低,PNI对糖尿病足患者的全因死亡具有一定的预测价值。

Objective To investigate the predictive value of prognostic nutritional index(PNI)for all-cause mortality in patients with diabetic foot.Methods Clinical data of 132 patients aged 60.5±10.02 years(89 were males)with diabetic foot admitted to the Department of Endocrinology of the Second People's Hospital of Kashgar from January 2018 to December 2019 were retrospectively analyzed.An annual telephone follow-up was conducted for all patients after discharge.During 3 years of follow-up 78 patients survived(survival group)and 54 patients died(fatal group).Based on the best cut-off value of PNI,there were 86 cases in the high PNI group(PNI≥41.62)and 46 cases in the low PNI group(PNI<41.62).Kaplan-Meier method was used to compare the survival rate of the two groups,and Cox proportional hazards model was used to explore the relationship between PNI and all-cause death in patients with diabetic foot.Results Log-rank test showed that the overall survival rate was lower in the low PNI group(P<0.001).Multivariate Cox regression analysis showed that PNI,coronary heart disease,and severe ulcer were independently associated with all-cause death in patients with diabetic foot(P<0.05).ROC curve analysis showed that the AUC of PNI for predicting all-cause mortality in patients with diabetic foot was 0.798(95%CI:0.721-0.875,P<0.0001),the best cut-off value was 41.62 with a sensitivity of 61.1%and specificity of 83.3%.Conclusion Higher PNI is associated with lower mortality in patients with diabetic foot,and PNI may be able to predict all-cause mortality in patients with diabetic foot in kashgar District of Xinjiang.