诊断时的营养风险指数评分可有效预测抗中性粒细胞胞浆抗体相关性血管炎患者的不良预后。

Nutrition Risk Index Score at Diagnosis Can Effectively Predict Poor Prognosis in Patients With Antineutrophil Cytoplasmic Antibody-Associated Vasculitis.

机构信息

Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.

Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute for Immunology and Immunological Diseases, Yonsei University College of Medicine, Seoul, Republic of Korea.

出版信息

J Ren Nutr. 2022 Jul;32(4):423-431. doi: 10.1053/j.jrn.2021.06.004. Epub 2021 Jul 20.

DOI:10.1053/j.jrn.2021.06.004

PMID:34294554

Abstract

OBJECTIVES

This study investigated whether the nutritional risk index (NRI) score at diagnosis might be useful for anticipating poor prognosis, in particular, all-cause mortality and end-stage renal disease (ESRD) in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).

METHODS

The medical records of 242 immunosuppressive drug-naïve patients with AAV were retrospectively reviewed. Data at diagnosis and poor prognosis and medications during follow-up were assessed. The NRI score was calculated by 1.519 × serum albumin (g/L) + 41.7 × present (kg)/ideal body weight (kg).

RESULTS

The median age at diagnosis of patients with AAV (131 microscopic polyangiitis, 62 granulomatosis with polyangiitis, and 49 eosinophilic granulomatosis with polyangiitis) was 60 years (85 male). During follow-up, twenty-nine patients (12.0%) died after a period of 35.9 months, and 42 patients (17.4%) had ESRD for a period of 30.0 months. Using the receiver operator characteristic curve, the cutoffs of the NRI scores for all-cause mortality and ESRD were calculated as NRI ≤ 101.95 (sensitivity, 46.5%; specificity, 89.7%) and NRI ≤ 99.85 (sensitivity, 57.0%; specificity, 83.3%). In the multivariable Cox hazard model analyses, age (hazard ratio [HR], 1.035), five-factor score (HR, 1.623), and the NRI score ≤ 101.95 (HR, 4.262) were independent predictors of all-cause mortality, whereas, five-factor score (HR, 1.516), hypertension (HR, 1.906), and the NRI score ≤ 99.85 (HR, 3.623) were independent predictors of ESRD occurrence during follow-up in patients with AAV.

CONCLUSIONS

The NRI score at diagnosis may be a useful index to anticipate all-cause mortality and ESRD occurrence during follow-up in patients with AAV.

摘要

目的

本研究旨在探讨诊断时的营养风险指数（NRI）评分是否有助于预测不良预后，特别是抗中性粒细胞胞质抗体相关性血管炎（AAV）患者的全因死亡率和终末期肾病（ESRD）。

方法

回顾性分析 242 例免疫抑制药物初治 AAV 患者的病历资料。评估诊断时及不良预后时的数据和随访期间的药物使用情况。NRI 评分通过 1.519×血清白蛋白（g/L）+41.7×实际（kg）/理想体重（kg）计算得出。

结果

AAV 患者（131 例显微镜下多血管炎、62 例肉芽肿性多血管炎和 49 例嗜酸性粒细胞性肉芽肿性多血管炎）的中位年龄为 60 岁（85 例为男性）。在随访期间，29 例患者（12.0%）在 35.9 个月后死亡，42 例患者（17.4%）在 30.0 个月后发生 ESRD。使用受试者工作特征曲线，计算出 NRI 评分预测全因死亡率和 ESRD 的截断值分别为 NRI≤101.95（敏感性 46.5%，特异性 89.7%）和 NRI≤99.85（敏感性 57.0%，特异性 83.3%）。多变量 Cox 风险模型分析显示，年龄（风险比[HR]，1.035）、五因子评分（HR，1.623）和 NRI 评分≤101.95（HR，4.262）是全因死亡率的独立预测因素，而五因子评分（HR，1.516）、高血压（HR，1.906）和 NRI 评分≤99.85（HR，3.623）是 AAV 患者随访期间发生 ESRD 的独立预测因素。