预后营养指数与冠状动脉疾病患者的预后：一项系统评价和荟萃分析。
Prognostic nutritional index and prognosis of patients with coronary artery disease: A systematic review and meta-analysis.
作者信息
Zhang Shengjing, Wang Huanfen, Chen Saiya, Cai Shengsheng, Zhou Shigeng, Wang Congling, Ni Xiuyuan
机构信息
Department of Geriatrics, Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Wenzhou, China.
Department of Geriatrics, Wenzhou Geriatric Hospital, Wenzhou, China.
出版信息
Front Nutr. 2023 Mar 16;10:1114053. doi: 10.3389/fnut.2023.1114053. eCollection 2023.
BACKGROUND
This review assessed if prognostic nutritional index (PNI) can predict mortality and major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.
METHODS
PubMed, Web of Science, Scopus, and Embase were searched up to 1st November 2022 for all types of studies reporting adjusted associations between PNI and mortality or MACE in CAD patients. A random-effect meta-analysis was conducted for PNI as categorical or continuous variable. Subgroup analysis were conducted for multiple confounders.
RESULTS
Fifteen studies with 22,521 patients were included. Meta-analysis found that low PNI was a significant predictor of mortality in CAD patients as compared to those with high PNI (HR: 1.67 95% CI: 1.39, 2.00 = 95% < 0.00001). Increasing PNI scores were also associated with lower mortality (HR: 0.94 95% CI: 0.91, 0.97 = 89% = 0.0003). Meta-analysis demonstrated that patients with low PNI had significantly higher incidence of MACE (HR: 1.57 95% CI: 1.08, 2.28 = 94% = 0.02) and increasing PNI was associated with lower incidence of MACE (HR: 0.84 95% CI: 0.72, 0.92 = 97% = 0.0007). Subgroup analyses showed mixed results.
CONCLUSION
Malnutrition assessed by PNI can independently predict mortality and MACE in CAD patients. Variable PNI cut-offs and high inter-study heterogeneity are major limitations while interpreting the results. Further research focusing on specific groups of CAD and taking into account different cut-offs of PNI are needed to provide better evidence.
SYSTEMATIC REVIEW REGISTRATION
No CRD42022365913 https://www.crd.york.ac.uk/prospero/.
背景
本综述评估了预后营养指数（PNI）能否预测冠状动脉疾病（CAD）患者的死亡率和主要不良心脏事件（MACE）。
方法
截至2022年11月1日，在PubMed、科学网、Scopus和Embase数据库中检索所有报告CAD患者中PNI与死亡率或MACE之间校正关联的各类研究。对PNI作为分类变量或连续变量进行随机效应荟萃分析。对多个混杂因素进行亚组分析。
结果
纳入了15项研究，共22521例患者。荟萃分析发现，与高PNI的CAD患者相比，低PNI是CAD患者死亡率的显著预测因素（HR：1.67，95%CI：1.39，2.00；I² = 95%，P < 0.00001）。PNI评分升高也与较低的死亡率相关（HR：0.94，95%CI：0.91，0.97；I² = 89%，P = 0.0003）。荟萃分析表明，低PNI患者的MACE发生率显著更高（HR：1.57，95%CI：1.08，2.28；I² = 94%，P = 0.02），而PNI升高与较低的MACE发生率相关（HR：0.84，95%CI：0.72，0.92；I² = 97%，P = 0.0007）。亚组分析结果不一。
结论
通过PNI评估的营养不良可独立预测CAD患者的死亡率和MACE。PNI的不同临界值和研究间的高度异质性是解释结果时的主要局限性。需要针对特定CAD患者群体并考虑PNI不同临界值的进一步研究，以提供更好的证据。
系统评价注册
无，CRD42022365913 https://www.crd.york.ac.uk/prospero/ 。
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