Department of General Practice Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People's Republic of China.
Department of General Medicine, East Hospital, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510700, People's Republic of China.
Int J Chron Obstruct Pulmon Dis. 2023 Jun 12;18:1155-1167. doi: 10.2147/COPD.S402717. eCollection 2023.
Nutritional status is related to the clinical outcomes of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD). The aim of this study was to investigate the association between nutritional status, measured by the prognostic nutritional index (PNI), and adverse hospitalization outcomes in patients with AECOPD.
Consecutive AECOPD patients admitted to the First Affiliated Hospital of Sun Yat-sen University between January 1, 2015 to October 31, 2021 were enrolled. We collected the clinical characteristics and laboratory data of patients. Multivariable logistic regression models were developed to assess the relationship between the baseline PNI and adverse hospitalization outcomes. A generalized additive model (GAM) was used to identify any non-linear relationship. In addition, we performed a subgroup analysis to tested the robustness of the results.
A total of 385 AECOPD patients were involved in this retrospective cohort study. Based on the tertiles of PNI, patients in the lower tertiles of PNI showed more worse outcome incidence (30 [23.6%] versus 17 [13.2%] versus 8 [6.2%]; < 0.001). Multivariable logistic regression analysis revealed that the PNI were independently associated with adverse hospitalization outcomes after adjustment for confounding factors (Odds ratio [OR] = 0.94, 95% CI: 0.91 to 0.97, < 0.0001). After adjusting for confounders, smooth curve fitting showed a saturation effect, suggesting that the relationship between the PNI and adverse hospitalization outcomes was nonlinear. Two-piecewise linear regression model suggested that the incidence of adverse hospitalization outcomes significantly decreased with PNI level up to the inflection point (PNI = 42), and PNI was not associated with adverse hospitalization outcome after that point.
Decreased PNI levels at admission were determined to be associated with adverse hospitalization outcomes in patients with AECOPD. The results obtained in this study may potentially assist clinicians optimize risk evaluations and clinical management processes.
营养状况与慢性阻塞性肺疾病急性加重（AECOPD）患者的临床结局相关。本研究旨在探讨预后营养指数（PNI）评估的营养状况与 AECOPD 患者住院不良结局的关系。
连续纳入 2015 年 1 月 1 日至 2021 年 10 月 31 日期间中山大学附属第一医院收治的 AECOPD 患者。收集患者的临床特征和实验室数据。采用多变量逻辑回归模型评估基线 PNI 与住院不良结局的关系。采用广义相加模型（GAM）来识别任何非线性关系。此外，我们进行了亚组分析以检验结果的稳健性。
本回顾性队列研究共纳入 385 例 AECOPD 患者。根据 PNI 的三分位值，PNI 较低三分位的患者更易出现不良结局（30 [23.6%] 例比 17 [13.2%] 例比 8 [6.2%]；<0.001）。多变量逻辑回归分析显示，在校正混杂因素后，PNI 与住院不良结局独立相关（比值比 [OR] = 0.94，95%置信区间：0.91 至 0.97，<0.0001）。在校正混杂因素后，平滑曲线拟合显示出饱和效应，表明 PNI 与住院不良结局之间的关系是非线性的。两段线性回归模型提示，随着 PNI 水平达到拐点（PNI = 42），住院不良结局的发生率显著下降，而在此拐点后 PNI 与住院不良结局无关。
入院时 PNI 水平降低与 AECOPD 患者住院不良结局相关。本研究结果可能有助于临床医生优化风险评估和临床管理流程。
