Ahn Sung Soo, Pyo Jung Yoon, Song Jason Jungsik, Park Yong-Beom, Lee Sang-Won
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.
Ther Adv Musculoskelet Dis. 2023 Jul 29;15:1759720X231188818. doi: 10.1177/1759720X231188818. eCollection 2023.
Studies have proposed that nutritional and immune-related markers are relevant with patient outcomes of various medical conditions and could be a useful indicator of patient prognostication.
This study investigated whether a prognostic immune nutritional index (PINI) at diagnosis could predict adverse clinical outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV).
A retrospective, single-centre observational cohort analysis of patients with AAV.
All-cause mortality and end-stage renal disease (ESRD) were investigated outcomes during the observation period. PINI was calculated by serum albumin (g/mL) × 0.9 - monocyte count (/mm) × 0.0007, and the optimal cut-off of PINI was obtained using a Youden index-based bootstrapping method. Cox hazard analyses were performed to identify independent predictors of patient outcomes.
Of the 250 eligible patients, the median age of patients was 60.0 years, and 34.0% were men. During the disease course, 33 (13.2%) died and 42 (16.8%) developed ESRD, respectively. The ideal PINI cut-offs for all-cause mortality and ESRD were set as ⩽2.47 and ⩽3.12 (sensitivity and specificity of 75.1% and 60.6% for mortality and 46.2% and 78.6% for ESRD). AAV patients with PINI ⩽2.47 and those with PINI ⩽3.12 exhibited significantly higher rates for all-cause mortality and ESRD compared to those with PINI >2.47 and >3.12. In the multivariable Cox analysis, PINI ⩽2.47 (hazard ratio [HR]: 3.173, 95% confidence interval [CI]: 1.129, 8.916, = 0.029) was independently associated with all-cause patient mortality; however, PINI ⩽3.12 was not independently associated with ESRD (HR: 1.097, 95% CI: 0.419, 2.870, = 0.850).
Findings from this study demonstrated PINI could predict all-cause patient mortality in AAV, and a higher clinical attention is warranted in those with PINI ⩽2.47 at initial diagnosis.
研究表明，营养和免疫相关标志物与各种疾病的患者预后相关，可能是患者预后评估的有用指标。
本研究调查了诊断时的预后免疫营养指数（PINI）是否能预测抗中性粒细胞胞浆抗体相关性血管炎（AAV）患者的不良临床结局。
对AAV患者进行回顾性、单中心观察性队列分析。
观察期内的研究结局为全因死亡率和终末期肾病（ESRD）。PINI通过血清白蛋白（g/mL）×0.9 - 单核细胞计数（/mm）×0.0007计算得出，并使用基于约登指数的自抽样法获得PINI的最佳临界值。进行Cox风险分析以确定患者结局的独立预测因素。
250例符合条件的患者中，患者的中位年龄为60.0岁，男性占34.0%。在病程中，分别有33例（13.2%）死亡和42例（16.8%）发生ESRD。全因死亡率和ESRD的理想PINI临界值分别设定为≤2.47和≤3.12（死亡率的敏感性和特异性分别为75.1%和60.6%，ESRD的敏感性和特异性分别为46.2%和78.6%）。与PINI>2.47和>3.12的患者相比，PINI≤2.47和PINI≤3.12的AAV患者全因死亡率和ESRD发生率显著更高。在多变量Cox分析中，PINI≤2.47（风险比[HR]：3.173，95%置信区间[CI]：1.129，8.916，P = 0.029）与患者全因死亡率独立相关；然而，PINI≤3.12与ESRD无独立相关性（HR：1.097，95%CI：0.419，2.870，P = 0.850）。
本研究结果表明，PINI可预测AAV患者的全因死亡率，对于初诊时PINI≤2.47的患者应给予更高的临床关注。
