Ling Xuebin, Lin Chufen, Liu Jin, He Yibo, Yang Yongquan, Lu Na, Jie Wei, Liu Yong, Chen Shiqun, Guo Junli
Hainan Provincial Key Laboratory for Tropical Cardiovascular Diseases Research, Department of Cardiovascular Medicine of The First Affiliated Hospital, Key Laboratory of Emergency and Trauma of Ministry of Education, Hainan Medical University, Haikou, China.
Department of Health Medicine, The Affiliated Haikou Hospital of Xiangya Medical College, Central South University, Haikou, China.
Diabetol Metab Syndr. 2023 Oct 24;15(1):207. doi: 10.1186/s13098-023-01160-4.
The prognostic nutritional index (PNI) and different glucose metabolisms have been separately reported to be correlated with long-term prognosis in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). However, PNI application in patients with an impaired glucose metabolism has not been well validated, especially in pre-diabetic patients. This study evaluated whether PNI influences a long-term risk of mortality along different glucose metabolism statuses.
A total of 17,697 patients with AMI and a history of PCI were enrolled in this retrospective observational cohort study from January 2007 to December 2020. Three subgroups with different glucose metabolism statuses, including normal glucose regulation (NGR), pre-diabetes mellitus (pre-DM), and diabetes mellitus (DM), were divided into three groups according to the tertiles of PNI, respectively.
All-cause mortality occurred in 2613 (14.8%) patients within a median of 4.1 years of follow-up. Upon analyzing the Kaplan-Meier plots for the NGR, pre-DM, and DM groups, the incidence of all-cause or cardiovascular mortality in the low PNI (PNI-L, ≤ 42.7) subgroup was significantly higher than that in the median PNI (PNI-M, > 42.7 and ≤ 48.2) and high PNI (PNI-H, > 48.2) subgroups (all, P < 0.001). After adjusting for confounding factors, the hazard ratio (HR) for all-cause mortality in the PNI-L group significantly increased compared to that in the PNI-H subgroups of the NGR group (HR, 1.35; 95% CI 1.14-1.66; P < 0.001), pre-DM group (HR, 1.29; 95% CI 1.02-1.62; P < 0.001), and DM group (HR, 1.36; 95% CI 1.13-1.63; P < 0.001). Given that there was evidence of interactions between PNI and different glucose statuses (P for interaction < 0.001), patients were divided into nine subgroups, and we found that DM patients with PNI-L statuses had the highest risk of all-cause mortality compared to NGR patients with PNI-H statuses (HR, 1.69; 95% CI 1.42-2.01; P < 0.001).
Lower PNI is a significant and independent risk factor for all-cause mortality in AMI patients undergoing PCI with different glucose metabolism statuses, and this risk further increases with DM compared to NGR or pre-DM statuses.
预后营养指数（PNI）和不同的糖代谢情况已分别被报道与接受经皮冠状动脉介入治疗（PCI）的急性心肌梗死（AMI）患者的长期预后相关。然而，PNI在糖代谢受损患者中的应用尚未得到充分验证，尤其是在糖尿病前期患者中。本研究评估了PNI是否会影响不同糖代谢状态下的长期死亡风险。
本回顾性观察队列研究纳入了2007年1月至2020年12月期间共17697例有AMI病史且接受过PCI的患者。根据糖代谢状态将患者分为三个亚组，包括血糖正常调节（NGR）、糖尿病前期（pre-DM）和糖尿病（DM），并分别根据PNI的三分位数将这三个亚组再分为三组。
在中位随访4.1年期间，2613例（14.8%）患者发生了全因死亡。分析NGR、pre-DM和DM组的Kaplan-Meier曲线，低PNI（PNI-L，≤42.7）亚组的全因或心血管死亡发生率显著高于中位PNI（PNI-M，>42.7且≤48.2）和高PNI（PNI-H，>48.2）亚组（所有P<0.001）。在调整混杂因素后，PNI-L组全因死亡的风险比（HR）与NGR组、pre-DM组和DM组的PNI-H亚组相比显著增加（NGR组：HR，1.35；95%CI 1.14-1.66；P<0.001；pre-DM组：HR，1.29；95%CI 1.02-1.62；P<0.001；DM组：HR，1.36；95%CI 1.13-1.63；P<0.001）。鉴于有证据表明PNI与不同糖代谢状态之间存在相互作用（交互作用P<0.001），将患者分为九个亚组，我们发现与PNI-H状态的NGR患者相比，PNI-L状态的DM患者全因死亡风险最高（HR，1.69；95%CI 1.42-2.01；P<0.001）。
较低的PNI是接受PCI的不同糖代谢状态AMI患者全因死亡的一个显著且独立的危险因素，与NGR或pre-DM状态相比，并与DM相关，这种风险会进一步增加。
