Ye Xiao-Wen, Shao Yun-Xia, Tang Ying-Chun, Dong Xiong-Jun, Zhu Ya-Ning
Department of Nephrology, Wuhu Hospital, East China Normal University, Wuhu, China.
Front Med (Lausanne). 2024 Aug 30;11:1462874. doi: 10.3389/fmed.2024.1462874. eCollection 2024.
The nutritional status and coagulation function of peritoneal dialysis (PD) patients are closely associated with their prognosis. This study aims to investigate the prognostic value of the albumin-to-fibrinogen ratio (AFR) on mortality in PD patients and to establish a prognostic prediction model based on AFR.
We retrospectively collected data from 148 PD patients treated at our hospital between Oct. 2011 and Dec. 2021. Using the "survminer" package in R, we determined the optimal cutoff value for AFR and divided the patients into low-AFR and high-AFR groups. The primary endpoint of this study was overall survival (OS). Univariate and multivariate Cox analyses were used to assess the impact of AFR and other factors on prognosis, and a corresponding prognostic prediction model was constructed using a nomogram, which was evaluated through ROC curves, the c-index, and calibration plots.
The optimal cutoff value for AFR was 9.06. In the entire cohort, 30 patients (20.2%) were classified into the low-AFR group. Compared to the high-AFR group, patients in the low-AFR group were older, had lower total urine output over 24 h, higher blood urea nitrogen, higher total protein and urinary microalbumin levels, and longer remission times ( < 0.05). They also had a poorer OS (HR: 1.824, 95%CI: 1.282-2.594, < 0.05). Multivariate Cox analysis indicated that AFR was an independent prognostic factor for OS (HR: 1.824, 95% CI: 1.282-2.594, < 0.05). A prognostic prediction model based on AFR, age, and cause of ESRD was successfully validated for predicting OS in PD patients.
AFR represents a potential prognostic biomarker for PD patients. The prognostic prediction model based on AFR can provide accurate OS predictions for PD patients, aiding clinicians in making better-informed decisions.
腹膜透析（PD）患者的营养状况和凝血功能与其预后密切相关。本研究旨在探讨白蛋白与纤维蛋白原比值（AFR）对PD患者死亡率的预后价值，并建立基于AFR的预后预测模型。
我们回顾性收集了2011年10月至2021年12月在我院接受治疗的148例PD患者的数据。使用R语言中的“survminer”包，我们确定了AFR的最佳截断值，并将患者分为低AFR组和高AFR组。本研究的主要终点是总生存期（OS）。采用单因素和多因素Cox分析评估AFR及其他因素对预后的影响，并使用列线图构建相应的预后预测模型，通过ROC曲线、c指数和校准图对其进行评估。
AFR的最佳截断值为9.06。在整个队列中，30例患者（20.2%）被归类为低AFR组。与高AFR组相比，低AFR组患者年龄更大，24小时总尿量更低，但血尿素氮、总蛋白和尿微量白蛋白水平更高，缓解时间更长（P<0.05）。他们的总生存期也较差（HR：1.824，95%CI：1.282-2.594，P<0.05）。多因素Cox分析表明，AFR是OS的独立预后因素（HR：1.824，95%CI：1.282-2.594，P<0.05）。基于AFR、年龄和终末期肾病病因的预后预测模型在预测PD患者的OS方面得到了成功验证。
AFR是PD患者潜在的预后生物标志物。基于AFR的预后预测模型可以为PD患者提供准确的总生存期预测，帮助临床医生做出更明智的决策。
