红细胞分布宽度与预后营养指数联合对 PCI 患者预后的影响。
The Combination Effect of the Red Blood Cell Distribution Width and Prognostic Nutrition Index on the Prognosis in Patients Undergoing PCI.
机构信息
Department of Emergency, Tianjin Huanhu Hospital, Tianjin 300222, China.
Tianjin Key Laboratory of Ions and Molecular Function of Cardiovascular Diseases, Department of Cardiology, Tianjin Institute of Cardiology, The Second Hospital of Tianjin Medical University, Tianjin 300211, China.
出版信息
Nutrients. 2024 Sep 19;16(18):3176. doi: 10.3390/nu16183176.
BACKGROUND
Inflammation and malnutrition are related to adverse clinical outcomes in patients with coronary artery disease (CAD). However, it is unclear whether there is a relationship between the PNI (prognostic nutritional index) and RDW (red blood cell distribution width) regarding the impact on the prognosis in patients with CAD undergoing percutaneous coronary intervention (PCI).
METHODS
A total of 5605 consecutive CAD patients undergoing PCI were selected retrospectively. The patients were stratified into four groups according to the PNI [high PNI (H-PNI) and low PNI (L-PNI)] and RDW [high RDW (H-RDW) and low RDW (L-RDW)]. The cutoff values of RDW and PNI were calculated using receiver-operating characteristic curve analysis. The primary endpoint was 1-year all-cause mortality (ACM). The secondary endpoint was major adverse cardiac cerebrovascular events (MACCEs), the composite of cardiac death (CD), the recurrence of MI, target lesion revascularization (TLR), and stroke. A Cox proportional hazards model was used to evaluate the association between the PNI, RDW, and clinical endpoints.
RESULTS
During 1-year follow-up, 235 (4.19%) patients died. In multivariate regression analysis, the L-PNI/H-RDW group was found to have the highest risk of 1-year ACM [hazard ratio (HR) = 8.85, 95% confidence interval (CI): 5.96-13.15, = 0.020] with the H-PNI/L-RDW group as a reference, followed by the L-PNI/L-RDW (HR = 3.96, 95% CI: 2.60-6.00, < 0.001) and H-RDW/H-PNI groups (HR = 3.00, 95% CI: 1.99-4.50, < 0.001). Nomograms were developed to predict the probability of 1-year ACM and MACCEs.
CONCLUSIONS
CAD patients with L-PNI and H-RDW experienced the worst prognosis. The combination of PNI and RDW was a strong predictor of 1-year ACM. The coexistence of PNI and RDW appears to have a synergistic effect, providing further information for the risk stratification of CAD patients.
背景
炎症和营养不良与冠心病（CAD）患者的不良临床结局相关。然而，目前尚不清楚预后营养指数（PNI）和红细胞分布宽度（RDW）之间是否存在关系，以及它们对接受经皮冠状动脉介入治疗（PCI）的 CAD 患者的预后有何影响。
方法
回顾性选择了 5605 例连续的 CAD 患者接受 PCI。根据 PNI[高 PNI（H-PNI）和低 PNI（L-PNI）]和 RDW[高 RDW（H-RDW）和低 RDW（L-RDW）]将患者分为四组。使用受试者工作特征曲线分析计算 RDW 和 PNI 的截断值。主要终点为 1 年全因死亡率（ACM）。次要终点为主要不良心脑血管事件（MACCEs），包括心源性死亡（CD）、MI 复发、靶病变血运重建（TLR）和卒中的复合终点。使用 Cox 比例风险模型评估 PNI、RDW 与临床终点之间的关系。
结果
在 1 年随访期间，有 235 例（4.19%）患者死亡。多变量回归分析发现，与 H-PNI/L-RDW 组相比，L-PNI/H-RDW 组的 1 年 ACM 风险最高[风险比（HR）=8.85，95%置信区间（CI）：5.96-13.15， = 0.020]，其次是 L-PNI/L-RDW（HR=3.96，95%CI：2.60-6.00，<0.001）和 H-RDW/H-PNI 组（HR=3.00，95%CI：1.99-4.50，<0.001）。制定了列线图来预测 1 年 ACM 和 MACCEs 的概率。
结论
L-PNI 和 H-RDW 的 CAD 患者预后最差。PNI 和 RDW 的组合是 1 年 ACM 的强有力预测因子。PNI 和 RDW 的共存似乎具有协同作用，为 CAD 患者的风险分层提供了更多信息。
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