Jia Huafang, Yin Kaixiang, Zhao Jihu, Che Fengyuan
Department of Medicine, Qingdao University, Qingdao, Shandong, China.
Department of Emergency Medicine, The Affiliated Hospital of Qingdao University, Qingdao, China.
Front Nutr. 2024 Sep 17;11:1439803. doi: 10.3389/fnut.2024.1439803. eCollection 2024.
The study explores the association between inflammation/nutrition-based indicators, Parkinson's disease (PD), and all-cause mortality among adult participants.
The analysis included 38,091 participants from National Health and Nutrition Examination Survey (NHANES) 1999-2018. Inflammation/nutrition-based indicators were derived from a comprehensive set of parameters, including neutrophil-albumin ratio (NAR), prognostic nutritional index (PNI), monocyte-albumin ratio (MAR), red cell distribution width-albumin ratio (RAR), hemoglobin, albumin, lymphocyte, and platelet (HALP) score, advanced lung cancer inflammation index (ALI), geriatric nutrition risk index (GNRI), and controlling nutritional status (CONUT) score. PD status was determined based on self-reported anti-parkinsonian medication use. Mortality data were obtained from the National Death Index, linked up to December 30, 2019.
After multivariate adjustment, all inflammation/nutrition-based indicators showed significant associations with all-cause mortality among adult participants. The random survival forest emphasized the importance of inflammation/nutrition-based indicators and their components in predicting mortality, with PNI and RAR being the most important indicators for predicting all-cause mortality. Individuals with PD have a significantly higher risk of all-cause mortality compared to those without PD (HR = 1.747 [1.363-2.238], < 0.001) among adults. Additionally, elevated levels of inflammation/nutrition-based indicators are associated with a higher risk of all-cause mortality among individuals with PD compared to those without PD. This suggested a synergistic effect of PD and elevated levels of inflammatory/nutritional indicators on mortality risk. Specifically, individuals with PD and elevated NAR (HR = 2.066 [1.398-3.052], < 0.001), MAR (HR = 2.249 [1.612-3.138], < 0.001), RAR (HR = 1.617 [1.179-2.218], = 0.003), ALI (HR = 1.763 [1.225-2.537], = 0.002) and CONUT (HR = 2.221 [1.434-3.440], < 0.001), and not elevated PNI (HR = 1.771 [1.295-2.423], < 0.001), HALP (HR = 1.738 [1.242-2.432], = 0.001), and GNRI (HR = 2.689 [1.898-3.811], < 0.001) have a substantially higher risk of mortality compared to those without PD.
Inflammation and nutrition status play crucial roles in predicting all-cause mortality among adults, particularly in the context of PD. The study underscores the importance of considering both factors in mortality risk assessment and provides valuable insights for future research and clinical practice.
本研究探讨基于炎症/营养的指标、帕金森病（PD）与成年参与者全因死亡率之间的关联。
分析纳入了1999 - 2018年美国国家健康与营养检查调查（NHANES）的38,091名参与者。基于炎症/营养的指标源自一系列综合参数，包括中性粒细胞 - 白蛋白比值（NAR）、预后营养指数（PNI）、单核细胞 - 白蛋白比值（MAR）、红细胞分布宽度 - 白蛋白比值（RAR）、血红蛋白、白蛋白、淋巴细胞和血小板（HALP）评分、晚期肺癌炎症指数（ALI）、老年营养风险指数（GNRI）以及控制营养状况（CONUT）评分。PD状态根据自我报告的抗帕金森药物使用情况确定。死亡率数据来自国家死亡指数，截至2019年12月30日。
经过多变量调整后，所有基于炎症/营养的指标均显示与成年参与者的全因死亡率存在显著关联。随机生存森林分析强调了基于炎症/营养的指标及其组成部分在预测死亡率方面的重要性，其中PNI和RAR是预测全因死亡率的最重要指标。在成年人中，与无PD者相比，PD患者的全因死亡风险显著更高（HR = 1.747 [1.363 - 2.238]，P < 0.001）。此外，与无PD者相比，PD患者中基于炎症/营养的指标水平升高与更高的全因死亡风险相关。这表明PD与炎症/营养指标水平升高对死亡风险具有协同作用。具体而言，与无PD者相比，PD且NAR升高者（HR = 2.066 [1.398 - 3.052]，P < 0.001）、MAR升高者（HR = 2.249 [1.612 - 3.138]，P < 0.001）、RAR升高者（HR = 1.617 [1.179 - 2.218]，P = 0.003）、ALI升高者（HR = 1.763 [1.225 - 2.537]，P = 0.002）和CONUT升高者（HR = 2.221 [1.434 - 3.440]，P < 0.001），以及PNI未升高者（HR = 1.771 [1.295 - 2.423]，P < 0.001）、HALP未升高者（HR = 1.738 [1.242 - 2.432]，P = 0.001）和GNRI未升高者（HR =
