预后营养指数作为接受血管内治疗的慢性肢体威胁性缺血患者全因死亡率的新预测工具。
Prognostic Nutritional Index as a New Prediction Tool for All-Cause Mortality in Patients with Chronic Limb-Threatening Ischemia Undergoing Endovascular Therapy.
作者信息
Erdogan Onur, Erdogan Tugba, Panc Cafer, Tasbulak Omer, Altunova Mehmet, Arif Yalcin Ahmet, Erturk Mehmet
机构信息
Department of Cardiology, University of Health Sciences Türkiye, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye.
Division of Geriatrics, Department of Internal Medicine, Tekirdag Ismail Fehmi Cumalioglu City Hospital, Tekirdag, Türkiye.
出版信息
Sisli Etfal Hastan Tip Bul. 2024 Sep 30;58(3):346-353. doi: 10.14744/SEMB.2024.70094. eCollection 2024.
OBJECTIVES
Chronic Limb-Threatening Ischemia (CLTI) represents a complex manifestation of peripheral artery disease distinguished by symptoms such as ischemic rest pain, non-healing ulcers on the lower limb or foot, and the development of gangrene. CLTI is associated with a high risk of limb amputation, decreased quality of life, and substantial morbidity and mortality. The Prognostic Nutritional Index (PNI), which is calculated using albumin and lymphocyte levels, reflects the immunological and nutritional status. The objective of this study was to investigate the correlation between PNI levels and mortality among patients diagnosed with CLTI who underwent endovascular therapy.
METHODS
Individuals diagnosed with CLTI who received endovascular therapy below the knee in our tertiary care center were enrolled in this retrospective study. The patients were divided into two groups: survivors and non-survivors. Logistic regression analyses were performed to detect independent predictors of mortality and using Cox regression model, we assessed the relationship between PNI and mortality. Survival curves were estimated using the Kaplan-Meier method.
RESULTS
The study comprised 113 patients diagnosed with PAD who underwent EVT. The non-survivor group (42 patients) was older (62.9±10.9 vs. 67.7±9.9, p=0.045) and had a higher prevalence of chronic renal failure (22.5% vs. 42.9%, p=0.023) and congestive heart failure (8.5% vs. 21.4%, p:0.049) than the survivor group (71 patients). The median PNI value was lower in the non-survivor group than in the survivor group (35.9±5 vs 38.2±4.4, p=0.012). Cox regression analyses showed that Low PNI was associated with increased mortality (HR=0.931, CI=0.872-0.995, p=0.035). PNI cut-off of 37.009 showed 64.3% sensitivity, 64.8% specificity, and AUC of 0.642 for predicting all-cause mortality. Kaplan-Meier analysis supported higher PNI correlating with better survival.
CONCLUSION
The Prognostic Nutritional Index was independently associated with mortality among individuals diagnosed with Chronic Limb-Threatening Ischemia.
目的
慢性肢体威胁性缺血（CLTI）是外周动脉疾病的一种复杂表现，其特征为缺血性静息痛、下肢或足部不愈合溃疡以及坏疽的发生。CLTI与肢体截肢的高风险、生活质量下降以及高发病率和死亡率相关。使用白蛋白和淋巴细胞水平计算的预后营养指数（PNI）反映了免疫和营养状况。本研究的目的是调查接受血管内治疗的CLTI诊断患者中PNI水平与死亡率之间的相关性。
方法
在我们的三级护理中心接受膝下血管内治疗的CLTI诊断个体被纳入这项回顾性研究。患者分为两组：幸存者和非幸存者。进行逻辑回归分析以检测死亡率的独立预测因素，并使用Cox回归模型评估PNI与死亡率之间的关系。使用Kaplan-Meier方法估计生存曲线。
结果
该研究包括113例接受血管内治疗（EVT）的外周动脉疾病（PAD）诊断患者。非幸存者组（42例患者）比幸存者组（71例患者）年龄更大（6...9±10.9岁对67.7±9.9岁，p = 0.045），慢性肾衰竭（22.5%对42.9%，p = 0.023）和充血性心力衰竭（8.5%对21.4%，p = 0.049）的患病率更高。非幸存者组的PNI中位数低于幸存者组（35.9±5对38.2±4.4，p = 0.012）。Cox回归分析表明，低PNI与死亡率增加相关（HR = 0.931，CI = 0.872 - 0.995，p = 0.035）。PNI临界值为37.009时，预测全因死亡率的敏感性为64.3%，特异性为64.8%，曲线下面积（AUC）为0.642。Kaplan-Meier分析支持较高的PNI与更好的生存率相关。
结论
预后营养指数与慢性肢体威胁性缺血诊断个体的死亡率独立相关。
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