基于炎症的评分可预测慢性肾脏病合并慢性心力衰竭患者的慢性肾脏病进展。

Inflammation-based scores predict chronic kidney disease progression in patients with chronic kidney disease and chronic heart failure.

机构信息

Department of Nephrology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.

Division of Nephrology, Nanfang Hospital, Southern Medical University, National Clinical Research Center for Kidney Disease, State Key Laboratory of Organ Failure Research, Guangdong Provincial Institute of Nephrology, Guangdong Provincial Key Laboratory of Renal Failure Research, Guangzhou, China.

出版信息

Ren Fail. 2024 Dec;46(2):2432541. doi: 10.1080/0886022X.2024.2432541. Epub 2024 Nov 26.

DOI:10.1080/0886022X.2024.2432541

PMID:39593231

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11610343/

Abstract

BACKGROUND

Inflammation is associated with adverse outcomes of chronic kidney disease (CKD) or chronic heart failure (CHF), but few large data exist. We aimed to explore the clinical associations, and prognostic consequences of inflammation-based scores in patients with CKD and CHF.

METHODS

This work was a retrospective cohort study. Glasgow Prognostic Score (GPS), modified Glasgow Prognostic Score (mGPS), Prognostic Nutritional Index (PNI) and Prognostic Index (PI), were used to explore its relationship with CKD progression in patients with CKD stage 1-3b and CHF from the China Renal Data System (CRDS). The composite end point of this study was CKD progression which was defined as eGFR reduction of 40% or progression to end stage renal disease (ESRD).

RESULTS

Of 8491 patients were enrolled. Kaplan-Meier curve showed that compared to the lower inflammation-based scores, the increased scores have a higher rate of CKD progression, whether in GPS, mGPS, PNI or PI (log-rank test, < 0.001). After considering competing risk events, multivariable Cox hazards analysis revealed that GPS and PNI scores were significantly related to CKD progression [GPS: hazard ratio (HR) 1.40, 95% confidence interval (CI) 1.11-1.76, = 0.005; PNI: HR 1.54, 95% CI 1.25-1.89, < 0.001]. PNI showed acceptable prognostic value (C-index = 0.757, 95% CI 0.734-0.78) compared to GPS, mGPS and PI. In subgroup analysis, PNI was consistently related to CKD progression in patients with or without hypertension, DM, MI, VDH and CVD (P for interaction > 0.05).

CONCLUSIONS

Inflammation-based scores, especially PNI may be a useful clinical biomarker for CKD progression in CKD with CHF patients.

摘要

背景

炎症与慢性肾脏病（CKD）或慢性心力衰竭（CHF）的不良结局相关，但缺乏大型数据支持。本研究旨在探讨 CKD 和 CHF 患者中基于炎症的评分与临床相关指标及预后的关系。

方法

本研究为回顾性队列研究。来自中国肾脏病数据系统（CRDS）的 CKD 1-3b 期和 CHF 患者的 Glasgow 预后评分（GPS）、改良 Glasgow 预后评分（mGPS）、预后营养指数（PNI）和预后指数（PI）被用于探讨其与 CKD 进展的关系。本研究的复合终点为 CKD 进展，定义为 eGFR 下降 40%或进展至终末期肾病（ESRD）。

结果

共纳入 8491 例患者。Kaplan-Meier 曲线显示，与较低的炎症评分相比，升高的评分与 CKD 进展的发生率更高，无论是在 GPS、mGPS、PNI 还是 PI 中（log-rank 检验，<0.001）。在考虑竞争风险事件后，多变量 Cox 风险分析显示 GPS 和 PNI 评分与 CKD 进展显著相关[GPS：风险比（HR）1.40，95%置信区间（CI）1.11-1.76，P=0.005；PNI：HR 1.54，95%CI 1.25-1.89，P<0.001]。与 GPS、mGPS 和 PI 相比，PNI 显示出可接受的预后价值（C 指数=0.757，95%CI 0.734-0.78）。亚组分析显示，PNI 与高血压、DM、MI、VDH 和 CVD 患者或无这些合并症患者的 CKD 进展均显著相关（交互 P>0.05）。