Division of Nephrology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Division of Nephrology, People's Hospital of Huadu District, Guangzhou, China.
Ren Fail. 2024 Dec;46(2):2431140. doi: 10.1080/0886022X.2024.2431140. Epub 2024 Nov 28.
The prognostic value of nutritional scoring tools in assessing the relationship between nutritional status and prognosis in hemodialysis patients is unclear. This multicenter retrospective cohort study compared the Prognostic Nutritional Index (PNI), Controlling Nutritional Status scores (CONUT), and Geriatric Nutritional Risk Index (GNRI) for predictive accuracy of all-cause and cardiovascular mortality, especially the impact of dynamic changes over time on prognosis.
Hemodialysis patients from four hospitals were included. Laboratory data and nutrition scores were collected at the initiation of dialysis, and at 6th, 12th, and 18th months after dialysis initiation. A joint model analyzed the relationship between dynamic nutritional scores and prognosis. Predictive values were assessed using the area under the curve (AUC).
The study included 863 patients with a median follow-up of 37 months. During the follow-up, 23.8% of patients died, with 14% attributed to cardiovascular causes. Malnourished patients demonstrated higher risks for all-cause and cardiovascular mortality. Dynamic changes in PNI and GNRI scores were significantly associated with reduced all-cause and cardiovascular mortality risks. Precisely, longitudinal increases in PNI and GNRI scores corresponded to a 4% and 3% reduction in all-cause (PNI: HR, 0.96; 95% CI, 0.95-0.98; GNRI: HR, 0.97; 95% CI, 0.96-0.98) and cardiovascular mortality risk (PNI: HR, 0.96; 95% CI, 0.94-0.98; GNRI: HR, 0.97; 95% CI, 0.95-0.98) respectively, with longer dialysis duration. Changes in CONUT scores were not significantly associated with either all-cause or cardiovascular mortality. The AUCs of the three joint models indicated that the GNRI score (0.893) possessed higher predictive accuracy for all-cause mortality compared to PNI (0.832) and CONUT (0.852). Similar trends were observed for cardiovascular mortality.
Nutritional scores and their dynamic changes are intimately associated with mortality risk in hemodialysis patients. Compared to PNI and CONUT, the baseline GNRI and its post-dialysis variations demonstrate a superior predictive capability for all-cause and cardiovascular mortality in these patients.
营养评分工具在评估血液透析患者营养状况与预后之间的关系中的预后价值尚不清楚。这项多中心回顾性队列研究比较了预后营养指数（PNI）、控制营养状况评分（CONUT）和老年营养风险指数（GNRI）在全因和心血管死亡率方面的预测准确性，尤其是动态变化对预后的影响。
纳入了来自四家医院的血液透析患者。在透析开始时以及透析开始后 6、12 和 18 个月收集实验室数据和营养评分。联合模型分析了动态营养评分与预后之间的关系。使用曲线下面积（AUC）评估预测值。
研究纳入了 863 例患者，中位随访时间为 37 个月。随访期间，23.8%的患者死亡，其中 14%归因于心血管原因。营养不良的患者全因和心血管死亡率风险更高。PNI 和 GNRI 评分的动态变化与全因和心血管死亡率风险降低显著相关。具体而言，PNI 和 GNRI 评分的纵向增加分别对应全因死亡率风险降低 4%和 3%（PNI：HR，0.96；95%CI，0.95-0.98；GNRI：HR，0.97；95%CI，0.96-0.98）和心血管死亡率风险降低 4%和 3%（PNI：HR，0.96；95%CI，0.94-0.98；GNRI：HR，0.97；95%CI，0.95-0.98），透析时间越长。CONUT 评分的变化与全因或心血管死亡率均无显著相关性。三个联合模型的 AUC 表明，GNRI 评分（0.893）对全因死亡率的预测准确性高于 PNI（0.832）和 CONUT（0.852）。心血管死亡率也存在类似的趋势。
营养评分及其动态变化与血液透析患者的死亡风险密切相关。与 PNI 和 CONUT 相比，基线 GNRI 及其透析后的变化对这些患者的全因和心血管死亡率具有更好的预测能力。
