脓毒症相关性急性肾损伤重症患者的全免疫炎症值与死亡率之间的关联。

The association between pan-immune-inflammation value with mortality in critically ill patients with sepsis-associated acute kidney injury.

作者信息

Zhou Yidan, Hu Jingjing

机构信息

Department of Emergency Medicine, Hangzhou Third People's Hospital, Hangzhou, China.

出版信息

BMC Infect Dis. 2025 Apr 9;25(1):486. doi: 10.1186/s12879-025-10880-z.

DOI:10.1186/s12879-025-10880-z

PMID:40205347

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11980289/

Abstract

BACKGROUND

Sepsis-associated acute kidney injury (SA-AKI) significantly impacts global health. Early identification of SA-AKI patients at inflammatory and immune risk, followed by timely interventions, is critical for improving outcomes. The pan-immune-inflammation value (PIV) reflects systemic inflammation and immune status. However, its prognostic value in SA-AKI remains unexplored.

METHODS

This retrospective cohort study analyzed SA-AKI patients in the MIMIC-IV database. Cox regression assessed the association between PIV and mortality, while restricted cubic spline (RCS) regression explored the relationship between PIV and 30-day and 365-day mortality.

RESULTS

A total of 2,473 SA-AKI patients in our study were categorized into PIV quartiles: T1 (≤ 214), T2 (214-679), T3 (679-2,039), and T4 (> 2,039). PIV showed a nonlinear association with mortality. Higher PIV quartiles were linked to increased mortality, with 30-day rates of 26%, 22%, 35%, and 41% (P < 0.001) and 365-day mortality rates of 34%, 31%, 46%, and 54% (P < 0.001). Adjusted hazard ratios (HR) for 30-day mortality across quartiles were 1.00 (reference), 1.04(0.82, 1.31), 1.54 (1.25, 1.9), and 1.62 (1.32, 1.98), respectively. For 365-day mortality, the HR and 95% CI were 1.00 (reference), 1.06 (0.87, 1.30), 1.58 (1.32, 1.90), and 1.70 (1.42, 2.03). After adding PIV to SOFA score, the integrated discrimination improvement (IDI) for 30-day mortality was 0.005, and the net reclassification improvement (NRI) was 0.103. For 365-day mortality, the IDI was 0.009, and the NRI was 0.124. Regarding the APACHE II score, the IDI for 30-day mortality was 0.003, and the NRI was 0.081. For 365-day mortality, the IDI was 0.006, and the NRI was 0.107.

CONCLUSION

Elevated PIV independently predicts both short- and long-term adverse outcomes in SA-AKI patients. Incorporating PIV into established critical illness prediction models, such as SOFA and APACHE II, enhances their prognostic accuracy.

摘要

背景

脓毒症相关急性肾损伤（SA-AKI）对全球健康有重大影响。早期识别处于炎症和免疫风险的SA-AKI患者，并及时进行干预，对于改善预后至关重要。全免疫炎症值（PIV）反映全身炎症和免疫状态。然而，其在SA-AKI中的预后价值仍未得到探索。

方法

这项回顾性队列研究分析了多中心重症医学信息数据库第四版（MIMIC-IV）中的SA-AKI患者。Cox回归评估PIV与死亡率之间的关联，而受限立方样条（RCS）回归探讨PIV与30天和365天死亡率之间的关系。

结果

我们研究中的2473例SA-AKI患者被分为PIV四分位数：T1（≤214）、T2（214-679）、T3（679-2039）和T4（>2039）。PIV与死亡率呈非线性关联。较高的PIV四分位数与死亡率增加相关，30天死亡率分别为26%、22%、35%和41%（P<0.001），365天死亡率分别为34%、31%、46%和54%（P<0.001）。各四分位数30天死亡率的调整后风险比（HR）分别为1.00（参考值）、1.04（0.82，1.31）、1.54（1.25，1.9）和1.62（1.32，1.98）。对于365天死亡率，HR和95%可信区间分别为1.00（参考值）、1.06（0.87，1.30）、1.58（1.32，1.90）和1.70（1.42，2.03）。将PIV添加到序贯器官衰竭评估（SOFA）评分中后，30天死亡率的综合判别改善（IDI）为0.005，净重新分类改善（NRI）为0.103。对于365天死亡率，IDI为0.009，NRI为0.124。关于急性生理与慢性健康状况评分系统II（APACHE II）评分，30天死亡率的IDI为0.003，NRI为0.081。对于365天死亡率，IDI为0.006，NRI为0.107。