老年营养风险指数与改良肌酐指数联合评估对预测血液透析患者功能依赖的作用

Combined evaluation of geriatric nutritional risk index and modified creatinine index for predicting functional dependence in patients on Hemodialysis.

作者信息

Ni Rong, Qian Peng, Sun Ci, Xu Yusheng, Song Kai, Li Weiwei

机构信息

Department of Nephrology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004, China.

出版信息

BMC Nephrol. 2025 Apr 21;26(1):202. doi: 10.1186/s12882-025-04132-0.

DOI:10.1186/s12882-025-04132-0

PMID:40259223

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12010515/

Abstract

BACKGROUND

In patients undergoing hemodialysis, functional dependence has increasingly been recognized as a critical factor influencing both quality of life and clinical outcomes. This study evaluates the combined effect of the Geriatric Nutritional Risk Index (GNRI) and Modified Creatinine Index (mCI) on predicting functional dependence in patients undergoing maintenance hemodialysis (MHD).

METHODS

We conducted a cross-sectional survey at the Second Affiliated Hospital of Soochow University from June to December 2023. The study involved 208 MHD patients whose functional status was assessed using Katz and Lawton-Brod questionnaires. Patients were classified into either a normal functional group or a functional dependence group based on their scores. GNRI and mCI were categorized using cut-off values of 98.0 and 21.63 mg·kg·d, respectively. Logistic regression analysis was used to evaluate the risk factors and develop predictive models. The accuracy of these models was assessed through receiver operating characteristic (ROC) curves.

RESULTS

Functional dependence was observed in 110 patients (52.9%). The functional dependence group exhibited significantly higher age, prevalence of diabetes, and pulse pressure, but lower diastolic blood pressure, serum creatinine, serum albumin, cholesterol, GNRI, and mCI compared to the normal functional group (all P < 0.05). Logistic regression highlighted significant differences in the risk of functional dependence among the four groups based on GNRI and mCI thresholds (P < 0.05). The area under the curve (AUC) for the combined GNRI and mCI model was 0.708 (95% CI 0.638-0.778, P < 0.001), indicating superior predictive capability over the individual indices (GNRI alone AUC = 0.657, mCI alone AUC = 0.682).

CONCLUSION

GNRI and mCI, when used in combination, provide a more effective prediction of functional dependence in MHD patients than when used separately.

摘要

背景

在接受血液透析的患者中，功能依赖日益被视为影响生活质量和临床结局的关键因素。本研究评估老年营养风险指数（GNRI）和改良肌酐指数（mCI）对维持性血液透析（MHD）患者功能依赖的联合预测作用。

方法

2023年6月至12月，我们在苏州大学附属第二医院进行了一项横断面调查。该研究纳入了208例MHD患者，其功能状态采用Katz和Lawton-Brod问卷进行评估。根据得分将患者分为功能正常组或功能依赖组。GNRI和mCI分别采用98.0和21.63mg·kg·d的临界值进行分类。采用逻辑回归分析评估危险因素并建立预测模型。通过受试者工作特征（ROC）曲线评估这些模型的准确性。

结果

110例患者（52.9%）存在功能依赖。与功能正常组相比，功能依赖组的年龄、糖尿病患病率和脉压显著更高，但舒张压、血清肌酐、血清白蛋白、胆固醇、GNRI和mCI更低（均P<0.05）。逻辑回归显示，基于GNRI和mCI阈值的四组患者在功能依赖风险方面存在显著差异（P<0.05）。GNRI和mCI联合模型的曲线下面积（AUC）为0.708（95%CI 0.638-0.778，P<0.001），表明其预测能力优于单个指标（单独GNRI的AUC=0.657，单独mCI的AUC=0.682）。