Yao Jun, Wu Peng, Li Zhishu, Zhao Lingyan, Fu Ziqiao, Shi Ping, Xiong Xiaomin, Chen Xuping, Yu Bin, He Yan, Feng Tong, Zeng Jia, Duan Ran
Department of Respiratory and Critical Care, Guangyuan Central Hospital, Sichuan, China.
Department of Respiratory and Critical Care Medicine, Deyang People's Hospital, Affiliated Hospital of Chengdu College of Medicine, Deyang, China.
Front Nutr. 2025 Apr 28;12:1550490. doi: 10.3389/fnut.2025.1550490. eCollection 2025.
Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of global mortality, with systemic inflammation and malnutrition playing pivotal roles in its progression and outcomes. The Advanced Lung Cancer Inflammation Index (ALI), which integrates nutritional status and systemic inflammation, may offer potential prognostic value in COPD management.
This study aimed to evaluate the relationship between ALI and mortality outcomes in COPD patients, with a specific focus on the interplay between nutrition, inflammation, and their non-linear associations with all-cause and cardiovascular mortality.
Data were derived from the NHANES (1999-2018) cohort, comprising 47,880 participants, including 1,960 COPD patients. ALI was calculated using body mass index (BMI), serum albumin levels, and the neutrophil-to-lymphocyte ratio (NLR). Survival analyses, including Kaplan-Meier curves, Cox proportional hazards models, and restricted cubic splines, were used to assess the association between ALI and mortality outcomes, exploring non-linear trends and thresholds.
Higher ALI levels were significantly associated with reduced risks of all-cause and cardiovascular mortality in COPD patients. Protective effects plateaued at ALI thresholds (88.32 for all-cause mortality and 89.73 for cardiovascular mortality), with mortality risks reversing at excessively high levels for cardiovascular mortality.
ALI, as a composite marker of nutritional status and systemic inflammation, is a valuable prognostic tool for COPD patients. Its non-linear relationship with mortality underscores the need to optimize nutritional and inflammatory management strategies. These findings emphasize the critical importance of addressing malnutrition and systemic inflammation to improve COPD outcomes. Future research should validate these findings and investigate tailored nutritional interventions and anti-inflammatory treatments.
慢性阻塞性肺疾病（COPD）是全球死亡的主要原因，全身炎症和营养不良在其进展和结局中起关键作用。整合营养状况和全身炎症的晚期肺癌炎症指数（ALI）可能在COPD管理中具有潜在的预后价值。
本研究旨在评估ALI与COPD患者死亡率结局之间的关系，特别关注营养、炎症及其与全因死亡率和心血管死亡率的非线性关联之间的相互作用。
数据来自美国国家健康与营养检查调查（NHANES，1999 - 2018年）队列，包括47880名参与者，其中1960名COPD患者。使用体重指数（BMI）、血清白蛋白水平和中性粒细胞与淋巴细胞比率（NLR）计算ALI。生存分析，包括Kaplan - Meier曲线、Cox比例风险模型和受限立方样条，用于评估ALI与死亡率结局之间的关联，探索非线性趋势和阈值。
较高的ALI水平与COPD患者全因死亡率和心血管死亡率风险降低显著相关。在ALI阈值（全因死亡率为88.32，心血管死亡率为89.73）时保护作用达到平稳，心血管死亡率过高时死亡风险逆转。
ALI作为营养状况和全身炎症的综合标志物，是COPD患者有价值的预后工具。其与死亡率的非线性关系强调了优化营养和炎症管理策略的必要性。这些发现强调了解决营养不良和全身炎症以改善COPD结局的至关重要性。未来的研究应验证这些发现，并研究针对性的营养干预措施和抗炎治疗。
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