Ran Yan, Yang Yuqi, Peng Yanzhe, Da Jingjing, Qian Zuping, Yuan Jing, Zha Yan
Zunyi Medical University, Zunyi, China.
Department of Nephrology, Guizhou Provincial People's Hospital, Guiyang, China.
Ren Fail. 2025 Dec;47(1):2515531. doi: 10.1080/0886022X.2025.2515531. Epub 2025 Jun 8.
Malnutrition and inflammation are prevalent in hemodialysis (HD) patients and linked to cognitive impairment (CI). Naples prognostic score (NPS) is a comprehensive measure of patients' inflammation and nutritional status. This study is to evaluate the association of NPS and CI risk in HD patients.
Two thousand seven hundred twenty-five HD patients were recruited and NPS score obtained based on albumin, total cholesterol (TC), lymphocytes, neutrophils, and monocytes. Cognitive function was assessed with Mini-Mental State Examination score (MMSE). Logistic regression models, interactive analyses were conducted.
Among 2725 HD patients, the prevalence of CI is 33.8%, the mean MMSE score was 26.9 ± 3.9. After adjusting clinical confounders, NPS showed a positive associated with CI both as a continuous variable (OR = 1.120, 95% CI 1.029-1.221, = 0.009) and as a categorical variable (OR = 1.552, 95%CI: 1.146-2.110, = 0.005). The analysis revealed a negative correlation between NPS and MMSE scores, observed both as a continuous variable ( = -0.178, 95% CI -0.321 to -0.035, = 0.015) and as a categorical variable. Higher NPS was significantly associated with increased dementia risk (adjusted OR = 1.153, 95% CI 1.035-1.286, = 0.010). Among CI patients, the proportion of males was higher than that of females. Subgroup analysis showed that the effect of NPS on CI was more pronounced in individuals under 65 years, without diabetes and cerebrovascular disease (CVD). Except for males, low education level, non-CVD, and HD frequency less than three times per week, the association between NPS and dementia was more significant.
NPS was associated with cognitive impairment in HD patients with a positive dose-response effect.
营养不良和炎症在血液透析（HD）患者中普遍存在，并与认知障碍（CI）相关。那不勒斯预后评分（NPS）是对患者炎症和营养状况的综合评估。本研究旨在评估HD患者中NPS与CI风险的关联。
招募了2725例HD患者，并根据白蛋白、总胆固醇（TC）、淋巴细胞、中性粒细胞和单核细胞获得NPS评分。用简易精神状态检查表评分（MMSE）评估认知功能。进行了逻辑回归模型和交互分析。
在2725例HD患者中，CI的患病率为33.8%，平均MMSE评分为26.9±3.9。在调整临床混杂因素后，NPS作为连续变量（OR = 1.120，95%CI 1.029 - 1.221，P = 0.009）和分类变量（OR = 1.552，95%CI：1.146 - 2.110，P = 0.005）均与CI呈正相关。分析显示NPS与MMSE评分之间呈负相关，无论是作为连续变量（r = -0.178，95%CI -0.321至 -0.035，P = 0.015）还是分类变量。较高的NPS与痴呆风险增加显著相关（调整后的OR = 1.153，95%CI 1.035 - 1.286，P = 0.010）。在CI患者中，男性比例高于女性。亚组分析表明，NPS对CI的影响在年龄小于65岁、无糖尿病和脑血管疾病（CVD）的个体中更为明显。除男性、低教育水平、非CVD和每周HD次数少于三次外，NPS与痴呆之间的关联更为显著。
NPS与HD患者的认知障碍相关，具有正剂量反应效应。
