预后营养指数和中性粒细胞与淋巴细胞比值对维持性血液透析患者全因死亡风险的联合预测价值：一项为期5年的队列研究

Combined predictive value of prognostic nutritional index and neutrophil to lymphocyte ratio for all-cause mortality risk in maintenance hemodialysis patients: a cohort study followed for 5 years.

作者信息

Xu Fang, Cheng Shuang, Shu Peng, Liang Yilan, Wang Xia, Bai Haitao

机构信息

Department of Nephrology, Tongji Medical College, The Central Hospital of Wuhan, Huazhong University of Science and Technology, Wuhan, 430014, China.

出版信息

BMC Nephrol. 2025 Jul 1;26(1):319. doi: 10.1186/s12882-025-04273-2.

DOI:10.1186/s12882-025-04273-2

PMID:40596976

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12220028/

Abstract

BACKGROUND

To assess the prognostic value of the prognostic nutritional index (PNI) alongside the neutrophil-to-lymphocyte ratio (NLR) in forecasting all-cause mortality in patients undergoing maintenance hemodialysis (MHD), and to pinpoint independent risk factors linked to all-cause mortality, thereby facilitating the guidance of prompt clinical interventions.

METHODS

A retrospective cohort investigation was carried out with the gathering of comprehensive demographic and clinical biochemical information. The follow-up period ended in December 2024, with all-cause mortality serving as the primary outcome measure. The predictive capabilities of PNI and NLR regarding all-cause mortality in MHD patients were evaluated through receiver operating characteristic (ROC) curve analysis. In addition to the plotting of Kaplan-Meier curves, the Cox model was utilized to pinpoint risk factors affecting 5-year all-cause mortality in MHD patients.

RESULTS

A sum of 632 patients receiving MHD was analyzed during the follow-up. The area under the curve (AUC) for PNI and NLR was 0.739 and 0.668, with an optimal cutoff value of 43.094 and 2.937, respectively. Furthermore, patients presenting a PNI of ≥ 43.094 showed a better cumulative survival rate throughout the follow-up when compared to those with a PNI of < 43.094 (χ² = 56.461, P < 0.001). In contrast, patients with an NLR of ≥ 2.937 exhibited a diminished cumulative survival rate as opposed to those with an NLR under 2.937 (χ² = 125.414, P < 0.001). The Cox regression model identified male sex, utilization of central venous catheters (CVCs), an NLR of ≥ 2.937, increased absolute neutrophil count, and elevated aspartate aminotransferase (AST) levels for predicting 5-year all-cause mortality independently (P < 0.05). Conversely, a PNI of ≥ 43.094, along with high levels of hemoglobin, urea, and uric acid, were recognized as protective factors (P < 0.05).

CONCLUSION

Both PNI and NLR have significant predictive value concerning all-cause mortality in MHD patients.

CLINICAL TRIAL NUMBER

Not applicable.

摘要

背景

评估预后营养指数（PNI）与中性粒细胞与淋巴细胞比值（NLR）在预测维持性血液透析（MHD）患者全因死亡率方面的预后价值，并确定与全因死亡率相关的独立危险因素，从而为及时的临床干预提供指导。

方法

进行了一项回顾性队列研究，收集了全面的人口统计学和临床生化信息。随访期至2024年12月结束，以全因死亡率作为主要结局指标。通过受试者工作特征（ROC）曲线分析评估PNI和NLR对MHD患者全因死亡率的预测能力。除绘制Kaplan-Meier曲线外，还使用Cox模型确定影响MHD患者5年全因死亡率的危险因素。

结果

随访期间共分析了632例接受MHD的患者。PNI和NLR的曲线下面积（AUC）分别为0.739和0.668，最佳截断值分别为43.094和2.937。此外，与PNI<43.094的患者相比，PNI≥43.094的患者在整个随访期间的累积生存率更高（χ²=56.461，P<0.001）。相反，与NLR<2.937的患者相比，NLR≥2.937的患者累积生存率降低（χ²=125.414，P<0.001）。Cox回归模型确定男性、使用中心静脉导管（CVC）、NLR≥2.937、绝对中性粒细胞计数增加和天冬氨酸转氨酶（AST）水平升高是独立预测5年全因死亡率的因素（P<0.05）。相反，PNI≥43.094以及高水平的血红蛋白、尿素和尿酸被认为是保护因素（P<0.05）。