Chen Xinghua, Li Ziwei, Wei Xing, Yao Li
Intensive Care Unit, The Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Hefei, Anhui, China.
The Fifth Clinical School of Medicine, Anhui Medical University, Hefei, Anhui, China.
Front Nutr. 2025 Jul 23;12:1505404. doi: 10.3389/fnut.2025.1505404. eCollection 2025.
The association between neutrophil-lymphocyte ratio (NLR) prognostic nutritional index (PNI) and chronic critical illness (CCI) is unclear. We aimed to explore the association between NLR and PNI with CCI and whether it could be used as a tool for risk stratification in such patients.
A retrospective cohort study was conducted using the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database. The data collection spanned from 2008 to 2019, and the database was sourced from Beth Israel Deaconess Medical Center in Boston. The clinical data of patients who were admitted to ICU for the first time for more than 24 h were collected, including the values of NLR and PNI on the first day of admission. The primary outcomes of the study were whether critically ill patients progressed to CCI and the in-hospital all-cause mortality rate of patients with CCI. Multivariate logistic regression models were used to analyze the relationship between NLR and PNI and outcomes, and three models were used to adjust for possible confounders. Receiver operating characteristic (ROC) curves and the area under the curve (AUC) were utilized to evaluate the predictive value of these research indicators for the outcomes. Subgroup analyses were also performed to explore whether the association of the study metrics with outcome was robust across different patient populations.
A total of 5,637 critically ill patients were ultimately enrolled in the study, and 675 (12%) progressed to CCI, with in-hospital death occurring in 115 (17%) of these patients. In the adjusted model of critically ill patients progressing to CCI, the ORs for NLR and PNI were 1.050 (1.041-1.060) and 0.958 (0.944-0.971), respectively. The AUC were 0.755 (0.735-0.775) and 0.718 (0.697-0.739). In the adjusted model for in-hospital deaths in CCI patients, the ORs for NLR and PNI were 1.014 (1.003-1.025) and 0.951 (0.923-0.979), respectively. The AUC were 0.670 (0.619-0.721) and 0.677 (0.626-0.729), respectively. Results remain robust across patient populations.
High NLR and low PNI levels are associated with progression to CCI and in-hospital death in critically ill patients and can be used as a valid predictive tool for poor prognosis in critically ill patients.
中性粒细胞与淋巴细胞比值（NLR）、预后营养指数（PNI）与慢性危重病（CCI）之间的关联尚不清楚。我们旨在探讨NLR和PNI与CCI之间的关联，以及它们是否可作为此类患者风险分层的工具。
使用重症监护医学信息数据库-IV（MIMIC-IV）进行回顾性队列研究。数据收集时间跨度为2008年至2019年，数据库来源于波士顿的贝斯以色列女执事医疗中心。收集首次入住重症监护病房（ICU）超过24小时的患者的临床数据，包括入院第一天的NLR和PNI值。研究的主要结局是重症患者是否进展为CCI以及CCI患者的院内全因死亡率。使用多变量逻辑回归模型分析NLR和PNI与结局之间的关系，并使用三个模型调整可能的混杂因素。利用受试者工作特征（ROC）曲线和曲线下面积（AUC）评估这些研究指标对结局的预测价值。还进行了亚组分析，以探讨研究指标与结局之间的关联在不同患者群体中是否稳健。
最终共有5637例重症患者纳入研究，其中675例（12%）进展为CCI，这些患者中有115例（17%）发生院内死亡。在重症患者进展为CCI的校正模型中，NLR和PNI的比值比（OR）分别为1.050（1.041-1.060）和0.958（0.944-0.971）。AUC分别为0.755（0.735-0.775）和0.718（0.697-0.739）。在CCI患者院内死亡的校正模型中，NLR和PNI的OR分别为1.014（1.003-1.025）和0.951（0.923-0.979）。AUC分别为0.670（0.619-0.721）和0.677（0.626-0.729）。结果在不同患者群体中均保持稳健。
高NLR和低PNI水平与重症患者进展为CCI及院内死亡相关，可作为重症患者预后不良的有效预测工具。
