预后营养指数对心力衰竭合并急性肾损伤患者预后的非线性关联研究  

Nonlinear Association Between Prognostic Nutritional Indices and Prognosis of Patients with Heart Failure Combined with Acute Kidney Injury

作　　者：刘婷[1,2] 周浩 刘凯[1] 徐英[1,2] Liu Ting;Zhou Hao;Liu Kai;Xu Ying(Department of Cardiology,West China Hospital,Sichuan University,Chengdu 610041,China;West China School of Nursing,Sichuan University,Chengdu 610041,China)

机构地区：[1]四川大学华西医院心脏内科,成都610041 [2]四川大学华西医院护理学院,成都610041

出　　处：《成都医学院学报》2025年第2期241-245,共5页Journal of Chengdu Medical College

基　　金：四川省科学技术厅科技计划项目(No:2022YFS0356)。

摘　　要：目的 基于重症监护医疗信息市场(MIMIC-Ⅳ)数据库探讨预后营养指数(PNI)与心力衰竭(HF)合并急性肾损伤(AKI)患者28 d全因死亡风险之间的非线性关联,为临床护理工作提供指导。方法 回顾性收集2008-2019年符合条件的HF合并AKI患者数据,并按28 d预后情况分为存活组(n=1 370)与死亡组(n=503),通过限制性立方样条(RCS)分析,计算出28 d死亡风险比(HR)为1的PNI值,将患者分为高PNI组(≥34.70)和低PNI组(<34.70);使用单变量和广义Cox回归模型评估暴露因素与患者结局的相关性;采用Kaplan-Meier法绘制两组患者28 d的累积生存率曲线。结果 死亡组患者的PNI值显著低于存活组(P<0.05);RCS分析结果显示,PNI与28 d全因死亡风险整体呈非线性关系(χ^(2)=49.200,P<0.001);回归模型分析发现,当PNI≤17.05时,PNI每增加1个单位,患者死亡风险显著降低92.40%;当PNI> 17.05,即使PNI再增加,对死亡风险的影响也趋于平稳;Kaplan-Meier生存曲线显示,低PNI组的28 d累积生存率显著低于高PNI组(P<0.001)。结论 PNI与HF合并AKI患者28 d全因死亡风险呈非线性关联,研究结果为优化临床风险评估和护理干预提供了新视角。Objective Based on the Medical Information Mart for Intensive Care 4.0(MIMIC-Ⅳ)database,this study aims to explore the non-linear association between the prognostic nutritional index(PNI)and the 28-day all-cause mortality risk in patients with heart failure(HF)complicated by acute kidney injury(AKI),so as to provide guidance for clinical nursing practices.Methods Data of eligible HF patients with AKI were retrospectively collected from the MIMIC-Ⅳdatabase.The included patients were divided into survival and death groups based on their 28-day prognosis.A restrictive cubic spline(RCS)analysis was performed to calculate the PNI value corresponding to a hazard ratio(HR)of 1 for 28-day prognosis.And the patients were divided into high PNI(≥34.70)and low PNI(<34.70)groups.Univariate and multivariable Cox regression models were used to assess the association between exposure factors and patient outcomes.Kaplan-Meier survival curves were plotted for the 28-day cumulative survival rate between the two groups.Results The PNI value of the death group was significantly lower than that of the survival group(P<0.05).RCS analysis revealed a non-linear relationship between PNI and the 28-day all-cause mortality risk(χ^(2)=49.200,P<0.001).Regression model analysis showed that when PNI≤17.05,each increase of 1 unit in PN I significantly reduced the patient's mortality risk by 92.40%.However,when PNI>17.05,further increases in PNI had a minimal impact on the mortality risk.The Kaplan-Meier survival curve indicated that the 28-day cumulative survival rate was significantly lower in the low PNI group compared to the high PNI group(P<0.001).Conclusion PNI is non-linearly associated with the 28-day all-cause mortality risk in HF patients complicated by AKI.The findings offer new insights for optimizing clinical risk assessment and nursing interventions.

关 键 词：预后营养指数 急性心力衰竭 急性肾损伤 非线性关联 

分 类 号：R541.62[医药卫生—心血管疾病]