目的: 探讨营养风险指数(nutritional risk index,NRI)与肝脓肿(PLA)患者预后不良结局之间的关系,并评估NRI的预后预测价值。方法: 选取2016年6月至2021年12月期间就诊的PLA患者90例,根据NRI临界值83.5分,分为NRI<83.5组(n=44例)和NRI≥83.5组(n=46例),比较两组患者间的人口统计学资料、临床资料以及临床治疗效果,并利用Logistic回归分析模型和受试者操作特征(ROC)曲线对预后评估价值进行分析。结果: 与NRI≥83.5组PLA患者相比,NRI<83.5组患者的转移性感染(25.00 % vs 6.52 %)、急性肝衰竭(9.09 % vs 0.00 %)、急性呼吸衰竭(13.64 % vs 2.17 %)、上消化道出血(13.64 % vs 2.17 %)、肺部感染(20.45 % vs 6.52 %)、预后不良(45.45 % vs 19.57 %)和病死率(13.64 % vs 2.17 %)的风险明显更高(P＜0.05)。多元Logistic回归分析显示,年龄(HR=2.519,95 % CI=1.106-5.739)、BMI(HR=0.708,95 % CI=0.519-0.967)、PLT(HR=0.464,95 % CI=0.254-0.848)、TBil(HR=2.387,95 % CI=1.131-5.037)、PT(HR=2.201,95 % CI=1.076-4.501)和NRI(<83.5分)(HR=3.377,95 % CI=1.471-7.753)是PLA患者预后不良的独立预测因子(P＜0.05)。NRI预测PLA患者预后不良的ROC曲线下面积(AUC)=0.799,临界值=87.65。结论: NRI水平较低是PLA预后不良的独立危险因素。
Objective: To explore the relationship between nutritional risk index (NRI) and poor prognosis of patients with liver abscess (PLA), and to evaluate the prognostic value of NRI. Methods: 90 PLA patients were selected from June 2016 to December 2021, and were divided into NRI<83.5 group (n=44 cases) and NRI ≥ 83.5 group (n=46 cases) according to the NRI threshold score of 83.5. The demographic data, clinical data and clinical treatment effect between the two groups were compared, and the prognostic evaluation value was analyzed using Logistic regression analysis model and subject operating characteristic (ROC) curve. Results: Compared with PLA patients in NRI ≥ 83.5 group, the risk of metastatic infection (25.00 % vs 6.52 %), acute liver failure (9.09 % vs 0.00 %), acute respiratory failure (13.64 % vs 2.17 %), upper gastrointestinal bleeding (13.64 % vs 2.17 %), lung infection (20.45 % vs 6.52 %), poor prognosis (45.45 % vs 19.57 %) and mortality (13.64 % vs 2.17 %) in NRI<83.5 group were significantly higher (P<0.05). Multiple logistic regression analysis showed that age (HR=2.519, 95 % CI=1.106-5.739), BMI (HR=0.708, 95 % CI=0.519-0.967), PLT (HR=0.464, 95 % CI=0.254-0.848), TBil (HR=2.387, 95 % CI=1.131-5.037), PT (HR=2.201, 95 % CI=1.076-4.501) and NRI (<83.5 points) (HR=3.377, 95 % CI=1.471-7.753) were independent predictors of poor prognosis in patients with PLA (P<0.05). The area under the ROC curve (AUC) of NRI predicting poor prognosis in patients with PLA=0.799, and the critical value=87.65. Conclusion: The low level of NRI is an independent risk factor for poor prognosis of PLA.
[1] 刘槿晴, 刘瑶, 傅蕾,等. 495例肝脓肿患者疾病经济负担及其影响因素[J]. 中华医院感染学杂志, 2021, 31(1):91-94.
[2] Yoo JJ, Lee TK, Kyoung DS, et al. A population‐based study of pyogenic liver abscess in Korea: Incidence, mortality and temporal trends during 2007‐2017[J]. Liver Int, 2021, 41(11): 2747-2758.
[3] Losie JA, Lam JC, Gregson DB, et al. Epidemiology and risk factors for pyogenic liver abscess in the Calgary Health Zone revisited: a population-based study[J]. BMC Infect Dis 2021, 21(1): 939.
[4] Liu YW, Tsai CH, Chou SE, et al. Geriatric nutritional risk index in screening malnutrition among young adult and elderly trauma patients[J].Formas J Surg, 2021, 54(5): 183-190.
[5] 杨妹, 吴燕丽, 邢柏. 老年脓毒症幸存者出院时老年营养风险指数与非计划再入院的相关性研究[J]. 现代预防医学, 2021, 48(21): 884-3888,3910.
[6] Seymour CW, Liu VX, Iwashyna TJ, et al. Assessment of clinical criteria for sepsis: for the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3)[J]. Jama, 2016, 315(8): 762-774.
[7] Nakamura T, Matsumoto M, Haraguchi Y, et al. Prognostic impact of malnutrition assessed using geriatric nutritional risk index in patients aged? 80 years with heart failure[J]. Eur J Cardiovasc Nurs, 2020, 19(2): 172-177.
[8] Beberashvili I, Azar A, Sinuani I, et al. Geriatric nutritional risk index, muscle function, quality of life and clinical outcome in hemodialysis patients[J]. Clin Nutr, 2016, 35(6): 1522-1529.
[9] Zhang Q, Zhang K, Zhang X, et al. Scored-GLIM as an effective tool to assess nutrition status and predict survival in patients with cancer[J]. Clin Nutr, 2021, 40(6): 4225-4233.
[10] Wiseman MJ. Nutrition and cancer: prevention and survival[J]. Br J Nutr, 2019, 122(5): 481-487.
[11] Yu J, Chen X, Li Y, et al. Pro-inflammatory cytokines as potential predictors for intradialytic hypotension[J]. Ren Fail, 2021, 43(1): 198-205.
[12] Uemura K, Doi T, Lee S, et al. Sarcopenia and low serum albumin level synergistically increase the risk of incident disability in older adults[J]. J Am Med Dir Assoc, 2019, 20(1): 90-93.
[13] 张奕翠, 陈康, 龙威, 等. 老年营养风险指数用于脓毒症病人预后评估[J]. 实用老年医学, 2017, 31(4): 366-369.
[14] 宋春洋, 祝淑钗, 高丝娜, 等. 老年营养风险指数与接受根治性放化疗的老年食管癌患者的预后关系研究[J]. 中华放射医学与防护杂志, 2020, 40(12): 926-931.
[15] 张慧, 张照如, 李家斌. 细菌性肝脓肿合并糖尿病患者的临床特点[J]. 中华传染病杂志, 2017, 35(6):364-368.
[16] Du Z, Zhou X, Zhao J, et al. Effect of diabetes mellitus on short-term prognosis of 227 pyogenic liver abscess patients after hospitalization[J]. BMC Infect Dis, 2020, 20(1): 145.
[17] 丁蕊, 王琦, 刘丽改, 等. 人类免疫缺陷病毒感染对肝脓肿预后的预测价值分析[J]. 肝脏, 2021, 26(9): 1019-1023,1056.
[18] Xu J, Zhou X, Zheng C. The geriatric nutritional risk index independently predicts adverse outcomes in patients with pyogenic liver abscess[J]. BMC Geriatr, 2019, 19(1): 14.
