心脑血管病防治2025，Vol.25Issue(4)：17-21,5.DOI:10.3969/j.issn.1009-816x.2025.04.005
预后营养指数与重症急性心肌梗死患者短期预后的相关性研究
Correlation between prognostic nutritional index and short-term prognosis in critically ill patients with acute myocardial infarction
摘要
Abstract
Objective To investigate the correlation between the prognostic nutritional index(PNI)and short-term prognosis in critically ill patients with acute myocardial infarction(AMI)admitted to the intensive care unit(ICU).Methods Data of AMI patients from the Medical Information Mart for Intensive Care(MIMIC-Ⅳ,v2.0)database were retrospectively analyzed,and the patients were divided into the survival group(1 049 cases)and the death group(360 cases)based on 30-day survival outcomes.General characteristics were compared between the two groups.Restricted cubic splines(RCS)were applied to visualize the relationship between PNI and the 30-day all-cause mortality risk in AMI patients,and the optimal PNI cutoffvalue was established.The study population was categorized into high and low PNI groups based on the optimal cutoffvalue.Kaplan-Meier survival analysis was used to compare the 30-day cumulative survival rates between the two groups.Cox proportional hazards models were developed to analyze the correlation between PNI and 30-day mortality in critically ill patients with AMI.Results A total of 1 409 adult AMI patients were included in this study.Compared to the survival group,the death group had higher age,sequential organ failure assessmen(SOFA)score,white blood cell count,mean red blood cell volume,alanine transaminase level,aspartate transaminase,prothrombin time,blood urea nitrogen,serum creatinine,anion gap,and blood magnesium,as well as higher proportions of patients receiving renal replacement therapy(RRT),norepinephrine,and phenylephrine treatments.The death group had higher proportions of patients with malignant tumors,chronic obstructive pulmonary disease,cirrhosis,chronic kidney disease,cardiac arrest,cardiogenic shock,and ventricular fibrillation,with statistically significant differences(P<0.05).The PNI,hemoglobin,platelet count,and serum calcium levels were higher in the surviving group,the proportion of intra-aortic balloon counterpulsation and the incidence of hypertension were also higher in the surviving group,and the hospitalization time was longer compared to those in the death group,the differences were statistically significant(P<0.05).RCS analysis showed a nonlinear relationship between PNI and the 30-day all-cause mortality risk in AMI patients(χ2=55.470,P<0.01),with a cutoffvalue of 40.26.Survival analysis showed that the 30-day cumulative survival rate was lower in the low PNI group compared to the high PNI group(χ2=40.520,P<0.01).Cox regression analysis showed that low level of PNI(<40.26)was an influencing factor for 30-day all-cause mortality in AMI patients admitted to the ICU(HR=1.293,95%CI=1.018-1.642,P<0.05).Age,SOFA score,prothrombin time,serum creatinine,anion gap,secrum magnesium,use of norepinephrine and phenylephrine,the presence of malignant tumors and cardiac arrest were factors influencing 30-day all-cause mortality in patients(P<0.05).Conclusion A low PNI(<40.26)at ICU admission is a factor affecting short-term prognosis in critically ill patients with AMI and has the potential to be a convenient tool for risk stratification and nutritional intervention.关键词
预后营养指数/急性心肌梗死/重症监护室/短期预后Key words
Prognostic nutritional index/Acute myocardial infarction/Intensive care unit/Short-term prognosis引用本文复制引用
蔡鸣箫,闵婕,周庆,钟磊..预后营养指数与重症急性心肌梗死患者短期预后的相关性研究[J].心脑血管病防治,2025,25(4):17-21,5.基金项目
浙江省自然科学基金(LGD20H150001) （LGD20H150001）
湖州市科技计划项目(2022GY20) （2022GY20）
