预后营养指数对老年脓毒症患者的预测价值

The Predictive Value of Prognostic Nutritional Index for Elderly Sepsis Patients

摘要: 目的：探讨预后营养指数(Prognostic Nutritional Index, PNI)与急诊ICU老年脓毒症患者死亡相关性及对老年脓毒症患者死亡的评估价值。方法：采用回顾性分析方法，分析2021年1月至2024年7月康复大学青岛医院东院区急诊ICU收治的老年脓毒症患者(年龄 ≥ 65岁)的基本信息和实验室检查数据。根据患者的住院结局将其分为生存组和死亡组，比较两组的一般资料和实验室数据。单因素和多因素Logistic回归分析PNI与老年脓毒症患者死亡的关系。绘制受试者工作曲线(Receiver operating characteristic, ROC)和计算曲线下面积(area under the curve, AUC)评估PNI的预测效能。结果：共纳入133例患者，生存组92例，死亡组41例，病死率为30.8%。生存组白蛋白、PNI、总蛋白、血小板均显著高于死亡组，具有统计学意义(P < 0.05)。死亡组SOFA、APACHE II评分、尿素氮水平显著高于生存组，差异具有统计学意义(P < 0.05)。单因素Logistic回归分析显示，PNI、SOFA评分、APACHE II评分、总蛋白、白蛋白、乳酸是导致老年脓毒症患者死亡的相关因素。多因素Logistic回归分析结果，PNI是脓毒症患者住院期间死亡的独立危险因素。ROC曲线分析结果显示：PNI、乳酸、SOFA、APACHE II评分预测脓毒症患者住院期间死亡的曲线下面积(AUC)分别为0.625、0.604、0.644、0.649。四项联合预测曲线下面积为0.697，敏感度为63.4%，特异度为78.3%。结论：低PNI是老年脓毒症患者预后的独立危险因素，有较好的敏感度和特异度，当与乳酸、SOFA、APACHE II评分联合预测时能够提高PNI预测老年脓毒症死亡的特异度。

Abstract: Objectives: To explore the correlation between Prognostic Nutritional Index (PNI) and mortality in elderly sepsis patients in the emergency department, as well as its evaluation value for mortality in elderly sepsis patients. Method: A retrospective analysis was conducted to analyze the basic information and laboratory test data of elderly sepsis patients (aged ≥ 65 years) admitted to the Emergency ICU of the East Campus of Qingdao Hospital of Rehabilitation University from January 2021 to July 2024. According to the hospitalization outcome, they were divided into a survival group and a death group, and their general information and laboratory data were compared between the two groups. Single-factor and multi-factor logistic regression analyses were used to assess the relationship between PNI and the death of elderly patients with sepsis. Receiver operating characteristic (ROC) and calculate area under the curve (AUC) are drawn to evaluate the predictive performance of PNI. Result: A total of 133 patients were included, with 92 in the survival group and 41 in the death group, resulting in a mortality rate of 30.8%. The survival group had significantly higher levels of albumin, PNI, total protein, and platelets than the death group, with statistical significance (P < 0.05). The SOFA, APACHE II scores, and urea nitrogen levels in the death group were significantly higher than those in the survival group, and the differences were statistically significant (P < 0.05). Univariate logistic regression analysis showed that PNI, SOFA score, APACHE II score, total protein, albumin, and lactate were related factors leading to death in elderly sepsis patients. According to the results of multiple logistic regression analysis, PNI is an independent risk factor for in-hospital mortality in sepsis patients. The ROC curve analysis results showed that the area under the curve (AUC) for predicting in-hospital mortality in sepsis patients using PNI, lactate, SOFA, and APACHE II scores was 0.625, 0.604, 0.644, and 0.649, respectively. The area under the four joint prediction curves is 0.697, with a sensitivity of 63.4% and a specificity of 78.3%. Conclusion: Low PNI is an independent risk factor for the prognosis of elderly sepsis patients, with good sensitivity and specificity. When combined with lactate, SOFA, and APACHE II scores for prediction, PNI can improve the specificity of predicting mortality in elderly sepsis patients.