Prognostic value of prognostic nutritional index in patients with acute intracranial atherosclerosis-related large vessel occlusion

doi:10.3877/cma.j.issn.1674-6880.2023.03.003

Abstract

Abstract:

Objective

To analyze the prognostic value and influencing factors of prognostic nutritional index (PNI) in patients with acute intracranial atherosclerosis-related large vessel occlusion (ICAS-LVO), so as to provide theoretical references for related clinical diagnosis and treatment.

Methods

A total of 356 hospitalized patients with ICAS-LVO were selected and divided into a high-value group (PNI ≥ 51.69, 144 cases) and a low-value group (PNI < 51.69, 212 cases) according to PNI by the quartile method. Their follow-up data were analyzed retrospectively. Multivariate logistic regression was used to analyze the relationship between PNI and patient-related indicators, and the receiver operating characteristic (ROC) curve was used to evaluate the predictive effect of PNI.

Results

The total cholesterol, triacylglycerol, serum albumin (ALB), lymphocyte count (LYMPH) and PNI in the high-value group were higher than those in the low-value group, while the high density lipoprotein-cholesterol (HDL-C), total protein and modified Rankin scale (MRS) scores were lower (all P < 0.05). At the 6th month of follow-up, the ALB, LYMPH and PNI in the high-value group were higher than those in the low-value group, and the MRS score and mortality rate were lower (all P < 0.05). Logistic regression analysis showed that total cholesterol [odds ratio (OR) = 1.828, 95% confidence interval (CI) (1.464, 2.491), P = 0.027], triacylglycerol [OR = 1.603, 95%CI (1.233, 2.125), P = 0.040], HDL-C [OR = 0.419, 95%CI (0.262, 0.603), P = 0.032], ALB [OR = 0.591, 95%CI (0.513, 0.678), P = 0.021], LYMPH [OR = 0.782, 95%CI (0.739, 0.853), P = 0.035] and PNI [OR = 0.332, 95%CI (0.251, 0.469), P = 0.003] were influential factors for poor prognosis of ICAS-LVO patients. The ROC curve showed that the sensitivity and specificity of PNI prediction were 82.3% and 71.8% respectively. The area under the curve was 0.819, and the 95%CI was 0.744-0.915 (P < 0.001).

Conclusion

PNI is an effective predictor for long-term prognosis in patients with ICAS-LVO, which can be used to identify patients with poor prognosis and provide new ideas for clinical treatment.

Key words: Prognostic nutritional index, Stroke, Atherosclerosis, Vascular occlusion, Prognostic assessment

Youfang Wang, Xingchao Li, Xiaosong Zhu, Qingmin Liu, Jianguo Zhang, Shuhong Yang, Ran Xiang, Mengmeng Zhang, Fengyuan Che. Prognostic value of prognostic nutritional index in patients with acute intracranial atherosclerosis-related large vessel occlusion[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(03): 193-197.

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References 25

1	Hendrix P, Sofoluke N, Adams MD, et al. Risk factors for acute ischemic stroke caused by anterior large vessel occlusion[J]. Stroke, 2019, 50 (5): 1074-1080.
2	Guglielmi V, LeCouffe NE, Zinkstok SM, et al. Collateral circulation and outcome in atherosclerotic versus cardioembolic cerebral large vessel occlusion[J]. Stroke, 2019, 50 (12): 3360-3368.
3	Yan Z, Shi Z, Wang Y, et al. Efficacy and safety of low-dose yirofiban for acute intracranial atherosclerotic stenosis related occlusion with residual stenosis after endovascular treatment[J]. J Stroke Cerebrovasc Dis, 2020, 29 (4): 104619.
4	Mirili C, Yilmaz A, Demirkan S, et al. Clinical significance of prognostic nutritional index (PNI) in malignant melanoma[J]. Int J Clin Oncol, 2019, 24 (10): 1301-1310.
5	Huang X, Hu H, Zhang W, et al. Prognostic value of prognostic nutritional index and systemic immune-inflammation index in patients with osteosarcoma[J]. J Cell Physiol, 2019, 234 (10): 18408-18414.
6	Hayashi J, Uchida T, Ri S, et al. Clinical significance of the prognostic nutritional index in patients undergoing cardiovascular surgery[J]. Gen Thorac Cardiovasc Surg, 2020, 68 (8): 774-779.
7	Zhang H, Tao Y, Wang Z, et al. Evaluation of nutritional status and prognostic impact assessed by the prognostic nutritional index in children with chronic kidney disease[J]. Medicine (Baltimore), 2019, 98 (34): e16713.
8	Shi WK, Zhang XH, Zhang J, et al. Predictive ability of prognostic nutritional index in surgically resected gastrointestinal stromal tumors: a propensity score matching analysis[J]. Jpn J Clin Oncol, 2019, 49 (9): 823-831.
9	Lee SF, Ng TY, Wong FCS. The value of prognostic nutritional index in follicular lymphoma[J]. Am J Clin Oncol, 2019, 42 (2): 202-207.
10	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.
11	中华医学会神经病学分会，中华医学会神经病学分会脑血管病学组.中国急性缺血性脑卒中诊治指南2018[J].中华神经科杂志，2018，51（9）：666-682.
12	Okugawa Y, Toiyama Y, Ohi M, et al. Comment on "Prognostic nutritional index, tumor-infiltrating lymphocytes, and prognosis in patients with esophageal cancer"[J]. Ann Surg, 2019, 270 (6): e104-e105.
13	Kosuga T, Konishi T, Kubota T, et al. Value of prognostic nutritional index as a predictor of lymph node metastasis in gastric cancer[J]. Anticancer Res, 2019, 39 (12): 6843-6849.
14	Shimizu T, Taniguchi K, Asakuma M, et al. Lymphocyte-to-monocyte ratio and prognostic nutritional index predict poor prognosis in patients on chemotherapy for unresectable pancreatic cancer[J]. Anticancer Res, 2019, 39 (4): 2169-2176.
15	Xu WJ, Ma Y, Wang YM, et al. The clinical value of PNI in assessing the prognosis of small cell lung cancer[J]. Sichuan Da Xue Xue Bao Yi Xue Ban, 2020, 51 (4): 573-577.
16	张晓芳，章颖，刘先进，等.三种常用指标体系在评估乙型肝炎病毒相关慢加急性肝衰竭患者短期预后中的应用比较[J/CD].中华危重症医学杂志（电子版），2022，15（5）：353-359.
17	熊峰，杨宏锋，颜骏，等. ICU患者胆汁淤积症相关危险因素分析及其对预后的影响[J/CD].中华危重症医学杂志（电子版），2022，15（1）：42-46.
18	Kose N, Akin F, Yildirim T, et al. The association between the lymphocyte-to-monocyte ratio and coronary artery disease severity in patients with stable coronary artery disease[J]. Eur Rev Med Pharmacol Sci, 2019, 23 (6): 2570-2575.
19	朱希山，赵业，马飞艳，等.营养状态评价在胃癌患者全胃切除术预后中的价值[J].中华医学杂志，2021，101（6）：421-428.
20	杨奎，韦正祥，李明新，等.不同营养支持方式对神经重症疾病患者膈肌厚度及预后的影响[J/CD].中华危重症医学杂志（电子版），2022，15（3）：215-219.
21	Schuetz P, Fehr R, Baechli V, et al. Individualised nutritional support in medical inpatients at nutritional risk: a randomised clinical trial[J]. Lancet, 2019, 393 (10188): 2312-2321.
22	Urquiza M, Fernandez N, Arrinda I, et al. Nutritional status is associated with function, physical performance and falls in older adults admitted to geriatric rehabilitation: a retrospective cohort study[J]. Nutrients, 2020, 12 (9): 2855.
23	蔡昂，李一，王留根，等.脑卒中失能患者营养不良的影响因素及预测模型分析[J].中华物理医学与康复杂志，2023，45（1）：24-28.
24	潘向滢，汪利萍，张月清，等.脑卒中评价量表的研究进展[J/CD].中华危重症医学杂志（电子版），2016，9（3）：205-207.
25	柏平，李丽英，张西强. 2019年临沂市居民健康素养调查分析[J].山东医学高等专科学校学报，2020，42（4）：263-266.

组别	例数	年龄（岁）	性别（例，男/女）	糖尿病史[例（%）]	高血压史[例（%）]	高血脂史[例（%）]	入院血糖（mmol/L）	总胆固醇（mmol/L）	甘油三酯（mmol/L）
低值组	212	62 ± 12	127/85	56（26.42）	96（45.28）	77（36.32）	6.26 ± 0.41	4.5 ± 0.8	1.9 ± 0.4
高值组	144	63 ± 11	88/56	41（28.47）	81（56.25）	68（47.22）	6.15 ± 0.28	5.3 ± 0.8	2.3 ± 0.4
t/χ²值		0.188	0.027	0.214	1.077	1.554	1.251	2.253	2.469
P值		0.696	0.862	0.685	0.318	0.232	0.268	0.031	0.017
组别	例数	HDL-C（mmol/L）	LDL-C（mmol/L）	总蛋白（g/L）	ALB（g/L）	LYMPH（× 10⁹/L）	MRS评分（分）	PNI
低值组	212	1.04 ± 0.15	2.9 ± 0.8	69 ± 10	29 ± 14	27 ± 11	3.9 ± 0.6	44 ± 7
高值组	144	1.17 ± 0.21	2.6 ± 0.7	62 ± 12	37 ± 12	39 ± 15	3.0 ± 0.8	59 ± 8
t/χ²值		2.096	0.822	1.728	1.869	2.838	3.131	5.205
P值		0.041	0.365	0.044	0.028	0.005	0.002	< 0.001

组别	例数	年龄（岁）	性别（例，男/女）	糖尿病史[例（%）]	高血压史[例（%）]	高血脂史[例（%）]	入院血糖（mmol/L）	总胆固醇（mmol/L）	甘油三酯（mmol/L）
低值组	212	62 ± 12	127/85	56（26.42）	96（45.28）	77（36.32）	6.26 ± 0.41	4.5 ± 0.8	1.9 ± 0.4
高值组	144	63 ± 11	88/56	41（28.47）	81（56.25）	68（47.22）	6.15 ± 0.28	5.3 ± 0.8	2.3 ± 0.4
t/χ²值		0.188	0.027	0.214	1.077	1.554	1.251	2.253	2.469
P值		0.696	0.862	0.685	0.318	0.232	0.268	0.031	0.017
组别	例数	HDL-C（mmol/L）	LDL-C（mmol/L）	总蛋白（g/L）	ALB（g/L）	LYMPH（× 10⁹/L）	MRS评分（分）	PNI
低值组	212	1.04 ± 0.15	2.9 ± 0.8	69 ± 10	29 ± 14	27 ± 11	3.9 ± 0.6	44 ± 7
高值组	144	1.17 ± 0.21	2.6 ± 0.7	62 ± 12	37 ± 12	39 ± 15	3.0 ± 0.8	59 ± 8
t/χ²值		2.096	0.822	1.728	1.869	2.838	3.131	5.205
P值		0.041	0.365	0.044	0.028	0.005	0.002	< 0.001

组别	例数	ALB（g/L）	LYMPH（× 10⁹/L）	MRS评分（分）	PNI	病死率[例（%）]
低值组	212	25 ± 7	24.8 ± 0.6	2.6 ± 0.4	48 ± 8	7（3.30）
高值组	144	32 ± 5	33.2 ± 1.1	1.9 ± 0.5	67 ± 11	3（2.08）
t/χ²值		2.339	2.602	3.345	5.114	2.363
P值		0.022	0.009	0.001	< 0.001	0.017

组别	例数	ALB（g/L）	LYMPH（× 10⁹/L）	MRS评分（分）	PNI	病死率[例（%）]
低值组	212	25 ± 7	24.8 ± 0.6	2.6 ± 0.4	48 ± 8	7（3.30）
高值组	144	32 ± 5	33.2 ± 1.1	1.9 ± 0.5	67 ± 11	3（2.08）
t/χ²值		2.339	2.602	3.345	5.114	2.363
P值		0.022	0.009	0.001	< 0.001	0.017

变量	单因素分析			多因素分析
变量	OR值	95%CI	P值	OR值	95%CI	P值
总胆固醇（mmol/L）	1.771	1.313 ~ 2.669	0.031	1.828	1.464 ~ 2.491	0.027
甘油三酯（mmol/L）	1.680	1.271 ~ 2.183	0.017	1.603	1.233 ~ 2.125	0.040
HDL-C（mmol/L）	0.462	0.288 ~ 0.696	0.041	0.419	0.262 ~ 0.603	0.032
总蛋白（g/L）	1.196	0.646 ~ 1.964	0.044	1.112	0.722 ~ 1.787	0.104
ALB（g/L）	0.627	0.564 ~ 0.692	0.028	0.591	0.513 ~ 0.678	0.021
LYMPH（× 10⁹/L）	0.866	0.818 ~ 0.920	0.005	0.782	0.739 ~ 0.853	0.035
PNI	0.381	0.223 ~ 0.611	< 0.001	0.332	0.251 ~ 0.469	0.003

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