极高预后营养指数与冠心病患者全因死亡率的相关性：中国前瞻性队列研究的二次分析。
Association between extremely high prognostic nutritional index and all-cause mortality in patients with coronary artery disease: secondary analysis of a prospective cohort study in China.
机构信息
Department of Cardiology, Xinjiang Medical University Affiliated First Hospital, No. 137, Liyushan Road, Urumqi, China.
Key Laboratory of High Incidence Disease Research in Xingjiang (Xinjiang Medical University, Ministry of Education), Urumqi, China.
出版信息
BMJ Open. 2024 Jun 16;14(6):e079954. doi: 10.1136/bmjopen-2023-079954.
OBJECTIVES
Decreased prognostic nutritional index (PNI) was associated with adverse outcomes in many clinical diseases. This study aimed to evaluate the relationship between baseline PNI value and adverse clinical outcomes in patients with coronary artery disease (CAD).
DESIGN
The Personalized Antiplatelet Therapy According to CYP2C19 Genotype in Coronary Artery Disease (PRACTICE) study, a prospective cohort study of 15 250 patients with CAD, was performed from December 2016 to October 2021. The longest follow-up period was 5 years. This study was a secondary analysis of the PRACTICE study.
SETTING
The study setting was Xinjiang Medical University Affiliated First Hospital in China.
PARTICIPANTS
Using the 50th and 90th percentiles of the PNI in the total cohort as two cut-off limits, we divided all participants into three groups: Q1 (PNI <51.35, n = 7515), Q2 (51.35 ≤ PNI < 59.80, n = 5958) and Q3 (PNI ≥ 59.80, n = 1510). The PNI value was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm).
PRIMARY OUTCOME
The primary outcome measure was mortality, including all-cause mortality (ACM) and cardiac mortality (CM).
RESULTS
In 14 983 participants followed for a median of 24 months, a total of 448 ACM, 333 CM, 1162 major adverse cardiovascular events (MACE) and 1276 major adverse cardiovascular and cerebrovascular events (MACCE) were recorded. The incidence of adverse outcomes was significantly different among the three groups (p <0.001). There were 338 (4.5%), 77 (1.3%) and 33 (2.2%) ACM events in the three groups, respectively. A restricted cubic spline displayed a J-shaped relationship between the PNI and worse 5-year outcomes, including ACM, CM, MACE and MACCE. After adjusting for traditional cardiovascular risk factors, we found that only patients with extremely high PNI values in the Q3 subgroup or low PNI values in the Q1 subgroup had a greater risk of ACM (Q3 vs Q2, HR: 1.617, 95% CI 1.012 to 2.585, p=0.045; Q1 vs Q2, HR=1.995, 95% CI 1.532 to 2.598, p <0.001).
CONCLUSION
This study revealed a J-shaped relationship between the baseline PNI and ACM in patients with CAD, with a greater risk of ACM at extremely high PNI values.
TRIAL REGISTRATION NUMBER
NCT05174143.
目的
降低预后营养指数（PNI）与许多临床疾病的不良预后相关。本研究旨在评估冠状动脉疾病（CAD）患者基线 PNI 值与不良临床结局之间的关系。
设计
本研究为前瞻性队列研究，纳入了 15250 例 CAD 患者，即新疆医科大学第一附属医院开展的根据 CYP2C19 基因型进行个体化抗血小板治疗的冠状动脉疾病（PRACTICE）研究，从 2016 年 12 月至 2021 年 10 月进行随访，最长随访时间为 5 年。本研究为 PRACTICE 研究的二次分析。
地点
本研究地点为中国新疆医科大学第一附属医院。
参与者
本研究使用总队列中 PNI 的第 50 和 90 个百分位数作为两个截断限，将所有参与者分为三组：Q1（PNI＜51.35，n=7515）、Q2（51.35≤PNI＜59.80，n=5958）和 Q3（PNI≥59.80，n=1510）。PNI 值的计算方法为：血清白蛋白（g/dL）的 10 倍+总淋巴细胞计数（mm）的 0.005 倍。
主要结局
主要结局指标为死亡率，包括全因死亡率（ACM）和心源性死亡率（CM）。
结果
在中位随访时间为 24 个月的 14983 名参与者中，共记录到 448 例 ACM、333 例 CM、1162 例主要不良心血管事件（MACE）和 1276 例主要不良心血管和脑血管事件（MACCE）。三组间不良结局发生率差异有统计学意义（p＜0.001）。三组的 ACM 事件发生率分别为 338（4.5%）、77（1.3%）和 33（2.2%）。限制性立方样条显示，PNI 与更差的 5 年结局（包括 ACM、CM、MACE 和 MACCE）之间呈 J 形关系。在调整了传统心血管危险因素后，我们发现只有 Q3 亚组中 PNI 值极高或 Q1 亚组中 PNI 值极低的患者 ACM 风险更高（Q3 与 Q2 相比，HR：1.617，95%CI 1.012 至 2.585，p=0.045；Q1 与 Q2 相比，HR=1.995，95%CI 1.532 至 2.598，p＜0.001）。
结论
本研究揭示了 CAD 患者基线 PNI 与 ACM 之间呈 J 形关系，PNI 值极高时 ACM 风险增加。
临床试验注册号
NCT05174143。
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