预后营养指数对心源性休克患者预后的预测价值OA

Objective To explore the predictive value of prognostic nutritional index(PNI)for the prognosis of patients with cardiogenic shock(CS).Methods The clinical data of 759 CS patients were extracted from the medical information mart for intensive care Ⅳ database.The patients were divided into survival group(n=384)and death group(n=375)according to the 90-day prognosis,and the risk factors affecting prognosis were analyzed by univariate analysis.The nonlinear trend relationship between PNI and the risk of 90-day mortality was analyzed by restricted cubic splines(RCS),and the patients were divided into high PNI group(≥39.36,n=377)and low PNI group(<39.36,n=382)according to the optimal cutoff value.The Kaplan-Meier method and Cox proportional hazard regression model were used to analyze the relationship between PNI and the 90-day and 360-day all-cause mortality of patients.Results A total of 759 CS patients were included in the study,the PNI was 39.32(34.04,44.31),and the 90-day all-cause mortality rate was 49.41%.There were significant differences in age,acute physiology and chronic health evaluationⅡscore,anion gap,creatinine,aspartate aminotransferase,total bilirubin,blood magnesium,PNI,hemoglobin,platelets,total hospital stay,treatment(mechanical ventilation,renal replacement therapy,norepinephrine,dopamine),and comorbidities(malignant tumors,acute kidney injury,hypertension,congestive heart failure)between the survival group and the death group(P<0.05).RCS analysis found that PNI and the risk of all-cause mortality at 90 days showed an overall nonlinear trend relationship(χ2=24.590,P<0.001).That is,as the index increased,the risk of death decreased,and the amplitude gradually slowed down and tended to be gentle.Kaplan-Meier survival curve analysis further confirmed this relationship.The patients in the low PNI group had low 90-day and 360-day cumulative survival rates and a higher risk of death(χ2=18.04,23.41,both P<0.001).After adjusting for confounding factors,Cox analysis found that PNI was negatively correlated with 90-day mortality[HR=1.461(95%CI:1.157-1.845),P=0.001]and 360-day mortality[HR=1.473(95%CI:1.188-1.827),P<0.001].Low PNI levels(<39.36)have predictive value for 90-day and 360-day mortality in CS patients.Conclusion Low PNI level(<39.36)is an independent risk factor for 90-day and 360-day all-cause mortality in CS patients.It can serve as an important predictor of clinical outcome in CS patients and help medical staff to assess the condition,adjust treatment strategies,and implement comprehensive nursing interventions.