预后营养指数对新疆喀什地区糖尿病足患者全因死亡的预测价值

Prognostic nutritional index in predicting survival for patients with diabetic foot ulcer in kashgar District of Xinjiang

关键词:  预后营养指数  糖尿病足  全因死亡

Key words:  prognostic nutritional index  diabetic foot  all-cause mortality

摘要:

目的 评估预后营养指数(prognostic nutritional index, PNI)对新疆喀什地区糖尿病足患者全因死亡的预测价值。 方法 采用回顾性队列研究方法，收集2018年1月—2019年12月新疆喀什地区第二人民医院内分泌科收治的132例糖尿病足患者临床资料，以患者出院之日作为起点进行电话随访（每年1次），以死亡或满3年为随访终点。根据3年随访时的生存情况分为生存组78例和死亡组54例。根据PNI最佳截断值分为高PNI组86例(PNI≥41.62)和低PNI组46例(PNI<41.62)，采用Kaplan-Meier法进行生存分析比较两组生存率，采用Cox比例风险模型探索PNI和糖尿病足患者全因死亡的关系。 结果 本研究最终纳入132例糖尿病足患者，平均年龄（60.5±10.02）岁，其中男性89例(67.4%)，随访期间共54例（40.9%）患者死亡。ROC曲线分析显示,PNI预测糖尿病足患者全因死亡的曲线下面积为0.798（95%CI: 0.721~0.875，P<0.000 1），最佳截断值41.62，灵敏度为61.1%，特异度为83.3%。Log-rank检验表明，低PNI组总生存率较低（P<0.001）。多因素Cox回归分析显示，PNI、冠心病、重型溃疡与糖尿病足患者全因死亡独立相关（P<0.05）。 结论 在新疆喀什地区，PNI高的糖尿病足患者死亡率较低，PNI对糖尿病足患者的全因死亡具有一定的预测价值。

Abstract:

Objective To investigate the predictive value of prognostic nutritional index(PNI) for all-cause mortality in patients with diabetic foot. Methods Clinical data of 132 patients aged 60.5±10.02 years(89 were males) with diabetic foot admitted to the Department of Endocrinology of the Second People’s Hospital of Kashgar from January 2018 to December 2019 were retrospectively analyzed. An annual telephone follow-up was conducted for all patients after discharge. During 3 years of follow-up 78 patients survived(survival group) and 54 patients died(fatal group). Based on the best cut-off value of PNI, there were 86 cases in the high PNI group(PNI≥41.62) and 46 cases in the low PNI group(PNI<41.62). Kaplan-Meier method was used to compare the survival rate of the two groups, and Cox proportional hazards model was used to explore the relationship between PNI and all-cause death in patients with diabetic foot. Results Log-rank test showed that the overall survival rate was lower in the low PNI group(P<0.001). Multivariate Cox regression analysis showed that PNI, coronary heart disease, and severe ulcer were independently associated with all-cause death in patients with diabetic foot(P<0.05). ROC curve analysis showed that the AUC of PNI for predicting all-cause mortality in patients with diabetic foot was 0.798(95%CI: 0.721-0.875, P<0.000 1), the best cut-off value was 41.62 with a sensitivity of 61.1% and specificity of 83.3%. Conclusion Higher PNI is associated with lower mortality in patients with diabetic foot, and PNI may be able to predict all-cause mortality in patients with diabetic foot in kashgar District of Xinjiang.