中性粒细胞/淋巴细胞比值和C反应蛋白/白蛋白比值对维持性血液透析患者全因死亡预测价值:随访5年的队列研究
Combined Predictive Value of Neutrophil-to-lymphocyte Ratio and C-reactive Protein-to-albumin Ratio for All-cause Mortality Risk in Patients with Maintenance Hemodialysis:Cohort Study Followed for 5 Years
陈汝满 1白亚飞 1王春莉 1安娜 1徐明芝 1贺纪清 1祁永慧 1王利恒 1李洪1
作者信息
- 1. 570311 海南省海口市,海南省人民医院海南医科大学附属海南医院血液净化中心
- 折叠
摘要
背景 已有研究表明中性粒细胞/淋巴细胞比值(NLR)对维持性血液透析(MHD)患者全因死亡有较好的预测价值,少有研究探讨C反应蛋白/白蛋白比值(CAR)对MHD患者全因死亡的预测及NLR联合CAR能否增强对MHD患者全因死亡的预测价值.目的 探讨NLR联合CAR对MHD患者全因死亡的预测价值,为提高MHD患者生存质量提供依据.方法 2017 年 1 月选取 175 例在海南省人民医院血液净化中心治疗的MHD患者为研究对象,收集其基线人口学资料及实验室检查结果.随访终点事件为全因死亡,随访截止日期为 2021-12-31.绘制受试者工作特征(ROC)曲线评价NLR、CAR及NLR联合CAR在MHD患者全因死亡中的预测价值,Kaplan-Meier生存曲线比较不同的NLR及CAR患者随访过程中累积生存率的差异;采用Cox比例风险回归模型分析MHD患者 5 年全因死亡的独立危险因素.结果 ROC曲线分析结果显示,NLR预测MHD患者全因死亡的ROC曲线下面积(AUC)为 0.743(95%CI=0.669～0.817,P＜0.001);CAR预测MHD患者全因死亡的AUC为 0.710(95%CI=0.627～0.794,P＜0.001);NLR联合CAR预测MHD患者全因死亡的AUC为 0.799(95%CI=0.732～0.867,P＜0.001).Kaplan-Meier生存曲线分析结果显示,至随访终点,基线NLR＞4.93 的患者随访期间累积生存率低于基线NLR≤4.93 的患者(χ2=32.753,P＜0.001).基线CAR＞0.795 的患者随访期间累积生存率低于基线CAR≤0.795 的患者(χ2=38.091,P＜0.001).多因素Cox比例风险回归模型分析结果显示,NLR＞4.93(HR=2.071,95%CI=1.226～3.499)、CAR＞0.795(HR=1.903,95%CI=1.155～3.136)是MHD患者 5 年全因死亡的独立危险因素(P＜0.05).透析龄增加(HR=0.984,95%CI=0.976～0.992)及铁蛋白升高(HR=0.998,95%CI=0.998～0.999)、25-羟维生素D[25-(OH)D]升高(HR=0.964,95%CI=0.941～0.987)、三酰甘油(TG)升高(HR=0.695,95%CI=0.506～0.955)是MHD患者 5 年全因死亡的保护因素(P＜0.05).结论 NLR、CAR对MHD患者全因死亡有预测价值,两者联合的预测价值更高;同时NLR及CAR升高均是MHD患者 5 年全因死亡的独立危险因素.
Abstract
Background Neutrophil-to-lymphocyte ratio(NLR)has been shown to have significant predictive value for all-cause mortality risk in patients with maintenance hemodialysis(MHD)in previous studies,however,whether C-reactive protein-to-albumin ratio(CAR)and the combination of NLR and CAR can enhance the predictive value for all-cause mortality risk in patients with MHD has not been investigated.Objective To investigate the combined predictive value of NLR and CAR for all-cause mortality of MHD patients,and to provide evidence for improving the quality of life of MHD patients.Methods The case data of 175 MHD patients in the Blood Purification Center of Hainan General Hospital in January 2017 were included,the deadline was December 31,2021,with the outcome of all-cause death.Receiver operating characteristic(ROC)curves were plotted for the predictive value of NLR+CAR,NLR,and CAR for the risk of all-cause death in MHD patients.Kaplan-Meier survival curve was used to compare the cumulative survival rate between the two groups.Cox regression analysis was used to analyze the independent risk factors of 5-year all-cause death in MHD patients.Results The area under the ROC curve(AUC)of NLR for predicting the risk of all-cause death in MHD patients was 0.743(95%CI=0.669-0.817,P＜0.001).The AUC of CAR for predicting the risk of all-cause death in MHD patients was 0.710(95%CI=0.627-0.794,P＜0.001).The AUC of NLR+CAR for predicting the risk of all-cause death in MHD patients was 0.799(95%CI=0.732-0.867,P＜0.001).Kaplan-Meier survival curve analysis showed that patients with NLR＞4.93 had lower cumulative survival than patients with NLR≤4.93(χ2=32.753,P＜0.001).The patients with CAR＞0.795 had a lower cumulative survival than patients with CAR≤0.795(χ2=38.091,P＜0.001).According to the results of the multiple Cox regression equation,dialysis age(HR=0.984,95%CI=0.976-0.992),ferritin(HR=0.984,95%CI=0.976-0.992),25-(OH)D(HR=0.964,95%CI=0.941-0.987)and triglyceride(HR=0.984,95%CI=0.976-0.992)were protective factors for all-cause mortality in 5-year MHD patients;NLR＞4.93(HR=2.071,95%CI=1.226-3.499)and CAR＞0.795(HR=1.903,95%CI=1.155-3.136)were independent risk factors for all-cause death in 5-year MHD patients(P＜0.05).Conclusion Compared with NLR or CAR alone,the combination of NLR and CAR can better predict the risk of all-cause mortality in MHD patients.Increased NLR and CAR were independent risk factors for all-cause mortality in 5-year MHD patients.
关键词
维持性血液透析/中性粒细胞/淋巴细胞比值/C反应蛋白/白蛋白比值/全因死亡/队列研究Key words
Maintenance hemodialysis/Neutrophil to lymphocyte ratio/C-reactive protein to albumin ratio/All-cause death/Cohort study引用本文复制引用
出版年
2024
国家科技期刊平台
NSTL
万方数据