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已发表论文

慢性阻塞性肺疾病危重症患者预后营养指数与死亡风险之间的关联：一项回顾性研究

 

Authors Liu QD, Wang DX

Received 25 January 2025

Accepted for publication 1 May 2025

Published 15 May 2025 Volume 2025:20 Pages 1493—1508

DOI http://doi.org/10.2147/COPD.S517676

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Jill Ohar

Qiu-Die Liu, Dao-Xin Wang

Department of Respiratory and Critical Care Medicine, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, People’s Republic of China

Correspondence: Dao-Xin Wang, Email 300293@hospital.cqmu.edu.cn

Background: The Prognostic Nutritional Index (PNI), an integrative measure of body’s immune and nutritional status, has demonstrated its prognostic value across a range of diseases. However, its role in critically ill patients with Chronic Obstructive Pulmonary Disease (COPD) remains unclear. This study investigates the association between PNI levels and clinical outcomes in critically ill COPD patients, with a focus on identifying its role as a potential predictor of mortality.
Methods: A retrospective analysis of 1,250 critically ill COPD patients from the MIMIC-IV (v2.2) database was conducted. Patients were grouped by PNI tertiles. Primary and secondary outcomes were 28-day and 90-day mortality, respectively. Associations were evaluated using restricted cubic splines, Cox proportional hazards regression analysis, and Kaplan‒Meier survival curves. The predictive performance of PNI was assessed via receiver operating characteristic (ROC) curves analysis, and a nomogram integrating Boruta-selected features was developed to enhance clinical utility.
Results: The final cohort comprised 1,250 critically ill COPD patients, with observed mortality rates of 25.3% and 33.2% at 28 and 90 days, respectively. Higher PNI levels were associated with reduced risk of both 28-day and 90-day mortality [28-day HR: 0.95 (95% CI: 0.93– 0.97), P < 0.001; 90-day HR: 0.94 (95% CI: 0.93– 0.96), P < 0.001]. Restricted cubic spline analysis confirmed this trend. Furthermore, ROC analysis demonstrated the utility of PNI as a predictor for 28-day mortality (AUC: 0.61). Boruta-selected features reinforced the importance of PNI, and the constructed nomogram exhibited excellent predictive accuracy (AUC: 0.712).
Conclusion: Higher PNI is linked to reduced mortality risk in critically ill COPD patients, indicating its potential as a prognostic marker.

Keywords: chronic obstructive pulmonary disease (COPD), the prognostic nutritional index (PNI), MIMIC-IV

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