2024 年第 1 期 第 19 卷

预后营养指数与急性主动脉夹层患者术后院内死亡的相关性分析

Correlation between prognostic nutrition index and postoperative in-hospital death in patients with acute aortic dissection

作者：昌伟1 王友兰2 何佳虹1 刘晓川1 喻应洪1

英文作者：Chang Wei1 Wang Youlan2 He Jiahong1 Liu Xiaochuan1 Yu Yinghong1

单位：1四川大学华西医院广安医院心胸外科，广安638000；2成都中医药大学附属广安医院手术室，广安638000

英文单位：1Department of Cardiothoracic Surgery Guang′an Hospital West China Hospital Sichuan University Guang′an 638000 China; 2Operating Room Guang′an Hospital Affiliated to Chengdu University of Traditional Chinese Medicine Guang′an 638000 China

关键词：急性A型主动脉夹层；院内死亡；预后营养指数；炎症

英文关键词：AcutetypeAaorticdissection;Deathinhospital;Prognosticnutritionalindex;Inflammation

• 摘要：

• 目的  探讨预后营养指数（PNI）与急性A型主动脉夹层（ATAAD）患者术后院内死亡的相关性。方法  选择2018年12月至2022年12月四川大学华西医院广安医院心胸外科收治的206例ATAAD患者，统计ATAAD患者住院30 d内全因死亡情况，并据此分为死亡组（32例）和存活组（174例）。术前评估PNI，收集临床资料，采用多因素Logistic回归分析ATAAD患者住院30 d内全因死亡的危险因素，受试者工作特征曲线分析PNI预测ATAAD患者住院30 d内全因死亡的价值。结果  死亡组血清白蛋白、外周血淋巴细胞计数以及PNI均低于存活组［（26.6±2.3）g/L比（32.0±5.2）g/L、（1.25±0.26）×109/L比（2.23±0.65）×109/L、（33±4）比（43±5）］（均P＜0.05）。合并急性肾损伤、体外循环时间过长是术后死亡的危险因素，PNI是保护因素（均P＜0.05）。PNI预测ATAAD患者住院30 d内全因死亡的临界值为35.92，曲线下面积为0.871（95%置信区间：0.817～0.913），敏感度为84.37%，特异度为88.51%。结论  术前PNI降低与ATAAD患者住院30 d内全因死亡有关。PNI可预测ATAAD患者术后短期死亡风险。

• Objective  To investigate the correlation between prognostic nutrition index (PNI) and postoperative in-hospital death in patients with acute type A aortic dissection (ATAAD). Methods  A total of 206 ATAAD patients admitted to Department of Cardiothoracic Surgery, Guang′an Hospital, West China Hospital, Sichuan University from December 2018 to December 2022 were selected. The all-cause death of ATAAD patients within 30 d of hospitalization was analyzed, and patients were divided into death group (32 cases) and survival group (174 cases). PNI was evaluated before surgery, and clinical data were collected. Multivariate Logistic regression was used to analyze the risk factors affecting all-cause death in patients with ATAAD within 30 d of hospitalization. The value of PNI in predicting all-cause death in patients with ATAAD within 30 d of hospitalization was analyzed by receiver operating characteristic curve. Results  The serum albumin, peripheral blood lymphocyte count and PNI in death group were lower than those in survival group ［(26.6±2.3)g/L vs (32.0±5.2)g/L, (1.25±0.26)×109/L vs (2.23±0.65)×109/L, (33±4) vs (43±5)］(all P＜0.05). Acute kidney injury and prolonged extracorporeal circulation were risk factors for postoperative death, and PNI was protective factor (all P＜0.05). PNI predicted all-cause death in ATAAD patients within 30 d of hospitalization with a critical value of 35.92, the area under the curve of 0.871 (95% confidence interval: 0.817-0.913), sensitivity of 84.37%, and specificity of 88.51%. Conclusion  Preoperative PNI reduction is associated with all-cause death within 30 d of hospitalization for ATAAD. PNI can predict the risk of short-term postoperative death in patients with ATAAD.