The predictive value of prognostic nutritional index combined with urea nitrogen/creatinine and DFR levels for poor prognosis in patients with acute cerebral infarction

doi:10.11958/20253177

Abstract

Abstract:

Objective To explore the predictive value of prognostic nutritional index (PNI) combined with urea nitrogen/creatinine, D-dimer/fibrinogen (DFR) and red blood cell distribution width (RDW) for poor prognosis in patients with acute cerebral infarction. Methods A total of 280 patients with acute cerebral infarction were selected as the research subjects by convenience sampling. According to the modified Rankin scale, they were divided into the good prognosis group (177 cases) and the poor prognosis group (103 cases). Clinical data of patients were collected, including their age, gender, body mass index (BMI) and history of underlying diseases (diabetes, coronary heart disease and hypertension). The fully automatic blood cell analyzer, fully automatic biochemical analyzer, whole blood C-reactive protein analyzer and the corresponding reagents were used to obtain serum homocysteine (Hcy), total lymphocyte count (TLC), serum albumin (ALB), hemoglobin (Hb), total cholesterol (TC), total serum protein (TP) and C-reactive protein (CRP). The levels of indicators such as high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), uric acid (UA), urea nitrogen, creatinine, D-dimer, fibrinogen and RDW were also collected. PNI and DFR were calculated. Spearman assay was used to analyze the correlation between PNI, urea nitrogen/creatinine, DFR, RDW and prognosis. Univariate and multivariate Logistic regression were used to analyze the influencing factors of poor prognosis in patients with acute cerebral infarction. The receiver operating characteristic (ROC) curve was drawn, and the area under the curve (AUC) was compared. Results The RDW, urea nitrogen/creatinine ratio and DFR were higher in the poor prognosis group than those in the good prognosis group (all P<0.05). The PNI index level was lower in the poor prognosis group than that in the good prognosis group (P<0.05). The results of univariate Logistic regression analysis showed that elevated PNI was a protective factor for poor prognosis in patients with acute cerebral infarction, while elevated urea nitrogen/creatinine ratio, elevated DFR and widened red blood cell distribution (RDW) were risk factors (all P<0.05). The PNI of patients with acute cerebral infarction was negatively correlated with poor prognosis (P<0.01). Urea nitrogen/creatinine, DFR and RDW were positively correlated with poor prognosis (all P<0.01). The results of Logistic multivariate regression analysis showed that elevated PNI was a protective factor for poor prognosis in patients with acute cerebral infarction, while elevated urea nitrogen/creatinine ratio, elevated DFR and widened RDW were risk factors. The results of ROC curve analysis showed that the AUC of the combination of the four was 0.986 (95%CI: 0.974-0.999), and the sensitivity and specificity were 84.50% and 99.40% respectively, both of which were superior to the individual detection. Conclusion Compared with patients with a good prognosis, those with a poor prognosis of acute cerebral infarction have a lower PNI, while levels of urea nitrogen/creatinine, DFR and RDW are higher. The combined detection of the four indicators has a high predictive value for the prognosis of patients with acute cerebral infarction.

Key words: brain infarction, prognosis, prognostic nutritional index, urea nitrogen/creatinine, D-dimer/fibrinogen ratio

CLC Number:

R743.33

Figures/Tables 7

References 31

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组别	n				年龄/岁			男性				BMI/（kg/m²）				糖尿病史
预后良好组	177				67.29±13.21			122（68.93）				23.49±1.28				28（15.82）
预后不良组	103				67.90±14.11			63（61.17）				23.66±1.37				25（24.27）
χ²或t					0.363			1.750				1.045				3.031
组别			冠心病史			高血压病史				Hb/（g/L）					TP/（g/L）
预后良好组			29（16.38）			88（46.33）				129.63±18.89					64.32±7.21
预后不良组			15（14.56）			61（59.22）				131.25±17.46					65.46±8.01
χ²或t			0.275			2.363				0.709					1.212
组别		CRP/ （mg/L）					TC/（mmol/L）				HDL-C/（mmol/L）			LDL-C/（mmol/L）
预后良好组		2.78±1.29					4.85±1.32				1.11±0.33			2.96±0.82
预后不良组		3.02±1.32					4.91±1.26				1.04±0.29			3.10±0.87
t		1.494					0.312				1.792			1.444
组别				Hcy/（μmol/L）					UA/（μmol/L）				RDW/%
预后良好组				17.28±9.45					320.01±93.89				14.59±1.92
预后不良组				19.12±11.61					323.24±105.81				15.32±2.01
t				1.445					0.265				3.049^＊＊

组别	n				年龄/岁			男性				BMI/（kg/m²）				糖尿病史
预后良好组	177				67.29±13.21			122（68.93）				23.49±1.28				28（15.82）
预后不良组	103				67.90±14.11			63（61.17）				23.66±1.37				25（24.27）
χ²或t					0.363			1.750				1.045				3.031
组别			冠心病史			高血压病史				Hb/（g/L）					TP/（g/L）
预后良好组			29（16.38）			88（46.33）				129.63±18.89					64.32±7.21
预后不良组			15（14.56）			61（59.22）				131.25±17.46					65.46±8.01
χ²或t			0.275			2.363				0.709					1.212
组别		CRP/ （mg/L）					TC/（mmol/L）				HDL-C/（mmol/L）			LDL-C/（mmol/L）
预后良好组		2.78±1.29					4.85±1.32				1.11±0.33			2.96±0.82
预后不良组		3.02±1.32					4.91±1.26				1.04±0.29			3.10±0.87
t		1.494					0.312				1.792			1.444
组别				Hcy/（μmol/L）					UA/（μmol/L）				RDW/%
预后良好组				17.28±9.45					320.01±93.89				14.59±1.92
预后不良组				19.12±11.61					323.24±105.81				15.32±2.01
t				1.445					0.265				3.049^＊＊

组别	n	PNI	尿素氮/肌酐	DFR（×10^-3）
预后良好组	177	52.06±4.65	13.98±3.46	19.68±3.03
预后不良组	103	44.55±6.12	21.60±4.97	39.06±7.01
t		11.587^＊＊	15.090^＊＊	32.032^＊＊

组别	n	PNI	尿素氮/肌酐	DFR（×10^-3）
预后良好组	177	52.06±4.65	13.98±3.46	19.68±3.03
预后不良组	103	44.55±6.12	21.60±4.97	39.06±7.01
t		11.587^＊＊	15.090^＊＊	32.032^＊＊

变量	β	SE	Wald χ²	P	OR（95%CI）
PNI	-0.276	0.036	59.346	<0.001	0.759（0.708~0.814）
尿素氮/肌酐	0.431	0.050	72.989	<0.001	1.539（1.394~1.698）
DFR	0.350	0.050	49.436	<0.001	1.419（1.287~1.565）
RDW	0.193	0.065	8.795	0.003	1.213（1.068~1.377）