营养及炎症指标与新型冠状病毒感染患者预后的相关性研究

李雨佳; 项洁; 张丽洁; 孟文文; 张婷

doi:10.16766/j.cnki.issn.1674-4152.003623

营养及炎症指标与新型冠状病毒感染患者预后的相关性研究

doi: 10.16766/j.cnki.issn.1674-4152.003623

李雨佳¹,
项洁^{1, 2, ,},
张丽洁²,
孟文文²,
张婷¹

1.
徐州医科大学第二临床医学院，江苏徐州 221000
2.
徐州医科大学附属医院康复医学科，江苏徐州 221000

基金项目:

国家重点研发计划项目 2020YFC2006604

详细信息

通讯作者:
项洁，E-mail：18052268386@163.com

中图分类号: R512.99 R563.1
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出版历程
- 收稿日期: 2023-11-12
- 网络出版日期: 2024-11-19

Research on the correlation between nutritional and inflammatory indicators and prognosis of COVID-19 patients

1.
The Second Clinical Medical College of Xuzhou Medical University, Xuzhou, Jiangsu 221000, China 221000

摘要

摘要: 目的探究外周血中营养及炎症相关指标对新型冠状病毒感染患者预后的影响。方法回顾性分析2022年11月—2023年2月就诊于徐州医科大学附属医院的新型冠状病毒感染患者1 351例，根据随访3个月的预后情况分为预后良好组(治愈或好转，1 091例)和预后不良组(放弃治疗或死亡，260例)。收集所有患者的一般临床资料、BMI、血清学营养及炎症指标等，计算并比较2组患者炎症、营养相关指标及复合指标。结果预后不良组患者的年龄、合并脑血管病、合并糖尿病、中性粒细胞计数、系统性免疫性炎症指数(SII)均高于预后良好组(P＜0.01)，预后不良组BMI、淋巴细胞计数、白蛋白水平、血小板计数、晚期肺癌炎症指数(ALI)、预后营养指数(PNI)低于预后良好组，差异均有统计学意义(P＜0.05)。多因素logistic回归分析结果显示，高龄是新型冠状病毒感染患者预后的独立危险因素(P < 0.05)，高ALI、高PNI均是新型冠状病毒感染患者预后的独立保护因素(P < 0.05)。ROC曲线分析结果显示，中性粒细胞、淋巴细胞、白蛋白、血小板的AUC分别为0.707(95% CI：0.672~0.742，P < 0.001)、0.728(95% CI：0.694~0.762，P < 0.001)、0.720(95% CI：0.686~0.753，P < 0.001)、0.645(95% CI：0.607~0.684，P < 0.001)；复合指标ALI、PNI的AUC分别为0.783(95% CI：0.744~0.821，P < 0.001)、0.744(95% CI：0.705~0.782，P < 0.001)。复合指标的曲线下面积更大，即复合指标的预测价值更高。结论血清学营养及炎症指标与新型冠状病毒感染患者预后相关，复合指标如ALI、PNI可以作为预后不良的预测指标，且预测价值更高。
- 新型冠状病毒感染 /
- 炎症 /
- 营养评价 /
- 预后
Abstract: Objective To investigate the effect of nutritional and inflammation-related composite indexes in peripheral blood on the prognosis of patients with novel coronavirus infection. Methods A retrospective analysis was conducted on 1 351 patients with novel coronavirus infection who attended the Affiliated Hospital of Xuzhou Medical University from November 2022 to February 2023. All patients were followed up for a 3-month-visit and categorized into a favorable prognosis group (cured or improved, n=1 091) and a poor prognosis group (died or treatment abandonment, n=260). General data, serologic nutritional index, serologic inflammatory index, and BMI were collected for all patients. The levels of independent and composite indexes related to nutrition and inflammation were calculated and compared between the two sets. Results Age, probability of combined diabetes mellitus, probability of combined cerebrovascular disease, neutrophil count, and systemic immune inflammation index (SII) levels were significantly higher in the poor prognosis group than in the good prognosis group (P < 0.01).The levels of BMI, lymphocyte count, albumin, platelet count, advanced lung cancer inflammation index (ALI), and prognostic nutritional index (PNI) in the poor prognosis group were significant lower than those in the good prognosis group (P < 0.05). The result of multivariate logistic regression analysis displayed that older age was an independent risk factor for poor prognosis in patients with viral pneumonia (P < 0.05), high ALI and PNI were protective indicators of poor prognosis (P < 0.05). The results of ROC curve analysis showed that the AUC for neutrophils, lymphocytes, albumin, and platelets were 0.707 (95% CI: 0.672-0.742, P < 0.001), 0.728 (95% CI: 0.694-0.762, P < 0.001), 0.720 (95% CI: 0.686-0.753, P < 0.001), 0.645 (95% CI: 0.607-0.684, P < 0.001), respectively. The AUC of composite indicators such as ALI and PNI were 0.783 (95% CI: 0.744-0.821, P < 0.001), 0.744 (95% CI: 0.705-0.782, P < 0.001), indicating that composite index have higher predictive value than the individual indicators. Conclusion Serological nutrition and inflammation independent indicators are associated with the prognosis of patients with novel coronavirus infection. ALI and PNI are predictive indicators for poor prognosis, offering higher predictive value.
- Novel coronavirus infection /
- Inflammation /
- Nutrition assessment /
- Prognosis

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图 1 炎症、营养单项指标预测新型冠状病毒感染患者预后不良的ROC曲线

Figure 1. ROC curve of single indexes of inflammation and nutrition predicting poor prognosis in patients with novel coronavirus infection

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图 2 ALI、PNI预测新型冠状病毒感染患者预后不良的ROC曲线

Figure 2. ROC curve of ALI and PNI predicting poor prognosis in patients with novel coronavirus infection

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表 1 2组新型冠状病毒感染患者一般资料比较

Table 1. Comparison of general data between two groups of patients infected with novel coronavirus

组别	例数	性别 (男/女, 例)	年龄 (x±s, 岁)	BMI (x±s)	高血压 [例(%)]	糖尿病 [例(%)]	冠心病 [例(%)]	脑血管病 [例(%)]
预后良好组	1 091	626/465	68.3±15.7	24.4±3.9	443(40.6)	252(23.1)	203(18.6)	274(25.1)
预后不良组	260	166/94	75.6±12.7	23.8±4.4	99(38.1)	89(34.2)	55(21.2)	125(48.1)
统计量		3.621^a	7.846^b	1.991^b	0.559^a	13.790^a	0.882^a	53.196^a
P值		0.057	＜0.001	0.047	0.455	＜0.001	0.348	＜0.001
注：^a为χ²值，^b为t值。

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表 2 2组新型冠状病毒感染患者炎症、营养指标及复合指标比较[M(P₂₅, P₇₅)]

Table 2. Comparison of inflammation and nutritional indicators between two groups of patients infected with novel coronavirus

组别	例数	中性粒细胞 (×10⁹/L)	淋巴细胞 (×10⁹/L)	白蛋白 (g/L)	血小板 (×10⁹/L)	ALI	SII	PNI
预后良好组	1 091	4.3(2.8, 6.5)	1.1(0.7, 1.6)	36.5(32.3, 40.1)	205.0(157.0, 272.0)	222.7(110.4, 434.8)	806.6(397.0, 1 596.5)	42.3(36.9, 47.4)
预后不良组	260	7.0(4.6, 11.0)	0.6(0.4, 1.0)	31.5(28.5, 35.7)	155.0(107.0, 215.0)	64.1(29.9, 144.8)	1 556.7(844.5, 3 312.9)	35.0(31.0, 40.7)
Z值		-10.333	-11.409	-11.029	-7.258	-12.136	-9.813	-12.451
P值		＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001	＜0.001

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表 3 影响新型冠状病毒感染患者预后的二元logistic回归分析

Table 3. Binary logistic regression analysis affecting prognosis of patients with novel coronavirus infection

变量	B	SE	Waldχ²	P值	OR值	95% CI
年龄	0.016	0.007	5.131	0.024	1.016	1.002~1.029
ALI	-0.002	0.001	11.477	0.001	0.998	0.996~0.999
PNI	-0.058	0.016	12.522	＜0.001	0.944	0.914~0.975

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