PAR联合NRS 2002对医养结合模式下肺部感染老年人预后的评估价值

安稳; 刘倩倩; 周庆博

doi:10.16766/j.cnki.issn.1674-4152.003789

PAR联合NRS 2002对医养结合模式下肺部感染老年人预后的评估价值

doi: 10.16766/j.cnki.issn.1674-4152.003789

安稳¹,
刘倩倩¹,
周庆博^{1, 2, ,}

1.
山东大学第二医院南部院区老年医学科，山东济南 250033
2.
山东大学第二医院神经内科

基金项目:

国家重点研发计划项目 2018YFC0114700

详细信息

通讯作者:
周庆博，E-mail：lianxiang1210@126.com

中图分类号: R563.1
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- 文章访问数: 13
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- 被引次数: 0
出版历程
- 收稿日期: 2023-09-29
- 网络出版日期: 2025-01-20

Study on the prognostic value of PAR combined with NRS 2002 in elderly patients with pulmonary infection under the combined mode of medical care and nursing

AN Wen¹,
LIU Qianqian¹,
ZHOU Qingbo^{1, 2
, ,}

1.
Department of Geriatric Medicine, South Branch of the Second Hospital of Shandong University, Jinan, Shandong 250033, China

摘要

摘要: 目的分析医养结合模式下肺部感染老年人的危险因素，探讨降钙素原与白蛋白比值联合营养状态对其预后的影响，以便于早期干预，减少不良预后的发生。方法回顾性分析2017年4月—2021年8月山东大学第二医院医养结合机构内146例肺部感染老年人的临床资料，根据发病后28 d预后将老年人分为生存组(99例)和死亡组(47例)。采用logistic回归分析研究影响肺部感染老年人28 d预后的相关因素，绘制ROC曲线分析相关因素对预后的预测价值。结果死亡组降钙素原与白蛋白比值(PAR)及营养风险筛查(NRS 2002)显著高于生存组，差异均有统计学意义(P＜0.05)。PAR(OR=1.938, 95% CI: 1.033~3.638)、NRS 2002(OR=2.443，95% CI: 1.280~4.663), 均为肺部感染老年人28 d预后的独立影响因素。PAR、NRS 2002预测肺部感染老年人预后的ROC曲线下面积分别为0.719、0.613，PAR最佳截断点为0.031，灵敏度为46.8%，特异度为87.9%，NRS 2002最佳截断点为5.5分，灵敏度为74.5%，特异度为47.5%，两者联合预测的AUC为0.732，灵敏度为61.7%，特异度为83.7%，优于单一指标的预测能力。结论 PCT、ALB及PAR、NRS 2002均可预测肺部感染老年人的病情严重程度，其中PAR与NRS 2002均为肺部感染老年人28 d预后的独立影响因素，且二者联合预测预后具有较高的临床价值。
- 医养结合模式 /
- 肺部感染 /
- 老年 /
- 营养风险筛查 /
- 降钙素原与白蛋白比值
Abstract: Objective To analyze the risk factors of pulmonary infection in the elderly under the combined mode of medical and nursing care, and explore the influence of the ratio of procalcitonin to albumin combined with nutritional status on the prognosis of the elderly, so as to facilitate early intervention and reduce the occurrence of adverse prognosis. Methods The clinical data of 146 elderly patients with pulmonary infection from April 2017 to August 2021 in the Second Hospital of Shandong University were retrospectively analyzed. The elderly were divided into survival group (n=99) and death group (n=47) according to their prognosis at 28 days. SPSS 22.0 statistical software was used for data analysis. Logistics regression analysis was performed on the related factors affecting the prognosis of the elderly with pulmonary infection at 28 d, and an ROC curve was drawn to analyze the predictive value of the related factors on the prognosis. Results Procalcitonin to albumin ratio (PAR) and nutritional risk screening 2002 (NRS 2002) in the death group were significantly higher than those in the survival group (P < 0.05). PAR (OR=1.938, 95% CI: 1.033-3.638), NRS 2002 (OR=2.443, 95% CI: 1.280-4.663) were independent influencing factors affecting the prognosis of lung infection at 28 days. The area under the ROC curve for PAR and NRS 2002 to predict the prognosis of elderly patients with pulmonary infection were 0.719 and 0.613, respectively. PAR ' s optimal cut-off point was 0.031, with a sensitivity of 46.8% and a specificity of 87.9%, and NRS 2002 ' s optimal cut-off point was 5.5, with a sensitivity of 74.5% and a specificity of 47.5%. The combined AUC was 0.732, the sensitivity was 61.7%, and the specificity was 83.7%, which was better than the prediction ability of a single index. Conclusion PCT, ALB, PAR, and NRS 2002 can predict the severity of lung infection in the elderly. PAR and NRS 2002 are independent risk factors for the prognosis of the elderly with lung infection at 28 days, and their combination has high clinical value in predicting the prognosis.
- Combination of the medical-care model /
- Pulmonary infection /
- The elderly /
- Nutritional risk screening /
- Procalcitonin to albumin ratio

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图 1 PAR、NRS 2002及两者联合对肺部感染老年人预后预测的ROC曲线

Figure 1. Prognostic ROC curve of PAR, NRS2002, and their combination in elderly patients with pulmonary infection

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图 2 肺部感染老年人危险分层分析

Figure 2. Risk stratification analysis of pulmonary infection in the elderly

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表 1 2组肺部感染老年人基线资料比较

Table 1. Comparison of baseline data between the two groups of elderly patients with pulmonary infection

项目	死亡组(n=47)	生存组(n=99)	统计量	P值
年龄(x ±s, 岁)	83.53±6.19	82.31±7.81	0.939^a	0.349
性别(男/女, 例)	21/26	72/27	10.841^b	0.001
既往疾病史[例(%)]
冠心病	38(26.03)	62(42.46)	4.905^b	0.027
糖尿病	15(10.27)	40(27.40)	0.978^b	0.323
高血压	32(21.92)	61(41.78)	0.577^b	0.448
脑血管病	37(25.34)	85(58.22)	1.181^b	0.277
自主咳嗽[例(%)]	22(15.07)	65(44.52)	4.702^b	0.030
吸烟史[例(%)]	6(4.11)	29(19.86)	4.776^b	0.029
白细胞计数[M(P₂₅, P₇₅), ×10⁹/L]	9.44(6.47, 16.51)	9.05(6.55, 13.36)	143.709^c	0.985
中性粒细胞计数[M(P₂₅, P₇₅), ×10⁹/L]	8.05(4.88, 14.36)	7.71(4.74, 11.01)	136.074^c	0.802
血小板计数[M(P₂₅, P₇₅), ×10⁹/L]	233.00(154.00, 318.00)	195.50(129.50, 286.50)	126.912^c	0.021
血红蛋白(x ±s, g/L)	96.94±24.11	94.33±24.51	0.603^a	0.548
D-二聚体[M(P₂₅, P₇₅), mg/L]	3.70(2.06, 6.42)	2.20(1.49, 3.77)	129.203^c	0.007
肌酐[M(P₂₅, P₇₅), μmol/L]	56.00(35.00, 88.00)	55.00(40.00, 75.00)	79.955^c	0.277
C反应蛋白[M(P₂₅, P₇₅), mg/mL]	64.97(21.69, 126.09)	63.71(20.90, 118.10)	141.419^c	0.196
降钙素原[M(P₂₅, P₇₅), ng/mL]	0.77(0.31, 1.76)	0.35(0.16, 0.69)	126.148^c	0.001
白蛋白(x ±s, g/L)	28.47±4.46	30.92±4.58	3.038^a	0.003
PAR[M(P₂₅, P₇₅)]	0.02(0.01, 0.07)	0.01(0.01, 0.02)	146.000^c	0.001
NRS 2002(x ±s, 分)	5.87±0.61	5.53±0.86	2.480^a	0.014
注：^a为t值，^b为χ²值，^c为Z值。

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表 2 变量赋值情况

Table 2. Variable assignment

变量	赋值方法
性别	女性=1，男性=0
冠心病	有=1，无=0
自主咳嗽	有=1，无=0
吸烟史	有=1，无=0
28 d预后	死亡=1，生存=0

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表 3 肺部感染老年人28 d预后的多因素logistic回归分析

Table 3. Multivariate logistic regression analysis of 28-day prognosis in elderly patients with pulmonary infection

变量	B	SE	Waldχ²	P值	OR(95% CI)
NRS 2002	0.893	0.330	7.342	0.007	2.443(1.280~4.663)
PLT	0.007	0.002	8.449	0.001	1.007(1.003~1.011)
PAR	0.662	0.321	4.243	0.039	1.938(1.033~3.638)

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表 4 PAR、NRS 2002及两者联合对肺部感染老年人预后的预测价值

Table 4. Prognostic value of PAR, NRS2002, and their combination in elderly patients with pulmonary infection

项目	AUC	95% CI	P值	临界值	灵敏度(%)	特异度(%)	约登指数
PAR	0.719	0.629~0.809	< 0.001	0.031	46.8	87.9	0.347
NRS 2002	0.613	0.521~0.706	0.027	5.5	74.5	47.5	0.220
PAR+NRS 2002	0.732	0.647~0.817	< 0.001		61.7	83.7	0.354

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