预后营养指数对肝脓肿患者预后的预测价值

摘要/Abstract

摘要： 目的探索预后营养指数(PNI)对细菌性肝脓肿合并脓毒症患者的预后意义。方法回顾性分析江苏大学附属宜兴医院202例肝脓肿患者的临床资料, 根据SOFA标准分为脓毒症组66例和非脓毒症组136例,脓毒症组中存活60例,死亡6例。比较2组患者的一般资料。多因素回归分析肝脓肿患者发生脓毒症的影响因素以及PNI对肝脓肿合并脓毒症患者预后的意义。以受试者工作特征曲线下面积(AUC)评估PNI对肝脓肿合并脓毒症患者的预测价值。结果脓毒症组的SOFA评分、WBC、ALT、AST、ALP、TBil、Scr、BUN、PT、APTT、CRP、肝脓肿大小高于非脓毒症组,而LYM、PLT、Alb、PNI低于非脓毒症组, 差异有统计学意义(P<0.05)。多因素回归分析显示,PLT、ALT、AST、TBil、Alb、PNI、Scr、APTT是肝脓肿并发脓毒症患者的独立危险因素。PNI预测肝脓肿发生脓毒症的AUC为0.843。最佳临界值为34.7时,灵敏度为75.7%,特异度为81.8%;当PNI<34.7时,肝脓肿患者进展为脓毒症的风险升高;且PNI与SOFA评分的相关性为R=-0.523(P<0.05)。死亡患者的SOFA评分、TBil、BUN高于存活患者,而PLT、PNI低于存活患者, 差异有统计学意义(P<0.05)。死亡与存活组间的治疗方案(肝穿刺引流术、使用升压药物)差异有统计学意义(P<0.05)。并发感染性休克、急性肾损伤、肝衰竭是合并脓毒症的肝脓肿患者死亡的相关因素。PNI是肝脓肿并发脓毒症患者死亡的影响因素。结论 PNI能预测肝脓肿患者并发脓毒症的发生;当PNI<34.7时,提示肝脓肿患者有进展为脓毒症的风险。PNI能预测肝脓肿并发脓毒症患者预后不良。

关键词: 肝脓肿, 脓毒症, 营养预后指数

Abstract: Objective To explore the significance of prognostic nutrition index (PNI) in patients with sepsis caused by pyogenic liver abscess (PLA). Methods The clinical data of 202 patients with PLA in our hospital were retrospectively analyzed, and the patients were divided into sepsis group and non-sepsis group according to the SOFA criteria. The sepsis group was divided into survival group and death group according to prognosis. General information was compared between the two groups. Univariate and multivariate Logistic regression were used to evaluate the effect of PNI on the prognosis of PLA patients with sepsis. Receiver operating characteristic (ROC) curve was plotted and area under the curve (AUC) was calculated to assess the prognostic significance of PNI in PLA patients with sepsis. Results The SOFA score, WBC, ALT, AST, ALP, TBil, Scr, BUN, PT, APTT, CRP, and size of liver abscess in the sepsis group were significantly higher than those in non-sepsis group (P<0.05). The LYM, PLT, ALB and PNI in the sepsis group were significantly lower than those in non-sepsis group (P< 0.05). Multivariate logistic regression analysis showed that PLT, ALT, AST, TBil, Alb, PNI, Scr and APTT were independent risk factors for PLA patients complicated with sepsis. Area under the ROC curve: PNI was 0.843. Using the Youden index, the optimal cutoff value of PNI was 34.7, with a sensitivity of 75.7% and a specificity of 81.8%.The results showed that when PNI＜34.7, patients were at greater risk of developing sepsis. The correlation between PNI and SOFA score was R=-0.523 (P<0.05). The SOFA score, TBil and BUN in the death group were significantly higher than those in the survival group (P< 0.05). The PLT and PNI of the death group were significantly lower than those in the survival group (P< 0.05). There was a statistically significant difference (P<0.05) in the treatment plans (liver puncture drainage, use of pressor drugs) between the death group and the survival group. Concurrent septic shock, acute kidney injury, and liver failure are related factors for mortality in PLA patients with sepsis (P<0.05).Multivariate regression analysis showed that PNI was an independent risk factor for death in PLA patients with sepsis. Conclusion PNI can predict the occurrence of sepsis in PLA patients. When PNI<34.7, the risk of progression to sepsis was higher. PNI can predict poor prognosis of PLA patients complicated with sepsis.

Key words: Pyogenic liver abscess, Sepsis, Prognostic nutrition index

肖颖, 金涛, 毛伯能, 张艳. 预后营养指数对肝脓肿患者预后的预测价值[J]. 肝脏, 2026, 31(1): 112-117.

XIAO Ying, JIN Tao, MAO Bo-neng, ZHANG Yan. The value of prognostic nutrition index in predicting the prognosis of patients with pyogenic liver abscess[J]. Chinese Hepatolgy, 2026, 31(1): 112-117.

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