Correlation Between Urine Protein Creatinine Ratio And Nutritional Status In Elderly Inpatients

ObjectiveAs a sensitive marker of early renal impairment,urine protein creatinine ratio is first recommended for screening,diagnosis and assessment of diabetic nephropathy and is now regarded as a marker of systemic vascular endothelial cell damage,dysfunction and inflammatory response,as well as an independent risk factor for cardiovascular disease and an independent predictor of adverse cardiovascular events.Studies have shown that urine protein creatinine ratio is associated with the nutritional status of patients with chronic kidney diseases(CKD)and an abnormally high urine protein creatinine ratio is associated with nutritional status.Little research has been done to determine the relationship between urine protein creatinine ratio and nutritional status in patients with non-chronic kidney diseases.The aim of this research is to investigate the correlation between urine protein-creatinine ratio and nutritional status in elderly inpatients with non-chronic kidney disease,and to find a sensitive,accurate and simple laboratory indicator for early nutritional screening to reduce the incidence of malnutrition.Materials and MethodsA convenience sampling method is used to include 320 elderly inpatients admitted to Qilu Hospital of Shandong University from October 2020 to September 2022,and general data such as age,weight,height,body mass index(BMI),personal history,and clinical data including neutrophil-to-lymphocyte ratio(NLR),prealbumin,albumin,haemoglobin(Hb),urine protein(UP),urine protein-creatinine ratio(UPCR),urine albumin-creatinine ratio(UACR),nutritional status and other clinical information.The Mini nutritional assessment-short form(MNA-sf)is used to assess the nutritional status of patients.Patients are considered to have normal nutritional status with a score greater than or equal to 12,otherwise they are considered to have abnormal nutritional status,where abnormal nutritional status included both malnutrition and risk of malnutrition.In this study,the patient’s nutritional status is regarded as the dependent variable,and the variables with statistically significant effects on the dependent variable are selected by univariate analysis,and the variables with statistically significant effects on the dependent variable are regarded as independent variables by univariate analysis and clinical experience,and the independent factors associated with nutritional status are obtained by binary logistic regression analysis.The binary logistic regression model is used to construct a line graph to reflect the predictive value and clinical utility of each risk factor for the occurrence of malnutrition,and finally to test the predictive value and clinical practicability of the model.Results1.A total of 320 elderly inpatients are included in this study according to the inclusion and exclusion criteria,of whom 209(65.31%)have normal nutritional status and 111(34.69%)have abnormal nutrition.2.The results of the univariate analysis of factors influencing the nutritional status of patients show that age,weight,body mass index,blood creatinine,pre-albumin,albumin,haemoglobin,urine protein creatinine ratio,urine albumin creatinine ratio,urine creatinine,urine total protein,urine albumin,lymphocyte count,neutrophil-lymphocyte ratio,triglycerides,gender,hypertension,heart failure,malignancy,cognitive impairment,and chronic obstructive pulmonary diseases are statistically significant differences(P<0.05).3.A multifactorial analysis of factors influencing the nutritional status of patients reveals that age(OR=1.06,p=0.037),BMI(OR=0.64,p<0.001),logUPCR(OR=4.04,p=0.012),neutrophil-lymphocyte ratio(NLR)(OR=1.33,p=0.009),malignancy(OR=3.32,P=0.004)and history of chronic obstructive pulmonary diseases(OR=6.02,P=0.007)are independent contributors to abnormal nutritional status in elderly inpatients with non-chronic kidney diseases.4.The predictive value of the line plot for the risk of developing malnutrition or undernutrition is assessed by using the subject operating characteristic(ROC)curve,which shows an AUC of 0.899,95%CI[0.858,0.940],a sensitivity of 88.0%and a specificity of 77.1%,indicating that the line plot model discriminates well;the DCA of the model shows that when the potential risk threshold is taken as 35.8%(i.e.the optimal cut-off value for the model in the ROC analysis),the decision curve lies above the image,achieving a good net benefit,indicating that the model has good clinical utility.Conclusions1.Urine protein-creatinine ratio(UPCR)is strongly associated with the nutritional status of elderly inpatients with non-chronic kidney disease.2.Elevated urine protein-creatinine ratio is an independent risk factor for the nutritional status of elderly inpatients with non-chronic kidney diseases,which is used to establish a predictive model for the risk of the development of malnutrition or malnutrition,and the model has high predictive value and clinical application.The urine protein creatinine ratio(UPCR)may be used as a new non-invasive indicator to assess the risk of malnutrition or malnutrition,providing novel ideas for the early identification,assessment and treatment of malnutrition.