| Background:Acute myocardial infarction(AMI)is a common acute critical disease with high incidence,sudden onset,and rapid progression.Malnutrition is prevalent in critically ill patients and is closely associated with adverse outcomes.More than 50%of AMI patients are malnourished.However,there is no recognized objective tool to evaluate the nutritional status of critically ill patients.Although prognostic nutrition index(PNI)is objective and effective,its value in predicting adverse outcomes in AMI patients remains controversial.In addition,the commonly used prognostic tools for critically ill AMI patients lack nutritional status assessment.Therefore,it is of great clinical significance to further study the prognostic value and risk stratification ability of PNI for adverse clinical outcomes in AMI patients.Purpose:To explore the prognostic value of prognostic nutrition index on adverse clinical outcomes in patients with acute myocardial infarction,and to analyze the effect of PNI on disease risk stratification ability of common prognostic assessment tools.Method:A total of 293 patients with confirmed AMI admitted to the intensive care unit(including cardiac,medical and surgical intensive care units)of our Hospital from January 2018 to January 2022 were collected.(1)According to the occurrence of all-cause deaths within 1 year of follow-up,the patients were divided into death group and non-death group for baseline analysis.(2)According to the value of PNI,the population was divided into normal group,moderate malnutrition group and severe malnutrition group,and the baseline conditions of the three groups were compared.(3)Based on the previous step,survival curve,Cox regression analysis and subgroup analysis were used to investigate the relationship between PNI on admission and all-cause mortality events.(4)The sensitivity and specificity of PNI,GRACE score and SOFA score were measured by receiver operating characteristic curve(ROC).Then we compared the differences of the three AUC.(5)PNI was combined with GRACE or SOFA scores to form a new model,and net weight subindex(NRI)and integrated discrimination improvement(IDI)were used to evaluate the risk stratification ability of the new model for all-cause mortality events.Results:The level of PNI in death group was lower than that in non-death group(P<0.001).Patients with moderate and severe malnutrition had longer hospital stays(P<0.001).PNI was negatively correlated with age,creatinine,GRACE score,SOFA score and length of ICU stay(all r<0,all P<0.05).Kaplan-Meier survival curves for PNI groups were statistically significant(log-rank test,P<0.001).In a fully adjusted Cox regression model,the 1-year event hazard ratio(95%Confidence interval)for severe malnutrition was 2.98(1.10-8.08).The AUC of 1-year all-cause deaths for PNI,GRACE,and SOFA scores were 0.787,0.811,and 0.859.In addition,adding PNI to a single GRACE scoring model improved its prediction of 1-year all-cause mortality events(C-statistic increased from 0.811 to 0.868,P=0.016;NRI=0.535,P<0.001;IDI=0.065,P=0.019).However,the addition of PNI did not enhance the risk stratification ability of SOFA score(C-statistic increased from 0.859 to 0.874,P=0.074;NRI=0.304,P=0.093;IDI=0.010,P=0.429).Conclusion:1.Low PNI was an independent risk factor for 1-year all-cause death in critically ill AMI patients.2.PNI has important clinical significance for risk stratification and early intervention of AMI patients. |
