Objective: To explore the predictive value of the prognostic nutritional index (PNI) in concurrently infected patients with acute-on-chronic liver failure (ACLF). Methods: 220 cases with ACLF diagnosed and treated at the First Affiliated Hospital of Xi'an Jiaotong University from January 2011 to December 2016 were selected. Patients were divided into an infection and non-infection group according to whether they had co-infections during the course of the disease. Clinical data differences were compared between the two groups of patients. Binary logistic regression analysis was used to screen out influencing factors related to co-infection. The receiver operating characteristic curve was used to evaluate the predictive value of PNI for ACLF co-infection. The measurement data between groups were compared using the independent sample t-test and the Mann-Whitney U rank sum test. The enumeration data were analyzed using the Fisher exact probability test or the Pearson χ(2) test. The Pearson method was performed for correlation analysis. The independent risk factors for liver failure associated with co-infection were analyzed by multivariate logistic analysis. Results: There were statistically significant differences in ascites, hepatorenal syndrome, PNI score, and albumin between the infection and the non-infection group (P < 0.05). Among the 220 ACLF cases, 158 (71.82%) were infected with the hepatitis B virus (HBV). The incidence rate of infection during hospitalization was 69.09% (152/220). The common sites of infection were intraabdominal (57.07%) and pulmonary infection (29.29%). Pearson correlation analysis showed that PNI and MELD-Na were negatively correlated (r = -0.150, P < 0.05). Multivariate logistic analysis results showed that low PNI score (OR=0.916, 95%CI: 0.865~0.970), ascites (OR=4.243, 95%CI: 2.237~8.047), and hepatorenal syndrome (OR=4.082, 95%CI : 1.106~15.067) were risk factors for ACLF co-infection (P < 0.05). The ROC results showed that the PNI curve area (0.648) was higher than the MELD-Na score curve area (0.610, P < 0.05). The effectiveness of predicting infection risk when PNI was combined with ascites and hepatorenal syndrome complications was raised. Patients with co-infections had a good predictive effect when PNI ≤ 40.625. The sensitivity and specificity were 84.2% and 41.2%, respectively. Conclusion: Low PNI score and ACLF co-infection have a close correlation. Therefore, PNI has a certain appraisal value for ACLF co-infection.
目的： 探讨预后营养指数（PNI）对慢加急性肝衰竭（ACLF）患者并发感染的预测价值。 方法： 选取2011年1月至2016年12月西安交通大学第一附属医院诊治的220例ACLF患者，根据病程中是否合并感染分为感染组和非感染组，比较两组患者临床资料的差异。用二元logistic回归分析，筛选出与合并感染有关的影响因素。再应用受试者操作特征曲线法（ROC）评估PNI对于ACLF合并感染的预测价值。计量资料组间数据比较采用独立样本t检验、Mann-Whitney U秩和检验；计数资料采用Fisher精确概率法检验或Pearson χ(2)检验进行分析；Pearson法进行相关性分析；用logistic多因素分析肝衰竭合并感染的独立危险因素。 结果： 感染组与非感染组患者腹水、肝肾综合征、PNI评分、白蛋白等差异有统计学意义（P值均< 0.05）。220例ACLF患者病因中乙型肝炎病毒（HBV）感染的有158例（71.82%），住院期间感染发生率为69.09%（152/220)；常见感染部位为腹腔感染（57.07%）和肺部感染（29.29%）。Pearson相关性分析显示PNI与终末期肝病模型联合血清钠（MELD-Na）呈负相关（r = -0.150, P < 0.05）。Logistic多因素分析结果显示低PNI评分（OR = 0.916, 95%CI: 0.865～0.970）、腹水（OR = 4.243, 95%CI: 2.237～8.047）、肝肾综合征（OR = 4.082, 95%CI: 1.106～15.067）是ACLF合并感染的危险因素（P值均< 0.05）。ROC结果显示PNI曲线下面积（0.648）高于MELD-Na评分的曲线下面积（0.610，P < 0.05)；PNI联合腹水、肝肾综合征合并症时，预测感染风险效能升高。当PNI≤40.625时，对患者合并感染有较好的预测作用，灵敏度和特异度分别为84.2%和41.2%。 结论： 低PNI评分与ACLF合并感染有密切关系，PNI对ACLF合并感染有一定的评估价值。.
Keywords: Infection; Liver failure; Prognostic nutritional index.