Background Studies have proposed that nutritional and immune-related markers are relevant with patient outcomes of various medical conditions and could be a useful indicator of patient prognostication. Objectives This study investigated whether a prognostic immune nutritional index (PINI) at diagnosis could predict adverse clinical outcomes in patients with antineutrophil cytoplasmic antibody-associated vasculitis (AAV). Design A retrospective, single-centre observational cohort analysis of patients with AAV. Methods All-cause mortality and end-stage renal disease (ESRD) were investigated outcomes during the observation period. PINI was calculated by serum albumin (g/mL) × 0.9 - monocyte count (/mm3) × 0.0007, and the optimal cut-off of PINI was obtained using a Youden index-based bootstrapping method. Cox hazard analyses were performed to identify independent predictors of patient outcomes. Results Of the 250 eligible patients, the median age of patients was 60.0 years, and 34.0% were men. During the disease course, 33 (13.2%) died and 42 (16.8%) developed ESRD, respectively. The ideal PINI cut-offs for all-cause mortality and ESRD were set as ⩽2.47 and ⩽3.12 (sensitivity and specificity of 75.1% and 60.6% for mortality and 46.2% and 78.6% for ESRD). AAV patients with PINI ⩽2.47 and those with PINI ⩽3.12 exhibited significantly higher rates for all-cause mortality and ESRD compared to those with PINI >2.47 and >3.12. In the multivariable Cox analysis, PINI ⩽2.47 (hazard ratio [HR]: 3.173, 95% confidence interval [CI]: 1.129, 8.916, p = 0.029) was independently associated with all-cause patient mortality; however, PINI ⩽3.12 was not independently associated with ESRD (HR: 1.097, 95% CI: 0.419, 2.870, p = 0.850). Conclusion Findings from this study demonstrated PINI could predict all-cause patient mortality in AAV, and a higher clinical attention is warranted in those with PINI ⩽2.47 at initial diagnosis.

中文翻译：

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预后免疫营养指数可以预测抗中性粒细胞胞浆抗体相关性血管炎患者的全因死亡率。

背景研究提出，营养和免疫相关标志物与各种医疗状况的患者结果相关，并且可能是患者预后的有用指标。目的 本研究调查了诊断时的预后免疫营养指数 (PINI) 是否可以预测抗中性粒细胞胞质抗体相关性血管炎 (AAV) 患者的不良临床结果。设计 AAV 患者的回顾性、单中心观察队列分析。方法对观察期内的全因死亡率和终末期肾病（ESRD）结果进行调查。PINI通过血清白蛋白（g/mL）×0.9-单核细胞计数（/mm3）×0.0007计算，并使用基于Youden指数的bootstrapping方法获得PINI的最佳截断值。进行 Cox 风险分析以确定患者结果的独立预测因素。结果 250例符合条件的患者中，患者中位年龄为60.0岁，其中男性占34.0%。在病程中，分别有 33 例（13.2%）死亡，42 例（16.8%）发展为 ESRD。全因死亡率和 ESRD 的理想 PINI 临界点设置为 ⩽2.47 和 ⩽3.12（死亡率的敏感性和特异性分别为 75.1% 和 60.6%，ESRD 的敏感性和特异性分别为 46.2% 和 78.6%）。与 PINI > 2.47 和 > 3.12 的患者相比，PINI ≤ 2.47 和 PINI ≤ 3.12 的 AAV 患者的全因死亡率和 ESRD 率显着更高。在多变量 Cox 分析中，PINI ⩽2.47（风险比 [HR]：3.173，95% 置信区间 [CI]：1.129、8.916，p = 0.029）与全因患者死亡率独立相关；然而，PINI ⩽3.12 与 ESRD 并不独立相关（HR：1.097，95% CI：0.419、2.870，p = 0.850）。结论 这项研究的结果表明，PINI 可以预测 AAV 患者的全因死亡率，对于初次诊断时 PINI ≤ 2.47 的患者，临床应给予更高的关注。