老年髋部骨折患者预后营养指数、系统性免疫炎症指数与术后肺部感染的关系

Associations of the prognostic nutritional index and systemic immune-inflammation index with postoperative pulmonary infection in elderly patients with hip fractures

摘要:

目的 探讨老年髋部骨折患者预后营养指数（PNI）、系统性免疫炎症指数（SII）与术后肺部感染的关系。方法 回顾性分析2023年1月—2026年1月中国人民解放军联勤保障部队第九〇三医院收治的242例老年髋部骨折患者的临床资料，根据术后住院期间肺部感染情况分为肺部感染组（26例）、无肺部感染组（216例）。比较两组患者术前临床资料及PNI、SII水平。采用多因素逐步Logistic回归模型分析影响老年髋部骨折患者术后肺部感染的因素，绘制受试者工作特征（ROC）曲线分析PNI、SII对老年髋部骨折患者术后肺部感染的预测价值。结果 肺部感染组的合并慢性阻塞性肺疾病（COPD）率、红细胞分布宽度、SII水平均高于无肺部感染组（P <0.05），肺部感染组的PNI水平低于无肺部感染组（P <0.05）。多因素逐步Logistic回归分析结果显示：合并COPD［O^R =3.149（95% CI：1.388，7.145）］、PNI水平低［O^R =0.283（95% CI：0.131，0.610）］和SII水平高［O^R =2.902（95% CI：1.476，5.706）］均为影响老年髋部骨折患者术后肺部感染的危险因素（P <0.05）。ROC曲线分析结果显示，PNI、SII及二者联合预测老年髋部骨折患者术后肺部感染的敏感性分别为73.08%（95% CI：0.520，0.877）、65.38%（95% CI：0.444，0.821）、88.46%（95% CI：0.687，0.970），特异性分别为68.98%（95% CI：0.623，0.750）、73.61%（95% CI：0.671，0.793）、89.35%（95% CI：0.843，0.930）。结论 老年髋部骨折患者PNI、SII与术后肺部感染有关，二者联合预测患者术后肺部感染可提高预测效能。

Abstract:

Objective To investigate the associations of the prognostic nutritional index (PNI) and systemic immune-inflammation index (SII) with postoperative pulmonary infection in elderly patients with hip fractures.Methods The medical records of 242 elderly patients with hip fractures treated at the Chinese People's Liberation Army Joint Logistics Support Force 903rd Hospital between January 2023 and January 2026 were retrospectively analyzed. According to the occurrence of pulmonary infection during the postoperative hospital stay, the patients were divided into a pulmonary infection group (n = 26) and a non-pulmonary infection group (n = 216). Preoperative clinical data and PNI and SII levels were compared between the groups. Multivariable stepwise logistic regression was used to identify factors associated with postoperative pulmonary infection, and receiver operating characteristic (ROC) curves were used to evaluate the predictive value of PNI and SII.Results The prevalence of chronic obstructive pulmonary disease (COPD), red blood cell distribution width, and SII were higher in the pulmonary infection group than in the non-pulmonary infection group, whereas PNI was lower (P < 0.05). Multivariable stepwise logistic regression showed that COPD [O^R = 3.149 (95% CI: 1.388, 7.145)], low PNI [O^R = 0.283 (95% CI: 0.131, 0.610) ], and high SII [O^R = 2.902 (95% CI: 1.476, 5.706) ] were risk factors for postoperative pulmonary infection in elderly patients with hip fractures (P < 0.05). The sensitivities of PNI, SII, and their combination for predicting postoperative pulmonary infection were 73.08% (95% CI: 0.520, 0.877), 65.38% (95% CI: 0.444, 0.821), and 88.46% (95% CI: 0.687, 0.970), respectively, and the corresponding specificities were 68.98% (95% CI: 0.623, 0.750), 73.61% (95% CI: 0.671, 0.793), and 89.35% (95% CI: 0.843, 0.930), respectively.Conclusion PNI and SII are associated with postoperative pulmonary infection in elderly patients with hip fractures. Their combined use may improve predictive performance.