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已发表论文
慢性阻塞性肺疾病合并高碳酸血症呼吸衰竭患者全因死亡率的营养及炎症预测因素：一项两中心前瞻性队列研究
Authors Zhang Z, Liu Y, Shen Z, Zhang K, Gao H, Chen Z, Liu Z
Received 11 August 2025
Accepted for publication 26 November 2025
Published 1 December 2025 Volume 2025:20 Pages 3907—3922
DOI https://doi.org/10.2147/COPD.S559986
Checked for plagiarism Yes
Review by Single anonymous peer review
Peer reviewer comments 2
Editor who approved publication: Dr Vanesa Bellou
Zishu Zhang,1,* Yuexian Liu,2,* Zongbo Shen,3,* Koudong Zhang,4,* Honglan Gao,5 Zhimin Chen,5 Zhongxiang Liu4
1Department of Respiratory and Critical Care Medicine, The People’s Hospital of Xiangshui, Yancheng, 224600, People’s Republic of China; 2Department of Neurology, 920th Hospital of the Joint Logistic Support Force, Kunming, 650032, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, The People’s Hospital of Lincang, Lincang, 677000, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People’s Hospital of Yancheng, Yancheng, 224000, People’s Republic of China; 5Department of Clinical Nutrition, The Yancheng Clinical College of Xuzhou Medical University, The First People’s Hospital of Yancheng, Yancheng, 224000, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Zhimin Chen, Department of Clinical Nutrition, The Yancheng Clinical College of Xuzhou Medical University, The First People’s Hospital of Yancheng, Yancheng, 224000, People’s Republic of China, Email chenzhimin@ycsyy.com Zhongxiang Liu, Department of Respiratory and Critical Care Medicine, tHe Yancheng Clinical College of Xuzhou Medical University, The First People’s Hospital of Yancheng, Yancheng, 224000, People’s Republic of China, Email liuzhongxiang711@163.com
Background: Patients with chronic obstructive pulmonary disease (COPD) complicated by hypercapnic respiratory failure (HRF) often have a poor prognosis. Systemic inflammation and malnutrition are associated with adverse outcomes in COPD, yet the prognostic value of nutritional/inflammatory markers remains underexplored in COPD patients with HRF.
Methods: This prospective two-center cohort study enrolled 582 COPD complicated by HRF patients. Six indices, including Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR), Systemic Immune-Inflammation Index (SII), Prognostic Nutritional Index (PNI), Neutrophil Percentage-to-Albumin Ratio (NPAR), and Hemoglobin-Albumin-Lymphocyte-Platelet index (HALP), were calculated from admission biomarkers. Associations with 24-month all-cause mortality were evaluated using restricted cubic splines, Kaplan-Meier analysis, multivariable Cox regression, machine learning (Random Survival Forests, Boruta), threshold effect and subgroup analysis. Predictive performance was assessed via the receiver operating characteristic curve (ROC) analysis.
Results: Over 24 months, 263 patients (45.2%) died. Non-survivors exhibited significantly higher NLR, PLR, SII, and NPAR, but lower PNI and HALP (P < 0.05). Kaplan-Meier analysis and Cox models confirmed that higher PNI (HR=0.72, 95% CI:0.54– 0.96) and HALP (HR=0.55, 95% CI:0.41– 0.74) were negatively correlated with all-cause mortality, while elevated PLR (HR=1.39, 95% CI:1.04– 1.85), NLR (HR=1.39, 95% CI:1.02– 1.88), SII (HR=1.51, 95% CI:1.11– 2.05), and NPAR (HR=1.46, 95% CI:1.10– 1.95) were positively correlated with all-cause mortality. For each one-standard-deviation increase in the indicators, all-cause mortality statistically significantly increased or decreased (P for trend < 0.05), with the exception of SII. Machine learning and ROC analyses consistently identified HALP, PNI, and NPAR as top predictors, with HALP demonstrating the highest importance. Subgroup analyses confirmed consistent prognostic utility for PNI, HALP, and NPAR.
Conclusion: PNI, HALP, and NPAR are promising, readily available predictors of all-cause mortality in COPD patients with HRF, potentially enhancing risk stratification and personalized management.
Keywords: inflammation, nutrition, COPD, all-cause mortality, hypercapnic respiratory failure
1Department of Respiratory and Critical Care Medicine, The People’s Hospital of Xiangshui, Yancheng, 224600, People’s Republic of China; 2Department of Neurology, 920th Hospital of the Joint Logistic Support Force, Kunming, 650032, People’s Republic of China; 3Department of Respiratory and Critical Care Medicine, The People’s Hospital of Lincang, Lincang, 677000, People’s Republic of China; 4Department of Respiratory and Critical Care Medicine, The Yancheng Clinical College of Xuzhou Medical University, The First People’s Hospital of Yancheng, Yancheng, 224000, People’s Republic of China; 5Department of Clinical Nutrition, The Yancheng Clinical College of Xuzhou Medical University, The First People’s Hospital of Yancheng, Yancheng, 224000, People’s Republic of China
*These authors contributed equally to this work
Correspondence: Zhimin Chen, Department of Clinical Nutrition, The Yancheng Clinical College of Xuzhou Medical University, The First People’s Hospital of Yancheng, Yancheng, 224000, People’s Republic of China, Email chenzhimin@ycsyy.com Zhongxiang Liu, Department of Respiratory and Critical Care Medicine, tHe Yancheng Clinical College of Xuzhou Medical University, The First People’s Hospital of Yancheng, Yancheng, 224000, People’s Republic of China, Email liuzhongxiang711@163.com
Background: Patients with chronic obstructive pulmonary disease (COPD) complicated by hypercapnic respiratory failure (HRF) often have a poor prognosis. Systemic inflammation and malnutrition are associated with adverse outcomes in COPD, yet the prognostic value of nutritional/inflammatory markers remains underexplored in COPD patients with HRF.
Methods: This prospective two-center cohort study enrolled 582 COPD complicated by HRF patients. Six indices, including Platelet-to-Lymphocyte Ratio (PLR), Neutrophil-to-Lymphocyte Ratio (NLR), Systemic Immune-Inflammation Index (SII), Prognostic Nutritional Index (PNI), Neutrophil Percentage-to-Albumin Ratio (NPAR), and Hemoglobin-Albumin-Lymphocyte-Platelet index (HALP), were calculated from admission biomarkers. Associations with 24-month all-cause mortality were evaluated using restricted cubic splines, Kaplan-Meier analysis, multivariable Cox regression, machine learning (Random Survival Forests, Boruta), threshold effect and subgroup analysis. Predictive performance was assessed via the receiver operating characteristic curve (ROC) analysis.
Results: Over 24 months, 263 patients (45.2%) died. Non-survivors exhibited significantly higher NLR, PLR, SII, and NPAR, but lower PNI and HALP (P < 0.05). Kaplan-Meier analysis and Cox models confirmed that higher PNI (HR=0.72, 95% CI:0.54– 0.96) and HALP (HR=0.55, 95% CI:0.41– 0.74) were negatively correlated with all-cause mortality, while elevated PLR (HR=1.39, 95% CI:1.04– 1.85), NLR (HR=1.39, 95% CI:1.02– 1.88), SII (HR=1.51, 95% CI:1.11– 2.05), and NPAR (HR=1.46, 95% CI:1.10– 1.95) were positively correlated with all-cause mortality. For each one-standard-deviation increase in the indicators, all-cause mortality statistically significantly increased or decreased (P for trend < 0.05), with the exception of SII. Machine learning and ROC analyses consistently identified HALP, PNI, and NPAR as top predictors, with HALP demonstrating the highest importance. Subgroup analyses confirmed consistent prognostic utility for PNI, HALP, and NPAR.
Conclusion: PNI, HALP, and NPAR are promising, readily available predictors of all-cause mortality in COPD patients with HRF, potentially enhancing risk stratification and personalized management.
Keywords: inflammation, nutrition, COPD, all-cause mortality, hypercapnic respiratory failure