Association Between Novel Inflammatory Markers and Arteriovenous Fistula Maturation Failure: A Predictive Model Based on Logistic Regression

In this retrospective cohort study of 144 patients with end-stage renal disease undergoing arteriovenous fistula (AVF) creation, we assessed preoperative systemic inflammatory and nutritional biomarkers—including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), systemic inflammation response index (SIRI), systemic immune-inflammation index (SII), albumin-to-alkaline phosphatase ratio (AAPR), and fibrinogen-to-albumin ratio (FAR)—and developed a multivariate logistic regression model to predict AVF maturation failure. We found that advanced age and elevated levels of PLR, SII, and FAR were significantly associated with AVF maturation failure. The final model, which incorporated all six markers, achieved an area under the ROC curve (AUC) of 0.794, outperforming individual biomarkers and prior prediction models. We also derived a practical scoring system to stratify patients by their risk of AVF failure.

本研究针对144例行动静脉瘘（arteriovenous fistula, AVF）成形术的终末期肾病患者开展回顾性队列研究，评估了术前全身炎症与营养生物标志物，包括血小板与淋巴细胞比值（platelet-to-lymphocyte ratio, PLR）、中性粒细胞与淋巴细胞比值（neutrophil-to-lymphocyte ratio, NLR）、全身炎症反应指数（systemic inflammation response index, SIRI）、全身免疫炎症指数（systemic immune-inflammation index, SII）、白蛋白与碱性磷酸酶比值（albumin-to-alkaline phosphatase ratio, AAPR）以及纤维蛋白原与白蛋白比值（fibrinogen-to-albumin ratio, FAR）；并构建了多因素logistic回归模型以预测动静脉瘘成熟失败风险。结果显示，高龄、PLR、SII及FAR水平升高与动静脉瘘成熟失败显著相关。纳入全部六项标志物的最终模型的受试者工作特征曲线下面积（area under the ROC curve, AUC）达0.794，优于单一生物标志物及既往同类预测模型。本研究同时开发出一套实用评分系统，用于对患者的动静脉瘘失败风险进行分层。