Prognostic nutritional index and the risk of acute kidney injury in patients with acute coronary syndrome

Abstract

OBJECTIVE: Recent studies have linked malnutrition with undesirable outcomes in cardiovascular diseases. However, the underlying mechanism is unknown. Contrast-induced acute kidney injury (CI-AKI) increased cardiovascular mortality after percutaneous coronary intervention (PCI). This study hypothesizes that prognostic nutritional index (PNI) plays a role in the development of CI-AKI in patients with acute coronary syndrome undergoing emergency PCI.METHODS: This study enrolled 551 patients. PNI was determined as 10× serum albumin (g/dL)+0.005×total lymphocyte count (mm³).CI-AKI was characterized as the increase in serum creatinine ≥0.3 mg/dL level within 48 h after PCI. Patients were classified as either CI-AKI (+) or CI-AKI (−).RESULTS: CI-AKI has occurred in 72 of 551 patients (13.1%). PNI was significantly lower in the CI-AKI (+) group than in the CI-AKI (-) group (44.4±6.6 versus 47.2±5.8, p<0.001, respectively). Multivariate logistic regression analysis showed that PNI [odds ratio, OR: 1.631, 95% confidence interval (CI): 1.168-2.308, p=0.02] and estimated glomerular filtration rate (OR: 3.26, 95%CI 1.733-6.143, p<0.001) were independent risk factors for CI-AKI.CONCLUSIONS: PNI is an independent risk factor for CI-AKI. The development of CI-AKI may be the mechanism responsible for the relationship between poor nutritional status and adverse cardiac events.

Association of prognostic nutritional index with risk of contrast induced nephropathy: A meta-analysis

“…Subgroup analysis showed that the OR of CIN in patients without ACS was 2.45 (95% CI: 1.729 to 3.471), while the OR was 5.103 (95% CI:1.553 to 16.771) in those with ACS (Figure 4). To support this finding, our further analysis of the PNI in patients with or without CIN also demonstrated a lower PNI in patients with CIN compared to those without (MD = -5.1, 95% CI: −6.87 to −3.33, p < 0.00001, I 2 = 96%, eight studies, 15,516 patients, sensitivity analysis: consistent; certainty of evidence: very low) (Figure 5) (7,9,11,16,17,(19)(20)(21).…”

“…The male proportion varied among the studies with a range of 54.4 to 84.1%. Six studies enrolled fewer than 1,000 patients (range: 251 to 925) ( 7 , 11 , 15 , 17 , 19 , 20 ), while four recruited more than 1,000 patients (range: 1,823 to 4,391) ( 9 , 16 , 18 , 21 ). All studies used circulating creatinine concentrations to determine the incidence of CIN in their participants.…”

“…The cut-off values for this binary variable are shown in Table 1 . The ten included studies were conducted in three countries: Korea ( n = 1) ( 16 ), China ( n = 2) ( 9 , 21 ), and Turkey ( n = 7) ( 7 , 11 , 15 , 17 – 20 ).…”

“…Eight studies were further excluded for the following reasons: (1) patients receiving cardiac surgery (n = 1); (2) articles presented as conference abstracts (n = 4); and (3) information related to PNI not provided (n = 3). Finally, a total of 10 studies with 17,590 patients were included for the current meta-analysis (Figure 1) (7,9,11,(15)(16)(17)(18)(19)(20)(21).…”

The prognostic nutritional index is associated with mortality of patients in intensive care unit

“…Hypoalbuminemia in critically ill patients can have various causes, such as poor nutritional status, impaired liver function, increased loss through the kidneys, and particularly the response to systemic inflammation (negative acute phase reactant) [8]. PNI using these two parameters was also proven to have prognostic value in various clinical conditions, including malignancy, infection, and cardiovascular disease [9][10][11][12].…”