Clinical Value of the Prognostic Nutrition Index in the Assessment of Prognosis in Critically Ill Patients with Stroke: A Retrospective Analysis

Abstract

Purpose. The purpose of study was to evaluate the association between prognostic nutritional index (PNI) and all-cause mortality of critically ill patients with stroke. Methods. Clinical data derived from Multiparameter Intelligent Monitoring in Intensive Care were analyzed. The primary endpoint was 30-day all-cause mortality; secondary endpoints were 90-day mortality and one-year cause mortality. The potential prognostic roles of PNI were analyzed by Cox proportional hazard models. The independent prognostic roles of PNI in the cases were analyzed by smooth curve fitting. Results. Concerning 30-day mortality, the HR (95% CI) for a high PNI (≥39.7) was 0.700 (0.544, 0.900; P = 0.00539 ), compared to a low PNI (<39.7). After adjusting for multiple confounders, the HR (95% CI) for a high PNI (≥39.7) was 0.732 (0.547, 0.978; P = 0.03514 ), compared to a low PNI (<39.7). Regarding 90-day and one-year mortality, a similar trend was observed. In addition, a nonlinear association between PNI and 30-day mortality was found. Using recursive algorithm and two-piecewise linear regression model, inflection point (IP) was calculated, which was 49.4. On the right side of the IP, there was a positive relationship between PNI and 30-day mortality, and the effect size, 95% CI, and P value were 1.04 (1.01, 1.07), P = 0.0429 , respectively. On the left of the IP, the effect size, 95% CI, and P value were 0.97 (0.96, 0.99) and 0.0011, respectively. Conclusions. The PNI was an independent predicting factor of 30-day, 90-day, and 1-year mortality of the critically ill patients with stroke. In addition, there was a U-shaped relationship between PNI and all-cause mortality of stroke patients. PNI was a risk factor for the outcome of stroke when PNI was >49.4, while PNI was a protective factor for outcome of stroke when PNI was <49.4.

Is Prognostic Nutritional Index Mortality Predictor in Patients with Acute Stroke in the Intensive Care Unit?

“…In our study, APACHE II and SOFA scores were higher and GCS was lower in the low PNI group than the high PNI group similar previous studies [3,23]. In addition, high APACHE II, SOFA and low GCS scores were independent risk factors for mortality.…”

“…Malnutrition is associated with chronic inflammation. Some studies have reported that chronic inflammation is associated with arrhythmias [3,17,20]. The other mechanism is electrolyte imbalance, trace element and vitamin deficiency that can be seen in the presence of malnutrition causing arrhythmia [17,19].…”

“…Hospital mortality was defined 30-day mortality as death from any cause after discharge. PNI was calculated by using following formula: "Serum albumin levels (g/dl) x 10 + total lymphocyte count in peripheral blood (per mm3) x 0.005" for each patient [3,11,13]. PNI was calculated on ICU admission.…”

“…Worldwide, it is responsible for approximately 11% of total deaths [2]. Because of the high mortality and morbidity rates associated with AS, the patients with AS are followed in intensive care unit (ICU) [3,4].…”

“…PNI has been associated with different inflammatory processes in previous studies [11,12,13]. Clinical trials have shown that lower PNI was related with poor survival in cancer cases following surgery [3,6,8]. There is a lack of studies and data about the relationship between the prognostic role of PNI and outcomes in patients with AS.…”