Prognostic nutritional index predicts acute kidney injury and mortality of patients in the coronary care unit

Abstract

The current study aimed to investigate whether prognostic nutritional index (PNI) is an independent predictor of acute kidney injury (AKI) and mortality of patients in the coronary care unit (CCU). In the present two-stage observational study of patients in the CCU, 6,444 patients from the Medical Information Mart for Intensive Care (MIMIC) III database were first enrolled (test cohort), after which 412 patients from Zhongnan Hospital of Wuhan University were recruited in the validation cohort. AKI was defined based on the Kidney Disease Improving Global Outcomes AKI criteria. The primary endpoint was the incidence of AKI stratified by severity, while the second endpoint included in-hospital mortality and 2-year mortality. In the test cohort, 4,457 (69.2%) patients developed AKI during hospitalization. Following multivariable adjustment, the highest quartile of the PNI value was associated with a 1.8-fold increased risk of AKI compared with the lowest quartile. For the prediction of AKI, the area under the receiver operating characteristic curve outperformed the acute physiology score III score and clinical model in patients with or without preexisting chronic kidney disease, and this was further validated in the hospital cohort used in the present study. A total of 2,219 patients suffered mortality during the 2-year follow-up, and PNI was indicated to independently predict the risk of in-hospital mortality and 2-year mortality in the test cohort and in the validation cohort. Decision curve analysis indicated that the PNI values were clinically useful; Therefore, the current study demonstrated that the PNI value is an independent predictor of AKI and mortality in patients within the CCU.

Association between Prognostic Nutritional Index and Contrast-Associated Acute Kidney Injury in Patients Complicated with Chronic Kidney Disease and Coronary Artery Disease

“…Malnutrition is common in patients with AKI and affects the occurrence and development of AKI independently of nonnutritional factors, increasing hospital death, complications, and medical costs [16][17][18]. In an observational study which recruited 6,444 patients from the Medical Information Mart for Intensive Care (MIMIC) III database and 412 patients from Zhongnan Hospital of Wuhan University conducted by Hu et al, the results demonstrated that PNI value was an independent predictor of AKI in patients within the coronary-care unit [8]. ere are some similarities between this study and ours.…”

“…It was demonstrated that malnutrition was common in patients with coronary artery disease (CAD) [5], and malnutrition was closely related to the occurrence of acute kidney injury (AKI) in hospitalized patients [6][7][8]. e prognostic nutritional index (PNI) is a screening tool for the nutritional status and has been described as a simple and objective indicator [9].…”

“…The prognostic nutritional index (PNI) is a screening tool for the nutritional status and has been described as a simple and objective indicator [ 9 ]. A previous study found an association between PNI and AKI in patients undergoing coronary artery bypass grafting and admitted in the coronary-care unit [ 8 , 10 ]. Patients with CKD and CAD were at high risk of CA-AKI.…”

Association of Preoperative Prognostic Nutritional Index and Postoperative Acute Kidney Injury in Patients with Colorectal Cancer Surgery

“…Therefore, more attention has been paid to the impact of nutritional and immune status on the prognosis of various cancers. PNI has been reported as a simple and objective indicator of patient Nutrients 2021, 13, 1604 2 of 13 survival and complications in acute and chronic diseases, such as AKI, heart failure, and various cancers [10][11][12][13][14]. Moreover, PNI was reported to be associated with postoperative complications and surgical prognosis in patients with colorectal cancer surgery [15][16][17][18].…”

Association of Preoperative Prognostic Nutritional Index and Postoperative Acute Kidney Injury in Patients Who Underwent Hepatectomy for Hepatocellular Carcinoma

“…The prognostic nutritional index (PNI), a biological marker, which can be determined through the serum albumin level and total lymphocyte count in peripheral blood, reflects a patient’s nutritional and inflammatory status [ 14 ]. The PNI was reportedly associated with survival or complications in various diseases, including cancer [ 15 , 16 , 17 , 18 ]. Recent studies have also indicated that the PNI is an effective predictor of prognosis in patients with HCC after hepatectomy [ 19 , 20 ].…”