Prognostic Nutritional Index Predicts Contrast-Induced Nephropathy in Patients with Acute Coronary Syndrome

Abstract

This study evaluated the effectiveness of prognostic nutritional index (PNI) in predicting contrast induced nephropathy (CIN) in patients with acute coronary syndrome (ACS). This study included 925 ACS patients (mean age 62.5 ± 12.4 years, 73.5% male); 604 were diagnosed as unstable angina pectoris/non–ST-elevation myocardial infarction (USAP/NSTEMI) and 321 as ST-elevation myocardial infarction (STEMI). The PNI formula was: 10 × serum albumin (g/dL) + .005 × total lymphocyte count (/mm3). The patients were divided into two groups: CIN (n = 232) and non-CIN (n = 693). Patients without CIN had a significantly lower PNI than patients with CIN (44.3 ± 6.9 vs 54.7 ± 7.4; P < .001). In the receiver operating characteristic (ROC) curve analysis, the cut-off value for PNI of 48.6 has 80% specificity and 81% sensitivity in predicting CIN (area under the ROC curve (AUC): .87, 95% CI [.84–.89]). PNI <48.6 (odds ratio (OR): 6.765, P < .001), pre-procedural creatinine levels (OR: 6.223, P < .001), left ventricular ejection fraction (LVEF) (OR: .960, P < .001), age (OR: 1.025, P = .005), diabetes mellitus (DM) (0R: 1.768, P = .006), contrast amount (OR: 1.003, P = .038), and having STEMI (OR: .594, P = .029) were found independently associated with CIN. PNI is a strong independent predictor of CIN in ACS patients.

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

“…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.…”

“…There was a trend of an association between a relatively higher incidence of CIN and small-scale studies (i.e., number of patients fewer than 1,000) ( Table 1 ). Seven studies provided information on the risk of CIN in patients with a low and high PNI ( 7 , 9 , 11 , 15 , 18 , 19 , 21 ). The cut-off values for this binary variable are shown in Table 1 .…”

“…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).…”

“…Several risk factors including older age, hemodynamic instability, pre-existing renal failure, diabetes mellitus (DM), heart failure, and the volume of contrast media have been reported to be linked to the development of CIN ( 3 ). On the other hand, malnutrition, which is commonly observed in critically ill patients and known to tightly correlate with acute kidney injury, has not been well studied ( 7 – 9 ). Among different assessments of nutritional status, the prognostic nutritional index (PNI), calculated based on the serum albumin concentration and peripheral blood lymphocyte count, is a reliable indicator of nutritional and immune status ( 9 – 11 ).…”