The predictive value of the prognostic nutritional index for contrast-induced nephropathy

Abstract

This study aims to evaluate the association between prognostic nutritional index (PNI) and contrast-induced nephropathy (CIN).Material and methods: A total of 251 patients who were at high risk for contrast nephropathy were included in the study. The patients were grouped according to their PNI score (PNI score <45 or PNI score ≥45). CIN was defined as a 25% relative increase, or 0.5 mg/dL absolute increase in serum creatinine level above baseline within 72 hours of contrast exposure, in the absence of an alternative explanation.Results: Two groups were assigned according to the PNI score. The first group consists of 111 patients (PNI<45) and the second group has 140 patients (PNI≥45). CIN developed in 162 (%64.8) patients. C-reactive protein was higher in the low-PNI group. Also, the patients with the low-PNI group had lower ejection fraction, lower serum albumin levels, and lower hemoglobin levels. CIN, postprocedure renal replacement therapy requirement and in-hospital mortality were higher in the low PNI group. Multivariable logistic regression analysis revealed that advanced age (p=0.012, [OR] = 1.044 [1.009-1.079]), low baseline GFR (p=0.033, [OR]= 1.022 [1.002-1.043]), high amount of contrast media (p=0.022, [OR]= 1.017 [1.002-1.031]), and low PNI score (p=0.033 , [OR]= 2.069 [1.060-4.039]) were independent predictors of CIN.Conclusion: Our study demonstrated that the PNI score was an independent risk factor for the development of CIN.

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

“…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 – 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.…”

“…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 ).…”

“…The quality of studies based on NOS is demonstrated in Table 1 . Six studies were considered to have a low risk of bias (range of total stars: 7–9) ( 7 , 9 , 17 – 19 , 21 ), while four were judged to be of low quality (range of total stars: 4–6) ( 11 , 15 , 16 , 20 ).…”