Prognostic nutritional index predicts clinical outcome in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Chen, Qingjie; Qu, Hui-Juan; Li, Dongze; Li, Xiaomei; Zhu, Jiajun; Xiang, Yang; Li, Lei; Ma, Yun; Yang, Yi‐Ning

doi:10.1038/s41598-017-03364-x

Cited by 84 publications

(95 citation statements)

References 41 publications

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“…Furthermore, our study is the first to reveal higher mortality among AMI with PEM in the United States. These findings are consistent with the result from the KAMIR‐based study mentioned above and other Asian studies that have used hypoalbuminemia, waist‐to‐hip ratio, body mass index, or other computed measures of nutrition as a surrogate for malnutrition among patients with ST‐elevated AMI undergoing PCI. Our results also concur with studies of PEM in other conditions such as heart failure, acute ischemic stroke, sepsis, hip fractures, and PEM among patients hospitalized in a general medical and surgical floor .…”

Section: Discussionsupporting

confidence: 89%

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

Adejumo

Adegbala

et al. 2019

J Parenter Enteral Nutr

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Background Protein‐energy malnutrition (PEM) diminishes amino acid and energy availability, impairing the body's healing capability after injury, such as in myocardial damage following acute myocardial infarction (AMI). Aims We sought to investigate the influence of PEM on clinical outcomes of AMI. Methods We identified records with a primary discharge diagnosis of AMI from the Nationwide Inpatient Sample (2012–2014), stratified by concomitant PEM. We matched PEM to no‐PEM (1:1) using a greedy algorithm–based propensity methodology and estimated the impact of PEM on health outcomes (SAS 9.4). Results Of the 332,644 hospitalizations for AMI, 11,675 had concomitant PEM accounting for roughly $US 1.5 billion and over 119,792 hospital days. PEM was associated with older age (74.43‐ vs. 66.90‐years; P < 0.0001), female sex (49.19% vs. 38.44%; P < 0.0001), black race (12.78% vs. 10.46%; P < 0.0001), and higher comorbidity burden (Deyo > 3: 32.77% vs. 16.69%; P < 0.0001). After propensity matching, PEM was associated with higher mortality (Adjusted odds ratio [AOR]: 1.59 [1.46–1.73]), cardiogenic shock (AOR: 2.26 [2.08–2.44]), discharge to secondary facilities (AOR: 2.21 [2.10–2.33]), charges ($135,500 [$131,956–139,139] vs. $81,084 [$79,241–82,970]), cardiac artery bypass surgery (AOR:1.81 [1.66–1.97]), intra‐aortic balloon pump placement (AOR: 1.83 [1.65–2.04]) and longer length of stay (10.15‐ vs. 5.52‐days). Conclusions PEM is a predisposing factor for devastating clinical outcomes among AMI hospitalizations. Higher prevention, identification and management of PEM among high‐risk individuals (older age, female sex, and black race) residing in the community are needed.

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Section: Discussionsupporting

confidence: 89%

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

Adejumo

Adegbala

et al. 2019

J Parenter Enteral Nutr

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“…PNI was initially reported to be an effective predictor for postoperative complications after surgery (7) and was considered as a predictive nutritional marker for various malignant diseases, such as breast cancer, esophageal cancer, gastric cancer, and so on (8)(9)(10). Besides, some studies have demonstrated that as a nutritional marker, PNI was related to the clinical prognosis of patients with cardiovascular diseases, including coronary atherosclerotic heart disease (CAD) and heart failure (11,12). It is not a rare condition for AIS patients to suffer from malnutrition: the prevalence of undernutrition was around 33% for acute stroke patients at admission (13,14).…”

Section: Discussionmentioning

confidence: 99%

Prognostic Nutritional Index for Predicting 3-Month Outcomes in Ischemic Stroke Patients Undergoing Thrombolysis

Xiang

Chen

et al. 2020

Front. Neurol.

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Objective: Malnutrition has been reported to be related to adverse prognosis in acute ischemic stroke (AIS) patients. Unfortunately, traditional nutritional assessment tools usually increase the workload of neurologists, which makes them unfeasible in the daily clinic work. We aimed to elucidate the association between the prognostic nutritional index (PNI), an easily obtainable baseline nutritional marker, and 3-month outcomes in AIS patients receiving intravenous thrombolysis (IVT). Research methods and procedures: The present study retrospectively included 405 patients. PNI was calculated as 5 * lymphocyte count (10 9 /L) + serum albumin concentration (g/L), and the good prognosis was defined as modified Rankin Scale score of 0-3. The relationship between PNI and clinical parameters was evaluated. The multiple logistic regression model was performed to find out independent predictors of the 3-month outcomes. Results: We found that the patients in the low PNI group had a higher frequency of anemia (12.9 vs. 2.3%, P < 0.001) and a higher level of the Controlling nutritional status (CONUT) score (P < 0.001). The relationship between PNI and nutrition-related factors, such as body mass index (r = 0.208, P = 0.001), age (r = −0.329, P < 0.001), total cholesterol (r = 0.268, P < 0.001) and hemoglobin concentration (r = 0.328, P < 0.001), was significant. Low PNI value (adjusted odds ratio: 2.250, confidence interval: 1.192-4.249, p = 0.012) stayed as an independent predictor for the poor outcome at three months, after adjustment for potential confounders. Conclusions: The PNI was independently associated with 3-month outcomes in AIS patients undergoing IVT. As an easily obtainable nutritional marker, PNI may be a useful nutritional assessment tool in the clinic work.

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“…These nutritional assessment tools showed prognostic value in patients with malignancy, heart failure, peripheral arterial disease and coronary artery disease [8][9][10][11]. Various studies have shown PNI to be a promising means of risk stratification for stable coronary artery disease (CAD) and acute ST-elevation myocardial infarction (STEMI) patients [11,12]. However, research was lacking in the utility of the CONUT score for the purposes of assessing clinical outcomes in CAD patients.…”

Section: Introductionmentioning

confidence: 99%

Association between Preoperative Nutritional Status and Clinical Outcomes of Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

Chen

Yang

et al. 2020

Nutrients

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Background: Malnutrition is associated with poor outcomes in patients with cancer, heart failure and chronic kidney disease. This study aimed to investigate the predictive value of the Controlling Nutritional Status (CONUT) score in coronary artery disease (CAD) patients. Methods: We recruited a cohort of 3118 patients with CAD undergoing percutaneous coronary intervention (PCI) from 2005 to 2015. Nutritional status was evaluated using the CONUT score, with higher scores reflecting worse nutritional status. Results: After adjustment for comorbidities and medication, an increased CONUT score was independently associated with a higher risk of acute myocardial infarction (AMI) (HR: 1.13; 95% CI: 1.03–1.24), cardiovascular (CV) death (HR: 1.18; 95% CI: 1.07–1.30), congestive heart failure (CHF) (HR: 1.11; 95% CI: 1.04–1.18), a major adverse cardiovascular event (MACE) (HR: 1.14; 95% CI: 1.07–1.22), and total CV events (HR: 1.11; 95% CI: 1.07–1.15). The subgroup analyses demonstrated that the association of the CONUT score existed independently of other established cardiovascular risk factors. In addition, CONUT significantly improved risk stratification for myocardial infarction (MI), cardiac death, CHF, MACEs and total CV events compared to conventional risk factors in CAD patients by the significant increase in the C-index (p < 0.05) and reclassification risk categories in cardiac death and MACEs. Conclusions: The CONUT score improved the risk prediction of adverse events compared to traditional risk factors in CAD patients after percutaneous coronary intervention (PCI).

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Prognostic nutritional index predicts clinical outcome in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention

Cited by 84 publications

References 41 publications

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

Inferior Outcomes of Patients With Acute Myocardial Infarction and Comorbid Protein‐Energy Malnutrition

Prognostic Nutritional Index for Predicting 3-Month Outcomes in Ischemic Stroke Patients Undergoing Thrombolysis

Association between Preoperative Nutritional Status and Clinical Outcomes of Patients with Coronary Artery Disease Undergoing Percutaneous Coronary Intervention

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