Risk analysis using the prognostic nutritional index in hemodialysis-dependent patients undergoing cardiac surgery

Abstract

The prognostic nutritional index is an effective prognostic tool used in gastrointestinal surgeries. However, its value has not been verified in cardiovascular surgeries. This study aimed to investigate its utility in hemodialysis-dependent patients undergoing cardiac surgery. We retrospectively reviewed data of 110 hemodialysis-dependent patients who underwent cardiac surgery between January 2006 and July 2016. 20 variables were evaluated for short- and long-term mortality prediction. Patients were divided into high and low prognostic nutritional index groups with values > 34 (n = 90) and ≤ 34 (n = 20), respectively. Preoperative characteristics and surgical outcomes were compared between both groups. Overall, the in-hospital mortality rate was 9% (n = 10) and the 1-, 3-, and 5-year actual survival rates were 69%, 58%, and 40%, respectively. Univariate analysis for hospital death revealed age ≥ 70 years, body mass index ≤ 18 kg/m, total cholesterol ≤ 120 mg/dl, concomitant procedures, albumin concentration ≤ 3.0 g/dl, and prognostic nutritional index ≤ 34 as risk factors. Multivariate logistic regression analysis confirmed age ≥ 70 years and concomitant procedures as independent risk factors. Whereas ejection fraction ≤ 30% and prognostic nutritional index ≤ 34 were strong independent predictors of long-term death. Patients in the low prognostic nutritional index group had significantly longer postoperative hospitalization, higher incidence of complications, significantly higher in-hospital mortality rate, and significantly lower actual survival rate. The low prognostic nutritional index affected surgical outcomes in hemodialysis-dependent patients undergoing cardiac surgery. Perioperative nutrition management based on the prognostic nutritional index may improve surgical outcomes.

Prognostic nutritional index may not be a good prognostic indicator for acute myocardial infarction

“…In 1984, Onodera simplified the linear predictive model using immune-nutritional indicators according to the following equation: PNI = SA (g/L) + (5 × total lymphocyte count [TLC] × 10 9 /L). This study showed that the model could be used safely when PNI was over 45 9 , but some reports showed that the optimal cut-off value of PNI is variable 10,11 . PNI was used to prognosticate various malignancies 12–16 , pulmonary embolism 17 , and other diseases.…”

Prognostic influence of objective nutritional indexes on mortality after surgical aortic valve replacement in elderly patients with severe aortic stenosis (from the nutrition‐SAVR trial)

“…PNI score, which has a better predictive value than albumin levels alone, is primarily used in the follow-up of patients with gastrointestinal malignancies, over the time it has been introduced as a prognostic predictor for many chronic diseases, especially for cardiovascular diseases. 17,21,28,32,33 Previously, Lee et al 34 reported that 374 patients who underwent coronary artery bypass surgery, PNI score ≤ 46.1 was found significantly higher short-term adverse events including morbidity, mortality, and ICU stay. 32 In 2019, Okuno et al 32 indicated that low PNI scores were a significant predictor of long-term mortality in patients undergoing TAVR.…”

“…According to the results of our study, the all‐cause mortality rate after SAVR appears to be higher in patients with low albumin levels. PNI score, which has a better predictive value than albumin levels alone, is primarily used in the follow‐up of patients with gastrointestinal malignancies, over the time it has been introduced as a prognostic predictor for many chronic diseases, especially for cardiovascular diseases 17,21,28,32,33 . Previously, Lee et al 34 reported that 374 patients who underwent coronary artery bypass surgery, PNI score ≤ 46.1 was found significantly higher short‐term adverse events including morbidity, mortality, and ICU stay 32 .…”

Prognostic Value of Pre-Treatment Prognostic Nutritional Index in Esophageal Cancer: A Systematic Review and Meta-Analysis

“…In general, our results indicated that patients with poor PNI value would have a high risk of post-operation complications which would shorten the OS time of the cancer patients. Moreover, poor nutritional and immune status could make cancer patients unable to tolerate post-operative adjuvant therapy (41). As a consequence, patients abandon post-operative adjuvant therapy, which shorten the survival time and make patients have a poor quality of life.…”