Kurumisawa Soki, Kawahito Koji
Department of Cardiovascular Surgery, Jichi Medical University, Yakushiji 3311-1, Shimotsuke, Tochigi, 329-0498, Japan.
J Artif Organs. 2018 Dec;21(4):443-449. doi: 10.1007/s10047-018-1056-z. Epub 2018 Jun 27.
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.
预后营养指数是一种用于胃肠外科手术的有效预后工具。然而，其在心血管外科手术中的价值尚未得到验证。本研究旨在探讨其在接受心脏手术的依赖血液透析患者中的效用。我们回顾性分析了2006年1月至2016年7月期间110例接受心脏手术的依赖血液透析患者的数据。评估了20个变量以预测短期和长期死亡率。患者被分为预后营养指数高组和低组，其值分别>34（n = 90）和≤34（n = 20）。比较了两组的术前特征和手术结果。总体而言，住院死亡率为9%（n = 10），1年、3年和5年的实际生存率分别为69%、58%和40%。对医院死亡的单因素分析显示，年龄≥70岁、体重指数≤18kg/m、总胆固醇≤120mg/dl、同期手术、白蛋白浓度≤3.0g/dl和预后营养指数≤34为危险因素。多因素logistic回归分析证实年龄≥70岁和同期手术为独立危险因素。而射血分数≤30%和预后营养指数≤34是长期死亡的强有力独立预测因素。预后营养指数低组患者术后住院时间明显延长、并发症发生率更高、住院死亡率明显更高且实际生存率明显更低。低预后营养指数影响了接受心脏手术的依赖血液透析患者的手术结果。基于预后营养指数的围手术期营养管理可能会改善手术结果。
