Dolapoglu Ahmet, Avci Eyup, Kiris Tuncay, Bugra Onursal
Department of Cardiovascular Surgery, Medical School, Balikesir University Tip Fakultesi, 10145, Balikesir, Turkey.
Department of Cardiology, Medical School, Balikesir University, 10145, Balikesir, Turkey.
J Cardiothorac Surg. 2019 Apr 11;14(1):74. doi: 10.1186/s13019-019-0898-7.
We aimed to investigate the predictive value of the prognostic nutritional index (PNI) regarding the development of acute kidney injury (AKI) after elective coronary artery bypass grafting (CABG).
A total of 336 consecutive patients with normal serum creatinine levels undergoing CABG were enrolled in this retrospective study. AKI was defined as meeting Acute Kidney Injury Network (AKIN) criteria based on the occurrence of creatinine changes within the first 48 h after CABG surgery. The patients were grouped according to whether they developed AKI or not into an AKI (-) and an AKI (+) group.
AKI developed in 88 (26.2%) of all patients. The PNI was independently predictive of AKI (OR: 0.829, 95% CI: 0.783-0.877, p < 0.001). Moreover, C-reactive protein (CRP), a history of diabetes mellitus, and positive inotropric usage were independent risk factors for AKI in the multivariate logistic regression analysis. The area under the curve (AUC) of the multivariable model, including positive inotrope support, a history of diabetes mellitus, and CRP, was 0.693 (95% CI: 0.626-0.760, p < 0.001) in predicting AKIN. When the PNI was added to the multivariable model, the AUC was 0.819 (95% CI, 0.762-0.865, z = 3.777, difference p = 0.0002). Also, the addition of the PNI to the multivariable model was associated with a significant net reclassification improvement estimated at 88.2% (p < 0.001) and an integrated discrimination improvement of 0.22 (p < 0.001).
Our study demonstrated that decreasing the PNI could be associated with the development of AKI after coronary artery bypass surgery.
我们旨在研究预后营养指数（PNI）对择期冠状动脉旁路移植术（CABG）后急性肾损伤（AKI）发生的预测价值。
本回顾性研究纳入了336例血清肌酐水平正常且连续接受CABG的患者。AKI定义为根据CABG手术后48小时内肌酐变化情况符合急性肾损伤网络（AKIN）标准。根据患者是否发生AKI将其分为AKI（-）组和AKI（+）组。
所有患者中有88例（26.2%）发生AKI。PNI是AKI的独立预测指标（OR：0.829，95%CI：0.783 - 0.877，p < 0.001）。此外，在多因素逻辑回归分析中，C反应蛋白（CRP）、糖尿病病史和使用正性肌力药物是AKI的独立危险因素。包括使用正性肌力药物支持、糖尿病病史和CRP的多变量模型预测AKIN的曲线下面积（AUC）为0.693（95%CI：0.626 - 0.760，p < 0.001）。当将PNI添加到多变量模型中时，AUC为0.819（95%CI，0.762 - 0.865，z = 3.777，差异p = 0.0002）。此外，将PNI添加到多变量模型中与显著的净重新分类改善相关，估计为88.2%（p < 0.001），综合鉴别改善为0.22（p < 0.001）。
我们的研究表明，冠状动脉旁路手术后PNI降低可能与AKI的发生有关。
