Özmen Rifat, İpekten Funda, Sarı Gülden, Tunçay Aydın, Özocak Okan, Topçu Fatma Sena, Öztürk Ahmet, Gündoğan Kürşat
Department of Cardiovascular Surgery, Faculty of Medicine, Erciyes University, Kayseri, Turkey.
Department of Biostatistics, Faculty of Medicine, Adıyaman University, Adıyaman, Turkey.
Braz J Cardiovasc Surg. 2025 Mar 18;40(2):e20230503. doi: 10.21470/1678-9741-2023-0503.
Cardiopulmonary bypass is known to be a cause of systemic inflammatory response. The systemic inflammatory response affects albumin and lymphocyte levels and is associated with the development of complications. Serum albumin and lymphocyte concentrations have been used to create inflammation-based risk scores, which predict prognosis in different patient groups. One of these risk scores is called the Prognostic Nutritional Index (PNI). In this study, our objective was to examine how changes in PNI values, measured at different times before and after surgery, impact clinical outcomes and hospital mortality.
One hundred and sixty-four patients were retrospectively scanned and included in the study. Patients were divided into aortic valve replacement (AVR) and mitral valve replacement (MVR) groups. The patient's preoperative and postoperative PNI values were examined. Duration of cross-clamping, cardiopulmonary bypass time, length of hospital and intensive care unit stay, postoperative mortality, atrial fibrillation, and acute kidney injury (AKI) development were evaluated.
Preoperative and second PNI values were lower in the patients that developed AKI and non-survivors. The PNI cutoff value was ≤ 28.01 in non-survivors (P=0.001). In the MVR group, the decrease in PNI value over time was statistically significant (P<0.001). There was a negative correlation between preoperative PNI value and length of stay in intensive care unit, cross-clamping, and cardiopulmonary bypass duration (P<0.05, P<0.01).
A correlation was determined between the PNI value and development of postoperative AKI and mortality. PNI value, an easy method to use, can be used in the follow-up of these patients.
已知体外循环是全身炎症反应的一个原因。全身炎症反应会影响白蛋白和淋巴细胞水平，并与并发症的发生有关。血清白蛋白和淋巴细胞浓度已被用于创建基于炎症的风险评分，以预测不同患者群体的预后。其中一种风险评分称为预后营养指数（PNI）。在本研究中，我们的目的是研究手术前后不同时间测量的PNI值变化如何影响临床结局和医院死亡率。
对164例患者进行回顾性扫描并纳入研究。患者分为主动脉瓣置换术（AVR）组和二尖瓣置换术（MVR）组。检查患者术前和术后的PNI值。评估主动脉阻断时间、体外循环时间、住院时间和重症监护病房停留时间、术后死亡率、房颤和急性肾损伤（AKI）的发生情况。
发生AKI的患者和非幸存者的术前和第二次PNI值较低。非幸存者的PNI临界值≤28.01（P=0.001）。在MVR组中，PNI值随时间的下降具有统计学意义（P<0.001）。术前PNI值与重症监护病房停留时间、主动脉阻断和体外循环持续时间呈负相关（P<0.05，P<0.01）。
确定了PNI值与术后AKI的发生和死亡率之间的相关性。PNI值是一种易于使用的方法，可用于这些患者的随访。
