D'Alonzo Michele, Massimo Baudo, Fiore Antonio, Capussela Jacopo, Abrami Gianluca, Folliguet Thierry, Muneretto Claudio
Cardiac Surgery Department, "Spedali Civili" Hospital, University of Brescia, Brescia, Italy.
Cardiac Surgery Department, "Henri Mondor" Hospital, University of Paris East, Creteil, France.
Indian J Thorac Cardiovasc Surg. 2025 May;41(5):532-540. doi: 10.1007/s12055-024-01891-7. Epub 2025 Jan 14.
The Prognostic Nutritional Index (PNI), calculated using serum albumin levels and blood lymphocyte count, reflects a patient's nutritional and immune status. It is commonly used as a prognostic tool following oncological surgery and in certain cardiovascular conditions. This study aims to assess whether the PNI can also serve as a prognostic indicator in patients undergoing surgical aortic valve replacement (SAVR).
A total of 471 low-risk patients with EuroSCORE II (European System for Cardiac Operative Risk Evaluation II) of ≤4%, who underwent isolated SAVR, were retrospectively analysed. Patients were divided into two groups based on their PNI values (cut-off, 46.75). Outcomes such as length of hospital stay, 30-day mortality, 1-year survival, and rehospitalization rates were compared between the groups.
The Low PNI group consisted of 116 patients, while the High PNI group included 355 patients. The latter were younger, but both groups had comparable comorbidities. All patients underwent SAVR with a bioprosthesis. There was no significant difference in 30-day mortality between the groups (Low PNI, 2.6% vs. High PNI, 0.9%, = 0.162). However, the 1-year survival rate was significantly lower in the Low PNI group (Low PNI, 5.2 ± 4.1% vs. High PNI, 1.7 ± 1.3%, = 0.039). Additionally, the 1-year rehospitalization rate was significantly higher in the Low PNI group (Low PNI, 13.8 ± 6.3% vs. High PNI, 7.7 ± 2.7%, = 0.040). Multivariate analysis identified PNI as a protective factor, while mechanical ventilation was associated with increased risk of death or rehospitalization at 1-year after SAVR.
The PNI is an inexpensive, accessible, and reliable tool that can be easily integrated into existing risk stratification scores for SAVR.
The online version contains supplementary material available at 10.1007/s12055-024-01891-7.
使用血清白蛋白水平和血液淋巴细胞计数计算的预后营养指数（PNI）反映了患者的营养和免疫状况。它常用于肿瘤手术后及某些心血管疾病的预后评估。本研究旨在评估PNI是否也可作为接受外科主动脉瓣置换术（SAVR）患者的预后指标。
对471例接受单纯SAVR且欧洲心脏手术风险评估系统II（EuroSCORE II）≤4%的低风险患者进行回顾性分析。根据PNI值（临界值为46.75）将患者分为两组。比较两组患者的住院时间、30天死亡率、1年生存率和再住院率等结局指标。
低PNI组有116例患者，高PNI组有355例患者。后者年龄较轻，但两组的合并症情况相当。所有患者均接受了生物瓣膜的SAVR手术。两组间30天死亡率无显著差异（低PNI组为2.6%，高PNI组为0.9%，P = 0.162）。然而，低PNI组的1年生存率显著较低（低PNI组为5.2±4.1%，高PNI组为1.7±1.3%，P = 0.039）。此外，低PNI组的1年再住院率显著较高（低PNI组为13.8±6.3%，高PNI组为7.7±2.7%，P = 0.040）。多因素分析确定PNI为保护因素，而机械通气与SAVR术后1年死亡或再住院风险增加相关。
PNI是一种廉价、易于获取且可靠的工具，可轻松纳入现有的SAVR风险分层评分中。
在线版本包含可在10.1007/s12055-024-01891-7获取的补充材料。
