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Yilmaz S, Zengin S, Dulger AC. Effects of Preoperative Nutritional Status and Lymphocyte Count on the Development of Early-term Atrial Fibrillation After Coronary Artery Bypass Grafting: A Retrospective Study. Braz J Cardiovasc Surg 2024; 39:e20230366. [PMID: 38748866 PMCID: PMC11099827 DOI: 10.21470/1678-9741-2023-0366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/31/2023] [Indexed: 05/19/2024] Open
Abstract
INTRODUCTION Although there are publications in the literature stating that parameters related to the nutritional status of patients are associated with the clinical outcomes of those with coronary artery disease, it is also stated that there is insufficient data on the relationship between nutritional indices and long-term outcomes and major adverse cardiovascular events in patients undergoing isolated coronary artery bypass grafting. METHODS This retrospective study was conducted with patients who underwent isolated elective on-pump coronary artery bypass grafting in our hospital. Patients who underwent emergency coronary artery bypass grafting or those with known atrial fibrillation in the preoperative period were excluded. Patients were analyzed and compared in two groups according to the development of postoperative atrial fibrillation. RESULTS The data of 93 coronary artery bypass grafting patients (71 [76%] males) with a mean age of 62.86 ± 9.53 years included in the study were evaluated. Both groups had similar preoperative ejection fraction value, hemoglobin level, age, number of distal bypasses, and postoperative mortality rates. Although the mean cardiopulmonary bypass and aortic cross-clamping times were higher in Group 1, they were not statistically significant. In our study, the mean prognostic nutrition index value was 51.76 ± 3002. CONCLUSION According to our study results, there was no statistically significant difference between prognostic nutrition index values and the development of atrial fibrillation after coronary artery bypass grafting, which is similar to some publications in the literature. We think that it would be beneficial to conduct randomized studies involving more patients on this subject.
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Affiliation(s)
- Seyhan Yilmaz
- Department of Cardiovascular Surgery, Giresun University Faculty of
Medicine, Giresun, Turkey
| | - Sabür Zengin
- Department of Cardiovascular Surgery, Giresun University Faculty of
Medicine, Giresun, Turkey
| | - Ahmet Cumhur Dulger
- Department of Gastroenterology, Giresun University Faculty of
Medicine, Giresun, Turkey
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Li Y, Wang Z, Sun T, Zhang B, Liang X. Geriatric nutritional risk index was associated with in-hospital mortality among cardiac intensive care unit patients. Front Nutr 2023; 10:1218738. [PMID: 37645626 PMCID: PMC10462258 DOI: 10.3389/fnut.2023.1218738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/21/2023] [Indexed: 08/31/2023] Open
Abstract
Background Identifying risk factors associated with cardiac intensive care unit (CICU) patients' prognosis can help clinicians intervene earlier and thus improve their prognosis. The correlation between the geriatric nutrition risk index (GNRI), which reflects nutritional status, and in-hospital mortality among CICU patients has yet to be established. Method The present study retrospectively enrolled 4,698 CICU patients. Based on the nutritional status, the participants were categorized into four groups. The primary endpoint was in-hospital mortality. The length of hospital stay and length of CICU stay were the secondary endpoints. To explore the correlation between nutritional status and in-hospital mortality, a logistic regression analysis was conducted. The nonlinear associations of GNRI with in-hospital mortality were evaluated using restricted cubic spline (RCS). Furthermore, subgroup analyses were conducted to evaluate the effect of the GNRI on in-hospital mortality across different subgroups, with calculation of the p for interaction. Result A higher risk of malnutrition was significantly linked to an increased incidence of in-hospital mortality (High risk vs. No risk: 26.2% vs. 4.6%, p < 0.001), as well as a longer length of hospital stay (High risk vs. No risk: 15.7, 9.1-25.1 vs. 8.9, 6.9-12.9, p < 0.001) and CICU stay (High risk vs. No risk: 6.4, 3.8-11.9 vs. 3.2, 2.3-5.1, p < 0.001). An elevated GNRI was significantly associated with an increased risk of in-hospital mortality even after controlling for pertinent confounding factors (High risk vs. No risk: OR, 95% CI: 2.37, 1.67-3.37, p < 0.001, p for trend <0.001). Additionally, the RCS model showed a linear relationship between GNRI and in-hospital mortality, with the risk of in-hospital mortality significantly decreasing as GNRI increased (non-linear p = 0.596). Furthermore, in the subgroups of hypertension, ventricular arrhythmias, cardiac arrest, shock, and chronic kidney disease, there was a significant interaction between nutritional status and in-hospital mortality. Conclusion Among CICU patients, a low GNRI was a significant predictor of in-hospital mortality. Furthermore, patients with a higher risk of malnutrition, as indicated by low GNRI values, experienced significantly longer hospital and CICU stays.
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Affiliation(s)
- Yuefeng Li
- The First People’s Hospital of Yulin, Yulin, Guangxi, China
| | - Zhengdong Wang
- The First People’s Hospital of Yulin, Yulin, Guangxi, China
| | - Tienan Sun
- Department of Cardiology, Affiliated Anzhen Hospital, Capital Medical University, Beijing, China
| | - Biyang Zhang
- Department of Cardiology, Affiliated Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xiangwen Liang
- The First People’s Hospital of Yulin, Yulin, Guangxi, China
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Almohammadi AA, Alqarni MA, Alqaidy MY, Ismail SA, Almabadi RM. Impact of the Prognostic Nutritional Index on Postoperative Outcomes in Patients Undergoing Heart Surgery. Cureus 2023; 15:e43745. [PMID: 37727198 PMCID: PMC10506361 DOI: 10.7759/cureus.43745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/18/2023] [Indexed: 09/21/2023] Open
Abstract
Background Malnutrition is associated with adverse outcomes in patients undergoing cardiac surgery. The prognostic nutritional index (PNI) is a validated tool for assessing nutritional status in cardiovascular diseases. This study aims to evaluate the prognostic value of PNI in heart surgery patients, including mortality rate, length of hospital and ICU stays, and infection rate, while investigating correlations with demographic and clinical characteristics. Methods A retrospective cross-sectional study was conducted in King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia. Data from electronic medical records of patients undergoing heart surgery between 2019 and 2021 were retrospectively reviewed. The study involved patients with valvular heart disease, including those requiring concomitant procedures. Statistical analysis was conducted using t-tests, logistic regression, and Kaplan-Meier survival curve analysis. Results This study included 264 individuals with a mean age of 56.48±12.11 years. The prevalence of low PNI was 50.80% and high PNI was 49.20%. No significant differences in PNI levels were found between individuals with various clinical conditions, except for target vessel revascularization. The mortality rate was slightly higher in the low PNI group, but not statistically significant. Significant differences in laboratory findings were observed between high and low PNI groups. Individuals with low PNI had longer hospital stays. Conclusion Lower PNI levels consistently correlate with longer hospital stays and higher morbidity and mortality rates, suggesting the potential importance of PNI and other nutritional markers in assessing risk and predicting outcomes in cardiac surgery patients.
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Affiliation(s)
| | - Maha A Alqarni
- Nutrition and Dietetics, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Marwah Y Alqaidy
- Nutrition and Dietetics, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Sarah A Ismail
- Nutrition and Dietetics, King Fahad Armed Forces Hospital, Jeddah, SAU
| | - Reem M Almabadi
- Nutrition and Dietetics, King Fahad Armed Forces Hospital, Jeddah, SAU
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Sun T, Ma M, Huang X, Zhang B, Chen Z, Zhao Z, Zhou Y. Prognostic impacts of geriatric nutritional risk index in patients with ischemic heart failure after percutaneous coronary intervention. Clin Nutr 2023; 42:1260-1267. [PMID: 37343410 DOI: 10.1016/j.clnu.2023.05.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 04/25/2023] [Accepted: 05/29/2023] [Indexed: 06/23/2023]
Abstract
BACKGROUND Malnutrition has been proven to be associated with increased risk of poor prognosis in a series of diseases. This study explored the association between poor nutritional status and prognosis in patients with ischemic heart failure (IHF) undergoing percutaneous coronary intervention (PCI). METHODS The study enrolled 1745 patients with IHF undergoing PCI. The mean follow-up time was 28.7 months. Nutritional status was assessed by geriatric nutritional risk index (GNRI). All patients were divided into four groups according to GNRI quartiles (median and interquartile range: 103.8, 99.9-107.7). The primary endpoint was major adverse cardiovascular events (MACE), and the secondary endpoints were each component of the primary endpoint as follows: all-cause mortality, non-fatal myocardial infarction (MI), and any revascularization. The Kaplan-Meier survival analyses were performed to evaluate the incidence of the endpoints among 4 groups. The multivariate Cox proportional hazards analysis confirmed the independent effect of GNRI on the primary endpoint and secondary endpoints. The restricted cubic spline (RCS) was performed to evaluate the non-linear association of GNRI with MACE. RESULT The negative correlation of the GNRI with MACE (Log-rank P < 0.001), all-cause mortality (Log-rank P < 0.001) and any revascularization (Log-rank P < 0.001) was confirmed through the Kaplan-Meier curves. Multivariate analysis showed that the decreased GNRI was independently related to increased risk of MACE (Quartile 1 versus Quartile 4: HR, 95% CI: 2.66, 2.01-3.51, P < 0.001), all-cause mortality (Quartile 1 versus Quartile 4: HR, 95% CI: 2.33, 1.54-3.50, P < 0.001) and any revascularization (Quartile 1 versus Quartile 4: HR, 95% CI: 3.42, 2.22-5.27, P < 0.001). In addition, the non-linear association of GNRI with MACE was shown through RCS and the risk of MACE decreased as the GNRI increased in general (Non-linear P < 0.001). CONCLUSION Decreased GNRI was an independent risk factor of MACE in IHF patients undergoing PCI.
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Affiliation(s)
- Tienan Sun
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Meishi Ma
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Xin Huang
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Biyang Zhang
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Zheng Chen
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Zehao Zhao
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China
| | - Yujie Zhou
- Department of Cardiology, Capital Medical University Affiliated Anzhen Hospital, Beijing 100089, China.
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Zhang S, Wang H, Chen S, Cai S, Zhou S, Wang C, Ni X. Prognostic nutritional index and prognosis of patients with coronary artery disease: A systematic review and meta-analysis. Front Nutr 2023; 10:1114053. [PMID: 37006923 PMCID: PMC10061069 DOI: 10.3389/fnut.2023.1114053] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/24/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundThis review assessed if prognostic nutritional index (PNI) can predict mortality and major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.MethodsPubMed, Web of Science, Scopus, and Embase were searched up to 1st November 2022 for all types of studies reporting adjusted associations between PNI and mortality or MACE in CAD patients. A random-effect meta-analysis was conducted for PNI as categorical or continuous variable. Subgroup analysis were conducted for multiple confounders.ResultsFifteen studies with 22,521 patients were included. Meta-analysis found that low PNI was a significant predictor of mortality in CAD patients as compared to those with high PNI (HR: 1.67 95% CI: 1.39, 2.00 I2 = 95% p < 0.00001). Increasing PNI scores were also associated with lower mortality (HR: 0.94 95% CI: 0.91, 0.97 I2 = 89% p = 0.0003). Meta-analysis demonstrated that patients with low PNI had significantly higher incidence of MACE (HR: 1.57 95% CI: 1.08, 2.28 I2 = 94% p = 0.02) and increasing PNI was associated with lower incidence of MACE (HR: 0.84 95% CI: 0.72, 0.92 I2 = 97% p = 0.0007). Subgroup analyses showed mixed results.ConclusionMalnutrition assessed by PNI can independently predict mortality and MACE in CAD patients. Variable PNI cut-offs and high inter-study heterogeneity are major limitations while interpreting the results. Further research focusing on specific groups of CAD and taking into account different cut-offs of PNI are needed to provide better evidence.Systematic Review RegistrationNo CRD42022365913 https://www.crd.york.ac.uk/prospero/.
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Affiliation(s)
- Shengjing Zhang
- Department of Geriatrics, Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Wenzhou, China
| | - Huanfen Wang
- Department of Geriatrics, Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Wenzhou, China
| | - Saiya Chen
- Department of Geriatrics, Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Wenzhou, China
| | - Shengsheng Cai
- Department of Geriatrics, Affiliated Wenzhou Hospital of Traditional Chinese Medicine, Zhejiang Chinese Medical University, Wenzhou, China
| | - Shigeng Zhou
- Department of Geriatrics, Wenzhou Geriatric Hospital, Wenzhou, China
| | - Congling Wang
- Department of Geriatrics, Wenzhou Geriatric Hospital, Wenzhou, China
| | - Xiuyuan Ni
- Department of Geriatrics, Wenzhou Geriatric Hospital, Wenzhou, China
- *Correspondence: Xiuyuan Ni,
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Bayram M, Duman ZM, Timur B, Aksu T, Yaşar E, Güneysu E, Buğra AK, Yalçın L, Polat M, Coşkun H, Gürsoy M, Aydın Ü. Prognostic values of the C-reactive protein to albumin ratio and prognostic nutritional index in carotid endarterectomy patients. Vascular 2022:17085381221111015. [PMID: 35739066 DOI: 10.1177/17085381221111015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES C-reactive protein to albumin ratio (CAR) and prognostic nutritional index (PNI) are novel parameters with proven prognostic importance in the postoperative outcomes of coronary and peripheral vascular diseases. In this study, we aimed to evaluate the ability of CAR and PNI to predict major cardiac and cerebrovascular events (MACCE) during the postoperative period of Carotid artery endarterectomy (CEA). METHODS A total of 505 carotid endarterectomy patients were retrospectively evaluated. Of 505 patients, 23 patients who died and who experienced myocardial infarction or major neurologic complication in the first 30 days after the operation were included in MACCE group (Group 1). The remaining 482 patients were included in Group 2. Receiver operating characteristics (ROC) curve analysis was used to evaluate preoperative serum albumin value, lymphocytes count, PNI, and CAR to predict the MACCE. The DeLong test was used to compare the area below the curve (AUC) with each of these parameters. RESULTS CAR (2.48 ± 1.82 and 1.64 ± 1.37) and CRP (9.98 ± 7.42 and 6.81 ± 5.70) values are statistically higher in Group 1 than in Group 2. PNI (41.59 ± 3.11 and 43.54 ± 4.20) and albumin (40.43 ± 3.15 and 42.35 ± 4.15) values were significantly lower in Group 1 than in Group 2. The accuracy of albumin (AUC: 0.669) in the prediction of MACCE was found to be the highest among CAR (AUC: 0.631), PNI (AUC:0.667), and CRP (AUC:0.631). CONCLUSION Preoperative nutritional and inflammatory status is significantly associated with post-operative outcomes. PNI and CAR can be used for preoperative evaluation, as CEA is recommended for patients who have low possibility of having postoperative major adverse events.
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Affiliation(s)
- Muhammed Bayram
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Zihni M Duman
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Barış Timur
- Department of Cardiovascular Surgery, 187456Istanbul DR. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey
| | - Timuçin Aksu
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Emre Yaşar
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Elif Güneysu
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Abdül Kerim Buğra
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Lokman Yalçın
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Mücahit Polat
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Hasan Coşkun
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Mete Gürsoy
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
| | - Ünal Aydın
- Department of Cardiovascular Surgery, 111319Cizre State Hospital, Şırnak, Turkey
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Eraslan Doganay G, Ulger G. The Relationship of Nutritional Treatments Applied to Patients in a Nutritional Clinic and Mortality. Cureus 2022; 14:e21579. [PMID: 35233299 PMCID: PMC8880877 DOI: 10.7759/cureus.21579] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2022] [Indexed: 12/13/2022] Open
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Baldemir R, Alagoz A. The Relationship Between Mortality, Nutritional Status, and Laboratory Parameters in Geriatric Chronic Obstructive Pulmonary Disease Patients. Cureus 2021; 13:e20526. [PMID: 35070560 PMCID: PMC8767440 DOI: 10.7759/cureus.20526] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2021] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND In geriatric patients, limitations in physical, mental, and/or social functions occur as a result of acute and/or chronic disease along with age-related degenerative changes. This study aimed to investigate the relationship between nutritional status, mean platelet volume (MPV), C-reactive protein (CRP)-to-albumin ratio (CAR), and mortality in geriatric chronic obstructive pulmonary disease (COPD) patients. METHODS Patients aged 65 years and older who were tertiary state hospitalized with COPD were included in the study. Demographic data of the patients, diagnosis, nutritional risk score-2002 (NRS-2002) score, and body mass index (BMI) were recorded. Glucose, MPV, CRP, albumin, CAR values of the patients, as well as 30-day and 90-day mortality status after nutritional evaluation, were determined. Patients hospitalized for a reason other than COPD, those using anti-inflammatory drugs, patients with missing data, and those in intensive care units were excluded from the study. Patients were divided into two groups based on NRS-2002: NRS-2002; 1 and 2, and NRS-2002; ≥3. RESULTS Four hundred eighteen patients were hospitalized for COPD. Of these patients, 279 were aged 65 and over, but due to missing data, only 261 patients' data were analyzed. The 30-day and 90-day mortality rates were quite high in patients with a diagnosis of COPD who needed nutritional support (37.5% and 49.8%). When the demographic data and laboratory values of the patients are examined according to the 30-day and 90-day mortality status, the MPV value is statistically significantly higher in those with mortality at the end of 90 days (p < 0.05). Despite the fact that the NRS-2002 ≥3 group had higher 30-day and 90-day mortality rates than the NRS-2002 1 or 2 groups, there was no statistically significant difference between the groups (p > 0.05). CONCLUSIONS As a result, 90-day mortality was observed in approximately half of the patients, and the majority of these patients were male. Parameters that could predict 30-day and 90-day mortality could not be determined without MPV. Inflammatory parameters such as MPV can guide the determination of nutritional needs, especially in geriatric patients with COPD. Because of the high mortality rates in geriatric patients with COPD who need nutritional support, nutritional support should be started without delay in these patients. There is a need for prospective randomized controlled multicenter studies on this subject.
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Affiliation(s)
- Ramazan Baldemir
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
| | - Ali Alagoz
- Anesthesiology and Reanimation, University of Health Sciences, Ankara Atatürk Chest Diseases and Thoracic Surgery Training and Research Hospital, Ankara, TUR
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