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Published on: February 2, 2021
Prognostic Nutritional Index Predicts Contrast-Associated Acute Kidney Injury in Patients with ST-Segment Elevation
Alparslan Kurtul1, Murat Gok2, Kerim Esenboga3
1Department of Cardiology, Hatay Mustafa Kemal University Faculty of Medicine, Hatay.
Insights
The prognostic nutritional index (PNI) can predict contrast-associated acute kidney injury (CA-AKI) in ST-elevation myocardial infarction (STEMI) patients undergoing primary percutaneous coronary intervention (PCI). Lower PNI values indicate a higher risk of developing CA-AKI.
Area of Science:
- Cardiology
- Nephrology
- Biochemistry
Background:
- Contrast-associated acute kidney injury (CA-AKI) is a complication in ST-elevation myocardial infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).
- The prognostic nutritional index (PNI), reflecting immunonutritional status, has been linked to outcomes in cardiovascular diseases.
Purpose of the Study:
- To evaluate the prognostic nutritional index (PNI) as a predictor for contrast-associated acute kidney injury (CA-AKI) development.
- To assess the utility of PNI for early risk stratification in STEMI patients undergoing primary PCI.
Main Methods:
- Retrospective analysis of 836 STEMI patients treated with primary PCI.
- Calculation of PNI using serum albumin and lymphocyte count.
- Division of patients into CA-AKI and non-CA-AKI groups.
Main Results:
- The incidence of CA-AKI was 9.4%.
- Patients with CA-AKI had significantly lower PNI values (35.2 ± 4.9) compared to those without (40.7 ± 3.7).
- A PNI cutoff of 38 demonstrated 82% sensitivity and 70% specificity for predicting CA-AKI; PNI < 38 was an independent predictor (OR 11.275).
Conclusions:
- The prognostic nutritional index (PNI) is inversely associated with contrast-associated acute kidney injury (CA-AKI) development in acute STEMI patients.
- PNI assessment upon admission can aid in the early risk stratification of STEMI patients for CA-AKI.
Background:
Contrast-associated acute kidney injury (CA-AKI) previously known as contrast-induced nephropathy is associated with a worse prognosis in patients with acute ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention (PCI). The prognostic nutritional index (PNI) is a simple index comprised of serum albumin level and lymphocyte count which reflects the immunonutritional-inflammatory status. Recently, clinical studies have shown associations between the PNI and clinical outcomes in several cardiovascular diseases. The aim of the study was to assess the possible utilization of the PNI to predict the development of CA-AKI after primary PCI.
Methods:
We retrospectively included 836 patients (mean age 58 ± 12 years, 76% men) with STEMI treated with primary PCI. The PNI was calculated as 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The patients were divided into two groups according to whether or not CA-AKI developed.
Results:
The overall incidence of CA-AKI was 9.4%. Compared to the patients without CA-AKI, those with CA-AKI had a significantly lower PNI value (40.7 ± 3.7 vs. 35.2 ± 4.9; p < 0.001). In receiver operating characteristic curve analysis, the optimal cutoff value of the PNI to predict CA-AKI was 38, with 82% sensitivity and 70% specificity (area under the curve 0.836, p < 0.001). In multivariate logistic regression analysis, PNI < 38, body mass index and creatinine were independently associated with CA-AKI (odds ratio 11.275, 95% confidence interval 3.596-35.351; p < 0.001).
Conclusions:
The PNI was inversely and significantly associated with the development of CA-AKI in acute STEMI. Assessing PNI at admission may be useful for early risk stratification of STEMI patients.
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