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Published on: September 22, 2020
Prognostic Nutritional Index as a New Prediction Tool for All-Cause Mortality in Patients with Chronic
Onur Erdogan1, Tugba Erdogan2, Cafer Panc1
1Department of Cardiology, University of Health Sciences Türkiye, Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Türkiye.
Insights
The Prognostic Nutritional Index (PNI) is linked to higher mortality in Chronic Limb-Threatening Ischemia (CLTI) patients undergoing endovascular therapy. Lower PNI scores indicate an increased risk of death in CLTI patients.
Area of Science:
- Vascular Surgery
- Cardiology
- Nutritional Science
Background:
- Chronic Limb-Threatening Ischemia (CLTI) is a severe form of peripheral artery disease, leading to amputation, reduced quality of life, and increased mortality.
- The Prognostic Nutritional Index (PNI), derived from albumin and lymphocyte counts, reflects a patient's nutritional and immunological status.
- Assessing prognostic markers is crucial for managing CLTI patients.
Purpose of the Study:
- To evaluate the association between Prognostic Nutritional Index (PNI) levels and mortality in patients with CLTI who underwent endovascular therapy.
- To identify PNI as a potential predictor of outcomes in CLTI.
Main Methods:
- A retrospective study included 113 patients with CLTI undergoing endovascular therapy (EVT).
- Patients were categorized into survivor and non-survivor groups.
- Logistic and Cox regression analyses, along with Kaplan-Meier survival curves, were used to assess mortality predictors and the relationship between PNI and survival.
Main Results:
- The non-survivor group was older and had a higher prevalence of comorbidities like chronic renal failure and congestive heart failure.
- A lower median PNI was observed in non-survivors compared to survivors (p=0.012).
- Low PNI was independently associated with increased mortality (HR=0.931, p=0.035), with a PNI cut-off of 37.009 showing predictive value for all-cause mortality (AUC=0.642).
Conclusions:
- The Prognostic Nutritional Index is an independent predictor of mortality in patients with CLTI.
- Higher PNI levels correlate with improved survival in this patient population.
- PNI can serve as a valuable tool for risk stratification in CLTI patients undergoing endovascular treatment.
Objectives:
Chronic Limb-Threatening Ischemia (CLTI) represents a complex manifestation of peripheral artery disease distinguished by symptoms such as ischemic rest pain, non-healing ulcers on the lower limb or foot, and the development of gangrene. CLTI is associated with a high risk of limb amputation, decreased quality of life, and substantial morbidity and mortality. The Prognostic Nutritional Index (PNI), which is calculated using albumin and lymphocyte levels, reflects the immunological and nutritional status. The objective of this study was to investigate the correlation between PNI levels and mortality among patients diagnosed with CLTI who underwent endovascular therapy.
Methods:
Individuals diagnosed with CLTI who received endovascular therapy below the knee in our tertiary care center were enrolled in this retrospective study. The patients were divided into two groups: survivors and non-survivors. Logistic regression analyses were performed to detect independent predictors of mortality and using Cox regression model, we assessed the relationship between PNI and mortality. Survival curves were estimated using the Kaplan-Meier method.
Results:
The study comprised 113 patients diagnosed with PAD who underwent EVT. The non-survivor group (42 patients) was older (62.9±10.9 vs. 67.7±9.9, p=0.045) and had a higher prevalence of chronic renal failure (22.5% vs. 42.9%, p=0.023) and congestive heart failure (8.5% vs. 21.4%, p:0.049) than the survivor group (71 patients). The median PNI value was lower in the non-survivor group than in the survivor group (35.9±5 vs 38.2±4.4, p=0.012). Cox regression analyses showed that Low PNI was associated with increased mortality (HR=0.931, CI=0.872-0.995, p=0.035). PNI cut-off of 37.009 showed 64.3% sensitivity, 64.8% specificity, and AUC of 0.642 for predicting all-cause mortality. Kaplan-Meier analysis supported higher PNI correlating with better survival.
Conclusion:
The Prognostic Nutritional Index was independently associated with mortality among individuals diagnosed with Chronic Limb-Threatening Ischemia.
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