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Prognostic Nutritional Index (PNI) As a Preoperative Screening Tool in Predicting Clinical Outcomes of Postoperative
Satbir Kaur1, Himani Pandya2, Gargee Bhatt1
1Department of Anesthesia, U. N. Mehta Institute of Cardiology and Research Centre, Ahmedabad, India.
Insights
Preoperative Onodera's prognostic nutrition index (PNI) effectively predicts longer intensive care unit and hospital stays in pediatric patients after congenital heart surgery. Lower PNI indicates increased postoperative morbidity, highlighting its clinical utility.
Area of Science:
- Pediatric Cardiac Surgery
- Nutritional Assessment
- Surgical Outcomes
Background:
- Postoperative outcomes in pediatric cardiac surgery are influenced by various factors.
- Nutritional status is increasingly recognized as a critical determinant of surgical recovery.
- Predictive tools for identifying at-risk pediatric patients are essential for optimizing care.
Purpose of the Study:
- To evaluate the predictive role of nutritional indices, including Onodera's prognostic nutrition index (PNI) and World Health Organization (WHO)-based anthropometrics, for postoperative outcomes in infants undergoing congenital heart defect surgery.
- To assess the correlation between these nutritional markers and surgical complexity with clinical outcomes such as length of stay and mechanical ventilation duration.
Main Methods:
- A prospective observational study enrolled 108 pediatric patients (<18 months) post-cardiac surgery.
- Onodera's PNI, WHO-based anthropometric measurements (weight-for-age Z-score), and perioperative albumin levels were analyzed.
- Outcomes assessed included intensive care unit (ICU) stay, hospital stay, and mechanical ventilation duration.
Main Results:
- A significant negative correlation was observed between lower PNI and increased length of ICU and hospital stays (P=.019 and P<.001, respectively).
- Patients in the low PNI group experienced significantly longer mechanical ventilation times, ICU stays, and hospital stays (P=.03, P=.01, P≤.001).
- Lower weight-for-age Z-scores were significantly associated with low PNI, even after adjusting for albumin and C-reactive protein (OR=1.411, P=.004).
Conclusions:
- Preoperative Onodera's PNI is a valuable and efficient tool for predicting postoperative clinical morbidity in pediatric patients undergoing congenital heart surgery.
- Nutritional assessment, particularly PNI, should be integrated into the preoperative evaluation to identify high-risk infants.
- Early identification of patients with low PNI can facilitate targeted interventions to improve surgical outcomes.
Abstract:
ObjectiveThe authors sought to evaluate the role of nutritional indices such as Onodera's prognostic nutrition index (PNI), World Health Organization (WHO)-based anthropometric measurements such as weight for age (w/a), height for age, weight for height, and perioperative serum albumin levels in the determination of postoperative clinical outcomes in pediatric patients who undergo surgery for congenital cardiac defects and surgical complexity (risk-adjusted congenital heart surgery score) and its correlation with postoperative course.Material and MethodsIn this prospective observational study, 108 post-pediatric cardiac surgery patients under the age of 18 months were enrolled between January 2023 and August 2023. Through receiver operating characteristic curve analysis we have found the cutoff value for PNI is ≤66.5 and >66.5. The above mentioned parameters were analyzed for postoperative clinical outcomes such as length of intensive care unit (ICU) stay, length of hospital stay, and duration of mechanical ventilation.ResultsSignificant negative correlation was found between length of ICU stay and hospital stay with lower PNI (P = .019 and <.001, respectively.). Analysis of low versus high PNI groups was suggestive of a remarkable increase in mechanical ventilation time (P = .03), length of ICU stay (0.01), and hospital stay (P ≤ .001) in the low PNI group. Lower WHO-based w/a Z score was found to be significantly associated with low PNI (<66.5), after adjusting for preoperative albumin, postoperative albumin drop, and C-reactive protein (odds ratio = 1.411 per unit 0.28 increment in W/azs, P = .004).ConclusionPreoperative Onoderas PNI is an effective and efficient tool for predicting postoperative clinical morbidity in pediatric patients undergoing congenital heart surgery.
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