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Published on: March 27, 2018
Prognostic nutritional index and long-term outcomes after coronary artery bypass grafting
Haichang Xu1, Weiqiang Li1, Shen-An-Nan Chen1
1Department of Cardiothoracic and Vascular Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, 330006, China.
Insights
Preoperative prognostic nutritional index (PNI) is linked to worse outcomes in patients undergoing coronary artery bypass grafting (CABG). Lower PNI predicts higher risks of major adverse cardiovascular events (MACE) and mortality after CABG surgery.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Nutritional Science
Background:
- Coronary heart disease (CHD) patients undergoing coronary artery bypass grafting (CABG) face risks of major adverse cardiovascular events (MACE) and mortality.
- The prognostic nutritional index (PNI) is a nutritional marker that may reflect patient health status.
- Evaluating preoperative PNI's role in predicting long-term outcomes after CABG is crucial for risk stratification.
Purpose of the Study:
- To investigate the association between preoperative prognostic nutritional index (PNI) and long-term outcomes in patients with coronary heart disease (CHD) undergoing coronary artery bypass grafting (CABG).
- To assess the relationship between PNI and major adverse cardiovascular events (MACE), all-cause mortality, and cardiovascular mortality post-CABG.
Main Methods:
- A single-center retrospective cohort study of 550 patients with CHD who underwent CABG.
- Prognostic nutritional index (PNI) was analyzed as a continuous variable and in tertiles.
- Multivariable Cox models, Kaplan-Meier, and receiver operating characteristic (ROC) analyses were used to assess associations with outcomes.
- Subgroup, sensitivity, and comparative analyses with Geriatric Nutritional Risk Index (GNRI) and EuroSCORE II were performed.
Main Results:
- Higher preoperative PNI was independently associated with significantly lower risks of MACE, all-cause mortality, and cardiovascular mortality after CABG.
- Patients in the highest PNI tertile had reduced risks of MACE and cardiovascular mortality compared to the lowest tertile.
- PNI showed modest discriminatory performance for predicting outcomes, with higher PNI correlating with better long-term prognosis.
Conclusions:
- Lower preoperative PNI is associated with increased long-term risks of MACE and mortality following CABG.
- The findings suggest PNI as a potential prognostic indicator in CABG patients.
- Caution is advised due to the study's retrospective nature and PNI's limited discriminatory power.
Aims:
This study examined whether preoperative prognostic nutritional index (PNI) was related to long-term major adverse cardiovascular events (MACE), all-cause mortality, and cardiovascular mortality in patients with coronary heart disease (CHD) undergoing coronary artery bypass grafting (CABG).
Methods:
This single-center retrospective cohort study analyzed 550 patients with CHD who underwent CABG at the First Affiliated Hospital of Nanchang University between January 2014 and August 2025. PNI was treated as both a continuous variable and tertiles. Multivariable Cox models were used to evaluate its associations with study outcomes, and Kaplan-Meier as well as receiver operating characteristic (ROC) analyses were additionally performed. Subgroup analyses, a sensitivity analysis excluding patients with chronic kidney disease (CKD), and supplementary comparisons with the Geriatric Nutritional Risk Index (GNRI) and EuroSCORE II were also undertaken.
Results:
Over a median follow-up of 46.1 months, 113 patients developed MACE, 94 died from any cause, and 61 died from cardiovascular causes. After multivariable adjustment, higher PNI remained independently related to lower risks of MACE (HR per 1-unit increase: 0.948, 95% CI 0.917-0.979; P = 0.001), all-cause mortality (HR 0.938, 95% CI 0.904-0.973; P < 0.001), and cardiovascular mortality (HR 0.939, 95% CI 0.900-0.980; P = 0.004). Patients in the highest tertile had lower risks of MACE and cardiovascular mortality than those in the lowest tertile. Similar overall patterns were observed in subgroup, quartile, and sensitivity analyses. Although PNI was significantly correlated with all three outcomes, its discriminatory performance was modest (AUCs: 0.596 for MACE, 0.616 for all-cause mortality, and 0.608 for cardiovascular mortality). GNRI and EuroSCORE II yielded numerically higher AUC values, and the combination of PNI with EuroSCORE II also showed a numerical improvement, but none of these differences reached statistical significance.
Conclusion:
Lower preoperative PNI corresponded to higher long-term risks of MACE, all-cause mortality, and cardiovascular mortality after CABG. However, these findings should be interpreted cautiously due to the single-center retrospective design and the limited discriminatory performance of PNI.
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