Prognostic nutritional index and the risk of acute kidney injury in patients with acute coronary syndrome

Sertdemir, Ahmet Lütfü; İcli, Abdullah; Aribas, Alpay; Tatar, Sefa; Akilli, Nazire Belgin; Alsancak, Yakup; Akilli, Hakan

doi:10.1590/1806-9282.20210460

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Revista da Associação Médica Brasileira

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Original Article • Rev. Assoc. Med. Bras. 67 (8) • Aug 2021 • https://doi.org/10.1590/1806-9282.20210460 copy

Prognostic nutritional index and the risk of acute kidney injury in patients with acute coronary syndrome

Authorship SCIMAGO INSTITUTIONS RANKINGS

SUMMARY

OBJECTIVE

Recent studies have linked malnutrition with undesirable outcomes in cardiovascular diseases. However, the underlying mechanism is unknown. Contrast-induced acute kidney injury (CI-AKI) increased cardiovascular mortality after percutaneous coronary intervention (PCI). This study hypothesizes that prognostic nutritional index (PNI) plays a role in the development of CI-AKI in patients with acute coronary syndrome undergoing emergency PCI.

METHODS

This study enrolled 551 patients. PNI was determined as 10× serum albumin (g/dL)+0.005×total lymphocyte count (mm³). CI-AKI was characterized as the increase in serum creatinine ≥0.3 mg/dL level within 48 h after PCI. Patients were classified as either CI-AKI (+) or CI-AKI (−).

RESULTS

CI-AKI has occurred in 72 of 551 patients (13.1%). PNI was significantly lower in the CI-AKI (+) group than in the CI-AKI (-) group (44.4±6.6 versus 47.2±5.8, p<0.001, respectively). Multivariate logistic regression analysis showed that PNI [odds ratio, OR: 1.631, 95% confidence interval (CI): 1.168–2.308, p=0.02] and estimated glomerular filtration rate (OR: 3.26, 95%CI 1.733–6.143, p<0.001) were independent risk factors for CI-AKI.

CONCLUSIONS

PNI is an independent risk factor for CI-AKI. The development of CI-AKI may be the mechanism responsible for the relationship between poor nutritional status and adverse cardiac events.

KEYWORDS:
Prognostic nutritional index; Acute kidney injury; Acute coronary syndrome; Percutaneous coronary intervention

Characteristics	551 of patients
Age (years)	62.5±10.7
Female, n (%)	204 (37)
Body mass index (kg/m²)	27.6±3.5
Admission heart rate (beats/min)	75.7±15.5
Admission systolic blood pressure (mmHg)	123.8±22.2
Admission diastolic blood pressure (mmHg)	73.4±15.4
Hypertension, n (%)	227 (41.2)
Diabetes mellitus, n (%)	163 (29.6)
Known coronary artery disease, n (%)	110(20.0)
Previous myocardial infarction, n (%)	66 (12.0)
Previous treatments
Acetylsalicylic acid, n (%)	127 (23.0)
β-Blocker, n (%)	67 (12.2)
Angiotensin-aldosterone system antagonists, n (%)	205 (37.2)
Clinical presentation
ST-segment elevation myocardial infarction, n (%)	368 (66.8)
Non-ST-segment elevation myocardial infarction, n (%)	122 (22.1)
Unstable angina pectoris, n (%)	61 (2.9)
Hematocrit (%)	41.1±4.8
Urea (mg/dL) median (interquartile range)	36.2 (17.3
Basal creatinine (mg/dL) median (interquartile range)	0.81 (0.24)
Serum albumin (mg/dL)	3.78±0.46
Prognostic nutritional index	46.8±6.0
Contrast amount (mL) median (interquartile range)	160 (70)
Estimated glomerular filtration rate (mL/min/1.73m²)	89.4±27.1
Left ventricular ejection fraction (%) median (interquartile range)	54 (18)
Transradial approach, n (%)	179 (32.5)
Mehran risk score median (interquartile range)	2.0 (5.0)
Contrast-induced acute kidney injury, n (%)	72 (13.1)
Cardiogenic shock, n (%)	16 (2.9)
Inhospital mortality, n (%)	17 (3.1)

Variables	CI-AKI (-) (n=479)Mean±SD/median (IQR)	CI-AKI (+) (n=72) Mean±SD/median (IQR)	p
Age (years)	62.1±10.7	65.1±10.1	0.02
Female, n (%)	175 (36.5%)	29 (40.3%)	0.54
BMI (kg/m²)	27.5±3.3	27.9±4.2	0.38
Hypertension, n (%)	195 (40.7%)	32 (44.4%)	0.54
Diabetes mellitus, n (%)	138 (28.8%)	25 (34.7%)	0.30
Smoking, n (%)	90 (18.8%)	8 (11.1)	0.03
Heart rate (beats/min)	75.2±15.3	79.2±16.8	0.06
Systolic BP (mmHg)	124.6±21.8	118.1±24.0	0.03
Diastolic BP (mmHg)	73.9±15.3	69.9±16.0	0.05
Previous stent, n (%)	68 (14.2%)	12 (16.7%)	0.57
Previous CABG, n (%)	24 (5.0%)	6 (8.3%)	0.24
Previous MI, n (%)	55 (11.5%)	11 (15.3%)	0.35
Previous treatments
β-Blocker, n (%)	57 (11.9%)	10 (13.9%)	0.63
ACE-İ/ARB, n (%)	177 (37.0%)	28 (38.9%)	0.75
Acetylsalicylic acid, n (%)	110 (23.0%)	17 (23.6%)	0.90
Clinical presentation
STEMI, n (%)	316 (66.0%)	52 (72.2%)	0.55
NSTEMI, n (%)	108 (22.5%)	14 (19.4%)
UAP, n (%)	55 (11.5%)	6 (8.3%)
Transradial approach, n (%)	158 (33.0%)	21 (29.2%)	0.51
Ejection fraction (%)	55 (15)	48 (17.5)	0.004
LVEDD (cm)	4.7±0.6	4.6±0.6	0.79
LVESD (cm)	3.0±0.8	3.1±0.8	0.11
Mehran risk score	2 (5)	5 (5)	<0.001
Glucose (mg/dL)	114 (98–149)	121(101–181)	0.26
Urea (mg/dL)	35.7 (28.7–45.5)	39.4 (30.1–54.4)	0.04
Basal creatinine (mg/dL)	0.80 (0.71–0.92)	0.90 (0.82–1.23)	<0.001
eGFR (mL/min/1.73m²)	91.6±26.5	75.0±27.1	<0.001
Hemoglobin (g/dL)	13.7±1.8	13.4±2.0	0.15
Hematocrit (%)	41.2±4.7	40.1±5.4	0.10
WBC (×10⁹/L)	8.3±2.4	8.0±2.1	0.43
Lymphocyte count (×10⁹/L)	1.8±0.7	1.6±0.6	0.03
Platelet count (×10⁹/L)	245.2±75.2	237.6±85.2	0.43
Total cholesterol (mg/dL)	195.3±47.1	186.1±55.2	0.18
LDL (mg/dL)	120.9±41.1	127.0±45.3	0.25
HDL (mg/dL)	36.9±9.7	34.4±11.3	0.08
Triglyceride (mg/dL)	158 (111–217)	147 (116–188)	0.23
Albumin (g/dL)	3.8±0.4	3.6±0.5	0.007
Prognostic nutritional index	47.2±5.8	44.4±6.6	<0.001
Culprit coronary lesion
Left anterior descending, n (%)	195 (40.7%)	38 (52.8%)	0.09
Circumflex, n (%)	105 (21.9%)	9 (12.5%)
Right, n (%)	171 (35.7%)	20 (27.8%)
Left main, n (%)	1 (0.2%)	1 (1.4%)
Bypass graft, n (%)	7 (1.5%)	4 (5.6%)
Contrast amount (mL)	160(60)	180 (81)	0.01
Hospital stay (day)	3 (2)	4 (3)	0.001
Cardiogenic shock	11 (2.3%)	5 (6.9%)	0.03
Inhospital mortality, n (%)	6 (1.3)	11 (15.3)	<0.001

Variables	Univariate analysis			Multivariate analysis
Variables	OR	(95%CI)	p	OR	(95%CI)	p
Age	2.08	(1.134–3.810)	0.01	1.65	(0.796–3.427)	0.17
Male	0.85	(0.514–1.416)	0.54
Systolic blood pressure	0.59	(0.319–1.093)	0.09	0.57	(0.301–1.105)	0.09
Heart rate	1.69	(0.747–3.819)	0.20	1.01	(0.995–1.027)	0.17
Ejection fraction	2.25	(1.364–3.710)	0.002	2.01	(1.135–3.558)	0.01
Urea	2.01	(1.183–3.435)	0.01	092	(0.467–1.813)	0.81
Basal creatinine	2.50	(1.388–4.515)	0.002	0.91	(0.400–2.089)	0.83
eGFR	3.72	(2.171–6.396)	<0.001	3.26	(1.733–6.143)	<0.001
HDL-C	1.72	(0.982–3.038)	0.07
Prognostic nutritional index	1.74	(1.281–2.708)	0.02	0.28	(1.631–2.308)	0.02
Mehran risk score	1.87	(1.139–3.122)	0.01	0.70	(0.348–1.417)	0.32
Contrast amount	3.38	(1.821–6.274)	<0.001	2.64	(1.582–4.916)	0.01
Cardiogenic shock	3.17	(1.070–9.422)	0.03	0.17	(0.680–9.144)	0.16

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[1] * Corresponding author: dralsertdemir@gmail.com