Prognostic nutritional index as a marker in heart surgical patients: a systematic review

Authors

DOI:

https://doi.org/10.33448/rsd-v11i9.32106

Keywords:

Intraoperative Complications; Thoracic Surgery; Heart Diseases; Nutritional Status; Intraoperative complications.

Abstract

Background: Until now, technological advances and new surgical methods have been insufficient to reduce the elevated risk of mortality and morbidity in patients undergoing cardiac surgery. It is known that preoperative malnutrition is correlated with morbidity, mortality, hospital admission and quality of life after surgery. The prognostic nutritional index (PNI) is calculated from serum albumin levels and peripheral lymphocyte counts. Studies have shown that a low PNI is an independent short-term and long-term adverse prognostic factor. Objective: To assess whether the nutritional prognostic index is a good prognostic marker to predict complications and death in cardiac surgical patients. Methodology: A systematic review was carried out in PubMed, Lilacs and SciELO databases, with the following descriptors: prognostic nutritional index and cardiac and surgery. Articles that evaluated the PNI and complications, including death, in cardiac surgical patients were chosen. Results: Nineteen publications were analyzed and included in the systematic review, of which 13 were prospective observational studies and 6 were retrospective observational studies. Of these studies, 9 were comparisons with other indices, 4 on PNI and postoperative complications and 6 on PNI and mortality, most of the studies demonstrate that the PNI is a useful tool to point out mortality and postoperative complications. Conclusion: The results suggest that the PNI is a useful tool to point out the risk of death and complications in the postoperative period of cardiac surgeries, but a common cut-off point for surgery has not yet been established.

References

Açıkel, M. E. T., & Korkut, A. K. (2019). Impact of Controlling Nutritional Status Score (CONUT) and Prognostic Nutritional Index (PNI) on Patients Undergoing Coronary Artery Bypass Graft Surgery. The Heart Surgery Forum, 22(4), E294–E297. https://doi.org/10.1532/hsf.2493

Allard, J. P., Keller, H., Jeejeebhoy, K. N., Laporte, M., Duerksen, D. R., Gramlich, L., Payette, H., Bernier, P., Davidson, B., Teterina, A., & Lou, W. (2016). Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study. Clinical Nutrition, 35(1), 144–152. https://doi.org/10.1016/j.clnu.2015.01.009

Bayram, Z., Efe, S. Ç., Karagöz, A., Doğan, C., Güvendi, B., Uysal, S., Akbal, Ö. Y., Yılmaz, F., Tokgöz, H. C., Acar, R. D., Kirali, M. K., Kaymaz, C., & Özdemir, N. (2022). Prognostic Impact of Nutritional Indices in Candidates for Heart Transplantation. Turk Kardiyoloji Dernegi Arsivi: Turk Kardiyoloji Derneginin Yayin Organidir, 50(2), 92–100. https://doi.org/10.5543/tkda.2022.21126

Birkmeyer, J. D., Stukel, T. A., Siewers, A. E., Goodney, P. P., Wennberg, D. E., & Lucas, F. L. (2003). Surgeon Volume and Operative Mortality in the United States. New England Journal of Medicine, 349(22), 2117–2127. https://doi.org/10.1056/NEJMsa035205

Buzby, G. P., Mullen, J. L., Matthews, D. C., Hobbs, C. L., & Rosato, E. F. (1980). Prognostic nutritional index in gastrointestinal surgery. The American Journal of Surgery, 139(1), 160–167. https://doi.org/10.1016/0002-9610(80)90246-9

Cai, Z., Tu, J., Xu, L., Lin, Y., Deng, B., Li, F., Chen, S., & Dong, N. (2022). Combining Prognostic Nutritional Index and Brain Natriuretic Peptide as a Predicting Tool for Heart Transplantation. Journal of Cardiovascular Development and Disease, 9(2), 40. https://doi.org/10.3390/jcdd9020040

Cho, J. S., Shim, J.-K., Kim, K.-S., Lee, S., & Kwak, Y.-L. (2021). Impact of preoperative nutritional scores on 1-year postoperative mortality in patients undergoing valvular heart surgery. The Journal of Thoracic and Cardiovascular Surgery, S0022-5223(20)33454-1. https://doi.org/10.1016/j.jtcvs.2020.12.099

Cooper, W. A., O’Brien, S. M., Thourani, V. H., Guyton, R. A., Bridges, C. R., Szczech, L. A., Petersen, R., & Peterson, E. D. (2006). Impact of Renal Dysfunction on Outcomes of Coronary Artery Bypass Surgery. Circulation, 113(8), 1063–1070. https://doi.org/10.1161/CIRCULATIONAHA.105.580084

Daly, L. E., Lonergan, M., & Graham, I. (1993). Predicting operative mortality after coronary artery bypass surgery in males. QJM: An International Journal of Medicine, 86(12), 771–778. https://doi.org/10.1093/oxfordjournals.qjmed.a068760

Felpel, K., Palmese, L., Urrutia, L., Zhang, Z., Shapero, M., Esbenshade, J., Hamid, S., & Vest, M. T. (2021). Nutritional assessment and comparison of nutritional indices in predicting adverse outcomes in patients undergoing left ventricular assist device implantation. Nutrition (Burbank, Los Angeles County, Calif.), 89, 111287. https://doi.org/10.1016/j.nut.2021.111287

Fortescue, E. B., Kahn, K., & Bates, D. W. (2001). Development and validation of a clinical prediction rule for major adverse outcomes in coronary bypass grafting∗∗A list of the members of the Academic Medical Center Consortium Quality Measurement and Management Initiative Working Group appears in the Appendix. The American Journal of Cardiology, 88(11), 1251–1258. https://doi.org/10.1016/S0002-9149(01)02086-0

Gucu, A., Ozluk, O. A., Guvenc, O., Sunbul, S. Ah., & Engin, M. (2021). The Importance of Prognostic Nutritional Index in Predicting Acute Renal Failure After On-Pump Coronary Artery Bypass Operations in Patients with Insulin-Dependent Diabetes Mellitus. The Heart Surgery Forum, 24(4), E651–E655. https://doi.org/10.1532/hsf.3859

Gucu, A., Ozluk, O. A., Sunbul, S. A., Engin, M., Seker, I. B., & Sunbul, A. (2021). Prognostic nutritional index as a marker of mortality: An observational cohort study of patients undergoing cardiac surgery. Reviews in Cardiovascular Medicine, 22(2), 499–503. https://doi.org/10.31083/j.rcm2202057

Gürbak, İ., Güner, A., Güler, A., Şahin, A. A., Çelik, Ö., Uzun, F., Onan, B., & Ertürk, M. (2021). Prognostic influence of objective nutritional indexes on mortality after surgical aortic valve replacement in elderly patients with severe aortic stenosis (from the nutrition-SAVR trial). Journal of Cardiac Surgery, 36(6), 1872–1881. https://doi.org/10.1111/jocs.15434

Hannan, E. L., Racz, M. J., Walford, G., Jones, R. H., Ryan, T. J., Bennett, E., Culliford, A. T., Isom, O. W., Gold, J. P., & Rose, E. A. (2005). Long-Term Outcomes of Coronary-Artery Bypass Grafting versus Stent Implantation. New England Journal of Medicine, 352(21), 2174–2183. https://doi.org/10.1056/NEJMoa040316

Hattler, B. G., Madia, C., Johnson, C., Armitage, J. M., Hardesty, R. L., Kormos, R. L., Pham, S. M., Payne, D. N., & Griffith, B. P. (1994). Risk stratification using the society of thoracic surgeons program. The Annals of Thoracic Surgery, 58(5), 1348–1352. https://doi.org/10.1016/0003-4975(94)91911-9

Hill, A., Nesterova, E., Lomivorotov, V., Efremov, S., Goetzenich, A., Benstoem, C., Zamyatin, M., Chourdakis, M., Heyland, D., & Stoppe, C. (2018). Current Evidence about Nutrition Support in Cardiac Surgery Patients—What Do We Know? Nutrients, 10(5), 597. https://doi.org/10.3390/nu10050597

Iwasa, M., Ogoshi, S., Kitagawa, S., Ohmori, Y., Iwasa, Y., Mizobuchi, S., Tamiya, T., & Isono, K. (1988). Effect of Preoperative Hyperalimentation for Patients with Esophageal Cancer and Usefulness of the Nutritional Assessment Index. Em J. R. Siewert & A. H. Hölscher (Orgs.), Diseases of the Esophagus (p. 264–267). Springer. https://doi.org/10.1007/978-3-642-86432-2_60

Jeon, H. G., Choi, D. K., Sung, H. H., Jeong, B. C., Seo, S. I., Jeon, S. S., Choi, H.-Y., & Lee, H. M. (2016). Preoperative Prognostic Nutritional Index is a Significant Predictor of Survival in Renal Cell Carcinoma Patients Undergoing Nephrectomy. Annals of Surgical Oncology, 23(1), 321–327. https://doi.org/10.1245/s10434-015-4614-0

Koch, C. G., Li, L., Kaplan, G. A., Wachterman, J., Shishehbor, M. H., Sabik, J., & Blackstone, E. H. (2010). Socioeconomic Position, Not Race, Is Linked to Death After Cardiac Surgery. Circulation: Cardiovascular Quality and Outcomes, 3(3), 267–276. https://doi.org/10.1161/CIRCOUTCOMES.109.880377

Kos, M., Titiz, H., Onec, B., Soysal, T., Kutlucan, A., Emen, S. S., & Kutlucan, L. (2016). Association of “controlling nutritional status index” and “prognostic nutritional index” with intensive care unit survival in elderly patients. European Geriatric Medicine, 7(1), 13–17.

Kucukosmanoglu, M., Kilic, S., Urgun, O. D., Sahin, S., Yildirim, A., Sen, O., & Kurt, İ. H. (2021). Impact of objective nutritional indexes on 1-year mortality after transcatheter aortic valve implantation: A prospective observational cohort study. Acta Cardiologica, 76(4), 402–409. https://doi.org/10.1080/00015385.2020.1747177

Kulier, A., Levin, J., Moser, R., Rumpold-Seitlinger, G., Tudor, I. C., Snyder-Ramos, S. A., Moehnle, P., & Mangano, D. T. (2007). Impact of Preoperative Anemia on Outcome in Patients Undergoing Coronary Artery Bypass Graft Surgery. Circulation, 116(5), 471–479. https://doi.org/10.1161/CIRCULATIONAHA.106.653501

Kurumisawa, S., & Kawahito, K. (2018). Risk analysis using the prognostic nutritional index in hemodialysis-dependent patients undergoing cardiac surgery. Journal of Artificial Organs: The Official Journal of the Japanese Society for Artificial Organs, 21(4), 443–449. https://doi.org/10.1007/s10047-018-1056-z

La Rovere, M. T., Maestri, R., Olmetti, F., Paganini, V., Riccardi, G., Riccardi, R., Pinna, G. D., & Traversi, E. (2017). Additional predictive value of nutritional status in the prognostic assessment of heart failure patients. Nutrition, Metabolism and Cardiovascular Diseases, 27(3), 274–280. https://doi.org/10.1016/j.numecd.2016.09.009

Larsson, J., Akerlind, I., Permerth, J., & Hörnqvist, J. O. (1994). The relation between nutritional state and quality of life in surgical patients. The European Journal of Surgery = Acta Chirurgica, 160(6–7), 329–334.

Lee, S. I., Ko, K.-P., Choi, C. H., Park, C.-H., Park, K. Y., & Son, K. H. (2020). Does the prognostic nutritional index have a predictive role in the outcomes of adult cardiac surgery? The Journal of Thoracic and Cardiovascular Surgery, 160(1), 145-153.e3. https://doi.org/10.1016/j.jtcvs.2019.08.069

Lin, Y., Chen, Q., Peng, Y., Chen, Y., Huang, X., Lin, L., Zhang, X., & Chen, L.-W. (2021). Prognostic nutritional index predicts in-hospital mortality in patients with acute type A aortic dissection. Heart & Lung: The Journal of Critical Care, 50(1), 159–164. https://doi.org/10.1016/j.hrtlng.2020.06.004

Lomivorotov, V. V., Efremov, S. M., Boboshko, V. A., Nikolaev, D. A., Vedernikov, P. E., Deryagin, M. N., Lomivorotov, V. N., & Karaskov, A. M. (2013). Prognostic value of nutritional screening tools for patients scheduled for cardiac surgery†. Interactive CardioVascular and Thoracic Surgery, 16(5), 612–618. https://doi.org/10.1093/icvts/ivs549

Lomivorotov, V. V., Efremov, S. M., Boboshko, V. A., Nikolaev, D. A., Vedernikov, P. E., Lomivorotov, V. N., & Karaskov, A. M. (2013). Evaluation of nutritional screening tools for patients scheduled for cardiac surgery. Nutrition, 29(2), 436–442. https://doi.org/10.1016/j.nut.2012.08.006

Mas-Peiro, S., Hoffmann, J., Seppelt, P. C., De Rosa, R., Murray, M.-I., Walther, T., Zeiher, A. M., Fichtlscherer, S., & Vasa-Nicotera, M. (2021). Value of prognostic nutritional index for survival prediction in trans-catheter aortic valve replacement compared to other common nutritional indexes. Acta Cardiologica, 76(6), 615–622. https://doi.org/10.1080/00015385.2020.1757854

Moher, D., Liberati, A., Tetzlaff, J., & Altman, D. G. (2009). Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement. The BMJ, 339, b2535. https://doi.org/10.1136/bmj.b2535

Mori, S., Usami, N., Fukumoto, K., Mizuno, T., Kuroda, H., Sakakura, N., Yokoi, K., & Sakao, Y. (2015). The significance of the prognostic nutritional index in patients with completely resected non-small cell lung cancer. PloS one, 10(9), e0136897.

Nashef, S. A. M., Roques, F., Michel, P., Gauducheau, E., Lemeshow, S., Salamon, R., & the EuroSCORE study group. (1999). European system for cardiac operative risk evaluation (EuroSCORE). European Journal of Cardio-Thoracic Surgery, 16(1), 9–13. https://doi.org/10.1016/S1010-7940(99)00134-7

Öcal, L., Küp, A., Keskin, M., Cerşit, S., Çelik, M., Eren, H., Gürsoy, M. O., Öztürkeri, B., Öztürk, B., & Turkmen, M. M. (2020). Prognostic significance of pre-procedural prognostic nutritional index in patients with carotid artery stenting. Journal of Stroke and Cerebrovascular Diseases: The Official Journal of National Stroke Association, 29(8), 104932. https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.104932

O’Connor, G. T., Morton, J. R., Diehl, M. J., Olmstead, E. M., Coffin, L. H., Levy, D. G., Maloney, C. T., Plume, S. K., Nugent, W., & Malenka, D. J. (1993). Differences between men and women in hospital mortality associated with coronary artery bypass graft surgery. The Northern New England Cardiovascular Disease Study Group. Circulation, 88(5), 2104–2110. https://doi.org/10.1161/01.CIR.88.5.2104

Okada, S., Shimada, J., Kato, D., Tsunezuka, H., Teramukai, S., & Inoue, M. (2017). Clinical significance of prognostic nutritional index after surgical treatment in lung cancer. The Annals of thoracic surgery, 104(1), 296–302.

Okuno, T., Koseki, K., Nakanishi, T., Sato, K., Ninomiya, K., Tomii, D., Tanaka, T., Sato, Y., Horiuchi, Y., Koike, H., Yahagi, K., Komiyama, K., Tanaka, J., Aoki, J., Yokozuka, M., Miura, S., & Tanabe, K. (2019). Evaluation of objective nutritional indexes as predictors of one-year outcomes after transcatheter aortic valve implantation. Journal of Cardiology, 74(1), 34–39. https://doi.org/10.1016/j.jjcc.2019.02.017

Onodera, T., Goseki, N., & Kosaki, G. (1984). Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkai Zasshi, 85(9), 1001–1005.

Panç, C., Yılmaz, E., Gürbak, İ., Uzun, F., & Ertürk, M. (2020). Effect of prognostic nutritional index on short-term survival after transcatheter aortic valve implantation. Turk Kardiyoloji Dernegi Arsivi: Turk Kardiyoloji Derneginin Yayin Organidir, 48(6), 585–593. https://doi.org/10.5543/tkda.2020.97709

Peng, D., Gong, Y., Hao, H., He, Z., Li, X., Zhang, C., & Zhou, L. (2017). Preoperative Prognostic Nutritional Index is a Significant Predictor of Survival with Bladder Cancer after Radical Cystectomy: A retrospective study. BMC Cancer, 17(1), 391. https://doi.org/10.1186/s12885-017-3372-8

Piggott, K. D., Liu, A., Monczka, J., Fakioglu, H., Narasimhulu, S. S., Pourmoghadam, K., & DeCampli, W. (2018). Inadequate preoperative nutrition might be associated with acute kidney injury and greater illness severity postoperatively. The Journal of Thoracic and Cardiovascular Surgery, 155(5), 2104–2109. https://doi.org/10.1016/j.jtcvs.2017.12.080

Ribeiro, A. L. P., Gagliardi, S. P. L., Nogueira, J. L. S., Silveira, L. M., Colosimo, E. A., & Nascimento, C. A. L. do. (2006). Mortality related to cardiac surgery in Brazil, 2000-2003. The Journal of Thoracic and Cardiovascular Surgery, 131(4), 907–909. https://doi.org/10.1016/j.jtcvs.2005.11.022

Stoppe, C., Goetzenich, A., Whitman, G., Ohkuma, R., Brown, T., Hatzakorzian, R., Kristof, A., Meybohm, P., Mechanick, J., Evans, A., Yeh, D., McDonald, B., Chourdakis, M., Jones, P., Barton, R., Tripathi, R., Elke, G., Liakopoulos, O., Agarwala, R., & Heyland, D. K. (2017). Role of nutrition support in adult cardiac surgery: A consensus statement from an International Multidisciplinary Expert Group on Nutrition in Cardiac Surgery. Critical Care, 21(1), 131. https://doi.org/10.1186/s13054-017-1690-5

Sun, K., Chen, S., Xu, J., Li, G., & He, Y. (2014). The prognostic significance of the prognostic nutritional index in cancer: A systematic review and meta-analysis. Journal of Cancer Research and Clinical Oncology, 140(9), 1537–1549. https://doi.org/10.1007/s00432-014-1714-3

Tasbulak, O., Guler, A., Duran, M., Sahin, A., Bulut, U., Avci, Y., Demir, A. R., Kahraman, S., Aydin, U., & Ertürk, M. (2021). Association Between Nutritional Indices and Long-Term Outcomes in Patients Undergoing Isolated Coronary Artery Bypass Grafting. Cureus, 13(7), e16567. https://doi.org/10.7759/cureus.16567

Tóth, K., Szabó, A., Menyhárd, J., Benke, K., Radovits, T., Pólos, M., Merkely, B., Gál, J., & Székely, A. (2022). Poor Preoperative Nutritional Status, but Not Hormone Levels, Are Associated With Mortality After Cardiac Surgery. Journal of Cardiothoracic and Vascular Anesthesia, 36(8 Pt B), 3074–3083. https://doi.org/10.1053/j.jvca.2022.04.035

Tranfield, D., Denyer, D., & Smart, P. (2003). Towards a methodology for developing evidence-informed management knowledge by means of systematic review. British Journal Management, 14,207-222. DOI: https://doi.org/10.1111/1467-8551.00375

Yost, G., Tatooles, A., & Bhat, G. (2018). Preoperative Nutritional Assessment with the Prognostic Nutrition Index in Patients Undergoing Left Ventricular Assist Device Implantation. ASAIO Journal (American Society for Artificial Internal Organs: 1992), 64(1), 52–55. https://doi.org/10.1097/MAT.0000000000000625

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16/07/2022

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QUEIROZ, B. G. S. S.; SANTOS, A. C. O. dos; SILVA, F. N. B. da .; ARRUDA, A. M. de; ALVES, J. F. N.; CAVALCANTE, . T. C. F.; SILVA, A. A. M. da. Prognostic nutritional index as a marker in heart surgical patients: a systematic review . Research, Society and Development, [S. l.], v. 11, n. 9, p. e50611932106, 2022. DOI: 10.33448/rsd-v11i9.32106. Disponível em: https://www.rsdjournal.org/index.php/rsd/article/view/32106. Acesso em: 20 apr. 2024.

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Vol. 11 No. 9

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Health Sciences

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Copyright (c) 2022 Barbara Giovanna Souza Silva Queiroz; Ana Célia Oliveira dos Santos; Fabiana Nogueira Benedito da Silva; Andressa Maranhão de Arruda; Juliana Fonseca Nogueira Alves; Taisy Cinthia Ferro Cavalcante; Amanda Alves Marcelino da Silva

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