Abstract

Background

Nutritional status predicts outcomes after TAVR. Predictive value of Prognostic Nutritional Index (PNI) was investigated in patients undergoing TAVR, and compared to other nutritional indexes.

Methods

A cohort of 114 patients undergoing TAVR in a high-volume centre was studied. A prospective 1-year follow-up was completed. PNI was estimated as follows: (10 × serum albumin[g/dl])+(0.005 × total lymphocytes [1000/μl]). One-year survival was compared in patients with PNI above vs below median; Kaplan–Meier curves were created. A multivariate analysis was used to assess predictive value of PNI for 1-year mortality. ROC curves were used to assess discrimination by PNI, and to compare it with Geriatric Nutritional Risk Index (GNRI) and Body Mass Index (BMI).

Results

Mean age was 82.2 years, 59.6% were male. Mean PNI was 46 ± 5. Pre-procedurally, no differences were found between patients with high vs. low PNI. One-year mortality was significantly higher in patients with low PNI values (19/57 vs. 4/57; p < .001). Complications did not differ. A higher PNI predicted 1-year survival, even after adjusting for clinical factors (model 1: HR 0.8, 95% CI 0.7–0.9, p < .0001) and laboratory parameters (NT-proBNP, IL-6, CRP, eGFR, cystatin C, haemoglobin) (model 2: HR 0.8, 95% CI 0.7–0.9, p < .05). ROC curves revealed a stronger predictive value for PNI (AUC 0.80) compared to GNRI (0.77) and BMI (0.6). The optimal cut-off for PNI was 45.

Conclusion

PNI is a useful and practical nutritional marker reflecting malnutrition and inflammation prior to the intervention, and strongly predicts 1-year survival. PNI seems to be a better prognostic marker than BMI or GNRI after TAVR.

中文翻译：

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与其他常见营养指标相比，预后营养指标对经导管主动脉瓣置换术生存预测的价值

摘要

背景

营养状况可预测 TAVR 后的结果。在接受 TAVR 的患者中研究了预后营养指数 (PNI) 的预测价值，并与其他营养指标进行了比较。

方法

研究了在一个高容量中心接受 TAVR 的 114 名患者的队列。完成了一项为期 1 年的前瞻性随访。PNI 估计如下：(10 × 血清白蛋白 [g/dl])+(0.005 × 总淋巴细胞 [1000/μl])。比较了 PNI 高于和低于中位数的患者的一年生存率；创建了 Kaplan-Meier 曲线。多变量分析用于评估 PNI 对 1 年死亡率的预测价值。ROC曲线用于评估PNI的歧视，并将其与老年营养风险指数（GNRI）和体重指数（BMI）进行比较。

结果

平均年龄为 82.2 岁，59.6% 为男性。平均 PNI 为 46 ± 5。在术前，高 PNI 与低 PNI 的患者之间没有发现差异。PNI 值低的患者一年死亡率显着较高（19/57 对 4/57；p  < .001）。并发症没有不同。即使在调整了临床因素（模型 1：HR 0.8, 95% CI 0.7–0.9, p  < .0001）和实验室参数（NT-proBNP、IL-6、CRP、eGFR、胱抑素 C，血红蛋白）（模型 2：HR 0.8, 95% CI 0.7–0.9, p  < .05）。与 GNRI (0.77) 和 BMI (0.6) 相比，ROC 曲线显示 PNI (AUC 0.80) 具有更强的预测价值。PNI 的最佳截止值为 45。

结论

PNI 是一种有用且实用的营养标志物，可反映干预前的营养不良和炎症，并强烈预测 1 年生存率。TAVR 后 PNI 似乎是比 BMI 或 GNRI 更好的预后标志物。