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

Malnutrition Status and Acute Kidney Injury

Authors

  • Arif Gucu, MD University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery, Yıldırım/BURSA, Turkey
  • Ozlem Arican Ozluk, MD University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiology, BURSA, Turkey
  • Orhan Guvenc, MD Medical Faculty of Uludağ University, Departments of Cardiovascular Surgery, Bursa, Turkey
  • Sadık Ahmet Sunbul, MD University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery, Yıldırım/BURSA, Turkey
  • Mesut Engin, MD University of Health Sciences, Bursa Yuksek Ihtisas Training and Research Hospital, Department of Cardiovascular Surgery, Yıldırım/BURSA, Turkey

DOI:

https://doi.org/10.1532/hsf.3859

Keywords:

Coronary artery disease, Coronary artery bypass grafting, Nutritional status, Diabetes Mellitus, Renal injury

Abstract

Background: After coronary artery bypass graft (CABG) operations, acute kidney injury (AKI) appears at 5-30% rates, and this rate increases even more in patients with diabetes mellitus (DM). Prognostic nutritional index (PNI) is known as a valuable parameter that affects cardiovascular surgery outcomes. In this current study, we aimed to investigate the importance of PNI value in predicting AKI after on-pump CABG operations in insulin-dependent diabetic patients.

Methods: A total of 254 consecutive patients with insulin-
dependent diabetes who underwent on-pump CABG in our clinic between January 2016 and January 2020 retrospectively were included in this study. In the postoperative period, patients were registered as the renal failure group (Group 1), and those who did not develop renal failure were registered as Group 2.

Results: A total of 255 patients with DM were included in the study. There were 82 patients in Group 1 and 173 patients in Group 2. There was no difference between the groups, in terms of age, gender, smoking, and hyperlipidemia rates. Hypertension rate significantly was higher in Group 2 (P = .001). In multivariate logistic regression analysis, hypertension (OR: 1.226, 95% CI: 1.114-2.459, P = .026), need for inotropic support (OR: 1.128, 95% CI: 1.070-1.784, P = .033), increased blood product use (OR: 1.291, 95% CI: 1.112-2.156, P = .021) preoperative high creatinine (OR: 3.563, 95% CI: 2.497-5.559, P < .001), and PNI (OR: 1.327, 95% CI: 1.118-2.785, P = .012) were independent predictors of AKI.

Conclusion: In our study, we determined PNI value as an independent predictor in predicting acute renal injury occurring after on-pump CABG operations in patients with insulin-dependent DM.

References

Abanoz M, Engin M. 2021. The effect of the relationship between post-cardiotomy neutrophil/lymphocyte ratio and platelet counts on early major adverse events after isolated coronary artery bypass grafting. Turk Gogus Kalp Damar Cerrahisi Derg. 29(1):36-44.

Aksoy R, Adademir T, Yilmaz E, et al. 2019. Is Hypoalbuminemia a Predictor for Acute Kidney Injury after Coronary Bypass Grafting in Diabetes Mellitus Patients? Braz J Cardiovasc Surg. 34(5):565-571.

Arques S. 2018. Human serum albumin in cardiovascular diseases. Eur J InternMed. 52:8-12.

Asimakopoulos G, Taylor KM. 1998. Effects of cardiopulmonary bypass on leukocyte and endothelial adhesion molecules. Ann Thorac Surg. 66: 2135–44.

Chen WC, Lin MH, Chen CL, et al. 2021. Comprehensive Comparisons among Inotropic Agents on Mortality and Risk of Renal Dysfunction in Patients Who Underwent Cardiac Surgery: A Network Meta-Analysis of Randomized Controlled Trials. J Clin Med. 10:1032.

de la Cruz KI, Bakaeen FG, Wang XL, et al. 2011. Hypoalbuminemia and long-term survival after coronary artery bypass: a propensity score analysis. Ann Thorac Surg. 91(3):671–5.

Dolapoglu A, Avci E, Kiris T, Bugra O. 2019. The predictive value of the prognostic nutritional index for postoperative acute kidney injury in patients undergoing on-pump coronary bypass surgery. J Cardiothorac Surg. 14(1):74.

Erdolu B, As AK, Engin M. 2020. The Relationship between the HATCH Score, Neutrophil to Lymphocyte Ratio and Postoperative Atrial Fibrillation After Off-Pump Coronary Artery Bypass Graf Surgery. Heart Surg Forum. 23(1):E88-E92.

Freeland K, Hamidian Jahromi A, Duvall LM, et al. 2015. Postoperative blood transfusion is an independent predictor of acute kidney injury in cardiac surgery patients. J Nephropathol. 4(4):121-6.

Gaffney AM, Sladen RN. 2015. Acute kidney injury in cardiac surgery. Curr Opin Anaesthesiol. 28(1):50–9.

Hayashi J, Uchida T, Ri S, et al. 2020. Clinical significance of the prognostic nutritional index in patients undergoing cardiovascular surgery. Gen Thorac Cardiovasc Surg. 68(8):774-779.

Kocogulları CU, Kunt AT, Aksoy R, et al. 2017. Hemoglobin A1c Levels Predicts Acute Kidney Injury after Coronary Artery Bypass Surgery in Non-Diabetic Patients. Braz J Cardiovasc Surg. 32(2):83-89.

Kubal C, Srinivasan A K, Grayson AD, et al. 2005. Effect of risk-adjusted diabetes on mortality and morbidity after coronary artery bypass surgery. Ann Thorac Surg. 79(5):1570-6.

Lee SI, Ko KP, Choi CH, et al. 2020. Does the prognostic nutritional index have a predictive role in the outcomes of adult cardiac surgery? J Thorac Cardiovasc Surg. 160(1):145-153.e3.

Mehta RL, Kellum JA, Shah SV, et al. 2007. Acute kidney injury network. Acute kidney injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care. 11(2):R31.

Nalysnyk L, Hernandez-Medina M, Krishnarajah G. 2010. Glycaemic variability and complications in patients with diabetes mellitus: evidence from a systematic review of the literature. Diabetes Obes Metab. 12(4):288-98.

Onodera T, Goseki N, Kosaki G. 1984. Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients. Nihon Geka Gakkaizasshi. 85(9): 1001–5.

Tumer NB, Kunt AT, Gunaydin S. 2019. Preoperative Urinary pH is Associated with Acute Kidney Injury Afer Cardiac Surgery in Non-Diabetic Patients. Heart Surg Forum. 22(5):E456-E461.

Usta S, Abanoz M. 2021. Can Preoperative Neutrophil To Lymphocyte Ratio Change (Deltanlr) Be Used as a Parameter in Predicting Acute Renal Failure Following Coronary Bypass Operations With Cardiopulmonary Bypass? Heart Surg Forum. 24(1):E194-E200.

Yang L, Yu W, Pan W, et al. 2021. A Clinical Epidemiological Analysis of Prognostic Nutritional Index Associated with Diabetic Retinopathy. Diabetes Metab Syndr Obes. 14:839-846.

Yuan SM. 2019. Acute Kidney Injury after Cardiac Surgery: Risk Factors and Novel Biomarkers. Braz J Cardiovasc Surg. 34(3):352-360.

Published

2021-07-27

How to Cite

GUCU, A., Ozluk, O. A., Guvenc, O., Sunbul, S. A., & 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: Malnutrition Status and Acute Kidney Injury. The Heart Surgery Forum, 24(4), E651-E655. https://doi.org/10.1532/hsf.3859

Issue

Section

Article