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Is Prognostic Nutritional Index Mortality Predictor in Patients with Acute Stroke in the Intensive Care Unit?

Year 2022, Volume: 13 Issue: 3, 416 - 423, 27.09.2022

Fatma İrem Yeşiler Behiye Deniz Kosovalı Ümit Gökhan Şendur Osman Yüksekyayla

https://doi.org/10.18663/tjcl.1151391

Abstract

Aim: The prognostic nutritional index (PNI) is a simple and useful score for predicting the prognosis in various diseases such as cancers, ischemic heart disease, and pulmonary embolism.The aim of our study is to investigate the association between PNI level and mortality rates of patients with ischemic or hemorrhagic AS admitted to the intensive care unit (ICU).
Material and Methods: We retrospectively analyzed records for 102 patients with ischemic and hemorrhagic AS admitted to the ICU between January 2017, and January, 2018.
Results: During the period,83.3% of 102 patients with ischemic AS, 45.1% were male.The patients were divided into two groups according to the cut-off PNI value (47.8). Patients in the low PNI group (PNI≤47.8) were older than high PNI group (PNI>47.8). Atrial fibrillation (p=0.02) and renal diseases (p=0.049) were observed more frequently in the low PNI group. APACHE II and SOFA scores were higher in the low PNI group. The length of mechanical ventilation, ICU and hospital stay were longer in the low PNI group (p<0.05). The ICU and hospital mortality rates were higher in the low PNI group (p<0.001). Presence of atrial fibrillation, high APACHE II and SOFA scores, low GCS and diastolic blood pressure, high neutrophil lymphocyte ratio and low PNI were determined as independent risk factors for mortality.
Conclusion: This study presented that low PNI level was closely associated with mortality in patients with AS. Thus, PNI may be considered as a new indicator in determining the prognosis in patients with AS.

Keywords

acute stroke mortality prognostic nutritional index intensive care unit

References

  • 1- Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec; 50(12): e344-e418.
  • 2- GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017; 16: 877–97.
  • 3- Liu Y, Yang X, Kadasah S, Peng C. Clinical Value of the Prognostic Nutrition Index in the Assessment of Prognosis in Critically Ill Patients with Stroke: A Retrospective Analysis. Comput Math Methods Med. 2022 May 9; 2022: 4889920.
  • 4- T-Bolayır A. Can the prognostic nutritional index be used as an indicator of mortality in patients with acute ischemic stroke? Cumhuriyet Medical Journal, 2020; 42(4): 484-490.
  • 5- Wada H, Dohi T, Miyauchi K, et al. Relationship between the prognostic nutritional index and long-term clinical outcomes in patients with stable coronary artery disease. J Cardiol. 2018 Aug;7 2(2): 155-161.
  • 6- Li D, Yuan X, Liu J, Li C, Li W. Prognostic value of prognostic nutritional index in lung cancer: a meta-analysis. J Thorac Dis. 2018 Sep;10(9): 5298-5307.
  • 7- Hayıroğlu Mİ, Keskin M, Keskin T, et al. A Novel Independent Survival Predictor in Pulmonary Embolism: Prognostic Nutritional Index. Clin Appl Thromb Hemost. 2018 May; 24(4): 633-639.
  • 8- Kang, M, Chang CT, Sung HH, et al. Prognostic Significance of Pre- to Postoperative Dynamics of the Prognostic Nutritional Index for Patients with Renal Cell Carcinoma Who Underwent Radical Nephrectomy. Ann Surg Oncol 2017; 24: 4067–4075.
  • 9- Xiang W, Chen X, Ye W, Li J, Zhang X, Xie D. Prognostic Nutritional Index for Predicting 3-Month Outcomes in Ischemic Stroke Patients Undergoing Thrombolysis. Front Neurol. 2020 Jun 26; 11: 599.
  • 10- Hu Y, Cao Q, Wang H, et al. Prognostic nutritional index predicts acute kidney injury and mortality of patients in the coronary care unit. Exp Ther Med. 2021 Feb; 21(2):123.
  • 11- Tokunaga R, Sakamoto Y, Nakagawa S et al. Prognostic Nutritional Index Predicts Severe Complications, Recurrence and Poor Prognosis in Patients With Colorectal Cancer Undergoing Primary Tumor Resection. Dis Colon Rectum 2015; 58: 1048-57.
  • 12- Hayashi J, Uchida T, Ri S, et al. Clinical significance of the prognostic nutritional index in patients undergoing cardiovascular surgery. Gen Thorac Cardiovasc Surg. 2020 Aug; 68(8): 774-779.
  • 13- Kos M, Titiz H, Onec B, et al. Association of “Controlling Nutritional Status Index” and “Prognostic Nutritional Index” with intensive care unit survival in elderly patients, European Geriatric Medicine 2016; 7: 13-17.
  • 14- Unosson M, Ek AC, Bjurulf P, von Schenck H, Larsson J. Feeding dependence and nutritional status after acute stroke. Stroke 1994; 25: 366– 71.
  • 15- Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999; 30: 744– 8.
  • 16- Wu LH, Chiou KR, Pan IJ, Hsiao SH. Malnutrition Affects the Outcomes of Patients with Low-Output Heart Failure and Congestion. Acta Cardiol Sin. 2021 May; 37(3): 269-277.
  • 17- Kurmus Ferik O, Akbuga K, Tolunay H, et al. Poor nutritional status is associated with arrhythmic events on 24 hour holter recording. Med Princ Pract. 2022 Apr 8 (doi: 10.1159/000524396).
  • 18- Tominaga T, Nonaka T, Hisanaga M, et al. Prognostic value of the preoperative prognostic nutritional index in oldest-old patients with colorectal cancer. Surg Today. 2020 May; 50(5): 449-459.
  • 19- Anaszewicz M, Budzyński J. Clinical significance of nutritional status in patients with atrial fibrillation: an overview of current evidence. J Cardiol. 2017; 69: 719–30.
  • 20- Guo Y, Lip GY, Apostolakis S. Inflammation in atrial fibrillation. J Am Coll Cardiol. 2012; 60: 2263–70.
  • 21- Iseki K, Miyasato F, Tokuyama K, et al. Low diastolic blood pressure, hypoalbuminemia, and risk of death in a cohort of chronic hemodialysis patients. Kidney Int. 1997; 51(4): 1212-7.
  • 22- Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the intensive care unit. Crit Care Med. 2011; 39(1): 163-9.
  • 23- Zhang B, Zhu Q, Lu Z. Prognostic nutrition index predicts outcomes in critically ill stroke patients: a database-based cohort study, European Heart Journal, Volume 42, Issue Supplement_1, October 2021,
  • 24- Vincent JL, Russell JA, Jacob M, et al. Albumin administration in the acutely ill: what is new and where next? Crit Care. 2014; 18(4):231.
  • 25- Zhao J, Liu K, Li S, et al. Prognostic nutritional index predicts clinical outcomes in patients with cerebral venous sinus thrombosis. BMC Neurol. 2021; 21(1): 404.
  • 26- Zhang XM, Chen D, Xie XH, Zhang JE, Zeng Y, Cheng AS. Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis. BMC Geriatr. 2021 Jun 2; 21(1): 339.
  • 27- Arsava EM, Aydoğdu İ, Güngör L, Işıkay CT, Yaka E. Nutritional Approach and Treatment in Patients with Stroke, An Expert Opinion for Turkey. Turk J Neurol. 2018; 24(3): 226-242.
  • 28- Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013 Oct; 88(1): 218-30.
  • 29- Ha YJ, Hur J, Go DJ, et al. Baseline peripheral blood neutrophil-to-lymphocyte ratio could predict survival in patients with adult polymyositis and dermatomyositis: A retrospective observational study. PLoS One. 2018 Jan 2;13(1): e0190411.
  • 30- Kahraman S, Zencirkıran Aguş H, Kalkan AK, et al. Prognostic nutritional index predicts mortality in infective endocarditis. Turk Kardiyol Dern Ars. 2020; 48(4): 392-402.

Is Prognostic Nutritional Index Mortality Predictor in Patients with Acute Stroke in the Intensive Care Unit?

Year 2022, Volume: 13 Issue: 3, 416 - 423, 27.09.2022

Fatma İrem Yeşiler Behiye Deniz Kosovalı Ümit Gökhan Şendur Osman Yüksekyayla

https://doi.org/10.18663/tjcl.1151391

Abstract

Aim: The prognostic nutritional index (PNI) is a simple and useful score for predicting the prognosis in various diseases such as cancers, ischemic heart disease, and pulmonary embolism.The aim of our study is to investigate the association between PNI level and mortality rates of patients with ischemic or hemorrhagic AS admitted to the intensive care unit (ICU).
Material and Methods: We retrospectively analyzed records for 102 patients with ischemic and hemorrhagic AS admitted to the ICU between January 2017, and January, 2018.
Results: During the period,83.3% of 102 patients with ischemic AS, 45.1% were male.The patients were divided into two groups according to the cut-off PNI value (47.8). Patients in the low PNI group (PNI≤47.8) were older than high PNI group (PNI>47.8). Atrial fibrillation (p=0.02) and renal diseases (p=0.049) were observed more frequently in the low PNI group. APACHE II and SOFA scores were higher in the low PNI group. The length of mechanical ventilation, ICU and hospital stay were longer in the low PNI group (p<0.05). The ICU and hospital mortality rates were higher in the low PNI group (p<0.001). Presence of atrial fibrillation, high APACHE II and SOFA scores, low GCS and diastolic blood pressure, high neutrophil lymphocyte ratio and low PNI were determined as independent risk factors for mortality.
Conclusion: This study presented that low PNI level was closely associated with mortality in patients with AS. Thus, PNI may be considered as a new indicator in determining the prognosis in patients with AS.

Keywords

ACUTE

References

  • 1- Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients With Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke: A Guideline for Healthcare Professionals From the American Heart Association/American Stroke Association. Stroke. 2019 Dec; 50(12): e344-e418.
  • 2- GBD 2015 Neurological Disorders Collaborator Group. Global, regional, and national burden of neurological disorders during 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015. Lancet Neurol. 2017; 16: 877–97.
  • 3- Liu Y, Yang X, Kadasah S, Peng C. Clinical Value of the Prognostic Nutrition Index in the Assessment of Prognosis in Critically Ill Patients with Stroke: A Retrospective Analysis. Comput Math Methods Med. 2022 May 9; 2022: 4889920.
  • 4- T-Bolayır A. Can the prognostic nutritional index be used as an indicator of mortality in patients with acute ischemic stroke? Cumhuriyet Medical Journal, 2020; 42(4): 484-490.
  • 5- Wada H, Dohi T, Miyauchi K, et al. Relationship between the prognostic nutritional index and long-term clinical outcomes in patients with stable coronary artery disease. J Cardiol. 2018 Aug;7 2(2): 155-161.
  • 6- Li D, Yuan X, Liu J, Li C, Li W. Prognostic value of prognostic nutritional index in lung cancer: a meta-analysis. J Thorac Dis. 2018 Sep;10(9): 5298-5307.
  • 7- Hayıroğlu Mİ, Keskin M, Keskin T, et al. A Novel Independent Survival Predictor in Pulmonary Embolism: Prognostic Nutritional Index. Clin Appl Thromb Hemost. 2018 May; 24(4): 633-639.
  • 8- Kang, M, Chang CT, Sung HH, et al. Prognostic Significance of Pre- to Postoperative Dynamics of the Prognostic Nutritional Index for Patients with Renal Cell Carcinoma Who Underwent Radical Nephrectomy. Ann Surg Oncol 2017; 24: 4067–4075.
  • 9- Xiang W, Chen X, Ye W, Li J, Zhang X, Xie D. Prognostic Nutritional Index for Predicting 3-Month Outcomes in Ischemic Stroke Patients Undergoing Thrombolysis. Front Neurol. 2020 Jun 26; 11: 599.
  • 10- Hu Y, Cao Q, Wang H, et al. Prognostic nutritional index predicts acute kidney injury and mortality of patients in the coronary care unit. Exp Ther Med. 2021 Feb; 21(2):123.
  • 11- Tokunaga R, Sakamoto Y, Nakagawa S et al. Prognostic Nutritional Index Predicts Severe Complications, Recurrence and Poor Prognosis in Patients With Colorectal Cancer Undergoing Primary Tumor Resection. Dis Colon Rectum 2015; 58: 1048-57.
  • 12- Hayashi J, Uchida T, Ri S, et al. Clinical significance of the prognostic nutritional index in patients undergoing cardiovascular surgery. Gen Thorac Cardiovasc Surg. 2020 Aug; 68(8): 774-779.
  • 13- Kos M, Titiz H, Onec B, et al. Association of “Controlling Nutritional Status Index” and “Prognostic Nutritional Index” with intensive care unit survival in elderly patients, European Geriatric Medicine 2016; 7: 13-17.
  • 14- Unosson M, Ek AC, Bjurulf P, von Schenck H, Larsson J. Feeding dependence and nutritional status after acute stroke. Stroke 1994; 25: 366– 71.
  • 15- Mann G, Hankey GJ, Cameron D. Swallowing function after stroke: prognosis and prognostic factors at 6 months. Stroke 1999; 30: 744– 8.
  • 16- Wu LH, Chiou KR, Pan IJ, Hsiao SH. Malnutrition Affects the Outcomes of Patients with Low-Output Heart Failure and Congestion. Acta Cardiol Sin. 2021 May; 37(3): 269-277.
  • 17- Kurmus Ferik O, Akbuga K, Tolunay H, et al. Poor nutritional status is associated with arrhythmic events on 24 hour holter recording. Med Princ Pract. 2022 Apr 8 (doi: 10.1159/000524396).
  • 18- Tominaga T, Nonaka T, Hisanaga M, et al. Prognostic value of the preoperative prognostic nutritional index in oldest-old patients with colorectal cancer. Surg Today. 2020 May; 50(5): 449-459.
  • 19- Anaszewicz M, Budzyński J. Clinical significance of nutritional status in patients with atrial fibrillation: an overview of current evidence. J Cardiol. 2017; 69: 719–30.
  • 20- Guo Y, Lip GY, Apostolakis S. Inflammation in atrial fibrillation. J Am Coll Cardiol. 2012; 60: 2263–70.
  • 21- Iseki K, Miyasato F, Tokuyama K, et al. Low diastolic blood pressure, hypoalbuminemia, and risk of death in a cohort of chronic hemodialysis patients. Kidney Int. 1997; 51(4): 1212-7.
  • 22- Keegan MT, Gajic O, Afessa B. Severity of illness scoring systems in the intensive care unit. Crit Care Med. 2011; 39(1): 163-9.
  • 23- Zhang B, Zhu Q, Lu Z. Prognostic nutrition index predicts outcomes in critically ill stroke patients: a database-based cohort study, European Heart Journal, Volume 42, Issue Supplement_1, October 2021,
  • 24- Vincent JL, Russell JA, Jacob M, et al. Albumin administration in the acutely ill: what is new and where next? Crit Care. 2014; 18(4):231.
  • 25- Zhao J, Liu K, Li S, et al. Prognostic nutritional index predicts clinical outcomes in patients with cerebral venous sinus thrombosis. BMC Neurol. 2021; 21(1): 404.
  • 26- Zhang XM, Chen D, Xie XH, Zhang JE, Zeng Y, Cheng AS. Sarcopenia as a predictor of mortality among the critically ill in an intensive care unit: a systematic review and meta-analysis. BMC Geriatr. 2021 Jun 2; 21(1): 339.
  • 27- Arsava EM, Aydoğdu İ, Güngör L, Işıkay CT, Yaka E. Nutritional Approach and Treatment in Patients with Stroke, An Expert Opinion for Turkey. Turk J Neurol. 2018; 24(3): 226-242.
  • 28- Guthrie GJ, Charles KA, Roxburgh CS, Horgan PG, McMillan DC, Clarke SJ. The systemic inflammation-based neutrophil-lymphocyte ratio: experience in patients with cancer. Crit Rev Oncol Hematol. 2013 Oct; 88(1): 218-30.
  • 29- Ha YJ, Hur J, Go DJ, et al. Baseline peripheral blood neutrophil-to-lymphocyte ratio could predict survival in patients with adult polymyositis and dermatomyositis: A retrospective observational study. PLoS One. 2018 Jan 2;13(1): e0190411.
  • 30- Kahraman S, Zencirkıran Aguş H, Kalkan AK, et al. Prognostic nutritional index predicts mortality in infective endocarditis. Turk Kardiyol Dern Ars. 2020; 48(4): 392-402.
There are 30 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Orıgınal Artıcle
Authors

Fatma İrem Yeşiler

Behiye Deniz Kosovalı 0000-0001-9385-6542

Ümit Gökhan Şendur

Osman Yüksekyayla

Publication Date September 27, 2022
Published in Issue Year 2022 Volume: 13 Issue: 3

Cite

APA Yeşiler, F. İ., Kosovalı, B. D., Şendur, Ü. G., Yüksekyayla, O. (2022). Is Prognostic Nutritional Index Mortality Predictor in Patients with Acute Stroke in the Intensive Care Unit?. Turkish Journal of Clinics and Laboratory, 13(3), 416-423. https://doi.org/10.18663/tjcl.1151391
AMA Yeşiler Fİ, Kosovalı BD, Şendur ÜG, Yüksekyayla O. Is Prognostic Nutritional Index Mortality Predictor in Patients with Acute Stroke in the Intensive Care Unit?. TJCL. September 2022;13(3):416-423. doi:10.18663/tjcl.1151391
Chicago Yeşiler, Fatma İrem, Behiye Deniz Kosovalı, Ümit Gökhan Şendur, and Osman Yüksekyayla. “Is Prognostic Nutritional Index Mortality Predictor in Patients With Acute Stroke in the Intensive Care Unit?”. Turkish Journal of Clinics and Laboratory 13, no. 3 (September 2022): 416-23. https://doi.org/10.18663/tjcl.1151391.
EndNote Yeşiler Fİ, Kosovalı BD, Şendur ÜG, Yüksekyayla O (September 1, 2022) Is Prognostic Nutritional Index Mortality Predictor in Patients with Acute Stroke in the Intensive Care Unit?. Turkish Journal of Clinics and Laboratory 13 3 416–423.
IEEE F. İ. Yeşiler, B. D. Kosovalı, Ü. G. Şendur, and O. Yüksekyayla, “Is Prognostic Nutritional Index Mortality Predictor in Patients with Acute Stroke in the Intensive Care Unit?”, TJCL, vol. 13, no. 3, pp. 416–423, 2022, doi: 10.18663/tjcl.1151391.
ISNAD Yeşiler, Fatma İrem et al. “Is Prognostic Nutritional Index Mortality Predictor in Patients With Acute Stroke in the Intensive Care Unit?”. Turkish Journal of Clinics and Laboratory 13/3 (September 2022), 416-423. https://doi.org/10.18663/tjcl.1151391.
JAMA Yeşiler Fİ, Kosovalı BD, Şendur ÜG, Yüksekyayla O. Is Prognostic Nutritional Index Mortality Predictor in Patients with Acute Stroke in the Intensive Care Unit?. TJCL. 2022;13:416–423.
MLA Yeşiler, Fatma İrem et al. “Is Prognostic Nutritional Index Mortality Predictor in Patients With Acute Stroke in the Intensive Care Unit?”. Turkish Journal of Clinics and Laboratory, vol. 13, no. 3, 2022, pp. 416-23, doi:10.18663/tjcl.1151391.
Vancouver Yeşiler Fİ, Kosovalı BD, Şendur ÜG, Yüksekyayla O. Is Prognostic Nutritional Index Mortality Predictor in Patients with Acute Stroke in the Intensive Care Unit?. TJCL. 2022;13(3):416-23.
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