Dataset Information

The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction.

ABSTRACT:

Background

Malnutrition is common in patients with acute myocardial infarction (AMI) and is associated with a poor prognosis. The prognostic value of the prognostic nutritional index (PNI) in patients with AMI remains controversial. We aimed to explore the relationship between PNI and all-cause mortality in critically ill patients with AMI and evaluate the incremental prognostic value of PNI to commonly used prognostic assessment tools.

Methods

The Medical Information Mart for Intensive Care-IV (MIMIC-IV) database was used to conduct a retrospective cohort analysis on 1180 critically ill patients with AMI. The primary endpoints were defined as 6-month and 1-year all-cause mortality. Cox regression analysis was used to investigate the relationship between admission PNI and all-cause mortality. The effect of adding PNI to sequential organ failure assessment (SOFA) score, or charlson comorbidity index (CCI) on its discriminative ability was assessed using C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI).

Results

Multivariate cox regression analysis demonstrated that the low PNI was regarded as an independent predictor of 1-year all-cause mortality in AMI patients admitted to ICU (adjusted Hazard Ratio: 95% CI = 1.75 (1.22-2.49)). The ROC test showed that admission PNI had a moderate predictive ability to predict all-cause mortality of critically ill patients with AMI. Furthermore, the net reclassification and integrated discrimination of the CCI alone model improved significantly with PNI. [C-statistic increased from 0.669 to 0.752, p < 0.001; NRI = 0.698, p < 0.001; IDI = 0.073, p < 0.001]. When PNI was added to the SOFA score, the C-statistic significantly improved from 0.770 to 0.805 (p < 0.001), and the NRI and IDI were estimated at 0.573 (p < 0.001) and 0.041 (p < 0.001), respectively.

Conclusion

PNI could be a novel predictor for identifying patients at high risk of 1-year all-cause mortality in critically ill patients with AMI. The addition of PNI to the SOFA score or CCI may be useful for very early risk stratification.

SUBMITTER: Huang Y

PROVIDER: S-EPMC10318819 | biostudies-literature | 2023 Jul

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction.

Huang Yuekang Y Zhang Qunhui Q Li Pengfei P Chen Meixiang M Wang Ruixin R Hu Jiaman J Chi Jianing J Cai Hua H Wu Ningxia N Xu Lin L

BMC cardiovascular disorders 20230704 1

<h4>Background</h4>Malnutrition is common in patients with acute myocardial infarction (AMI) and is associated with a poor prognosis. The prognostic value of the prognostic nutritional index (PNI) in patients with AMI remains controversial. We aimed to explore the relationship between PNI and all-cause mortality in critically ill patients with AMI and evaluate the incremental prognostic value of PNI to commonly used prognostic assessment tools.<h4>Methods</h4>The Medical Information Mart for Int ...[more]

PMID: 37403066

Similar Datasets

Project description:BackgroundNutritional status is a key factor influencing outcomes in critically ill patients with acute myocardial infarction (AMI). This study investigated the association between the Geriatric Nutritional Risk Index (GNRI) and mortality among ICU-admitted AMI patients, as well as GNRI's potential to improve the predictive accuracy of current scoring systems.MethodsIn this retrospective cohort study, data from 5,506 ICU-admitted AMI patients were sourced from three open-access critical care databases. Based on GNRI scores, patients were grouped into two categories: GNRI ≤ 98 and GNRI > 98. Statistical tools such as logistic regression and Cox proportional hazards models assessed in-hospital and 30-day mortality. Kaplan-Meier survival curves and restricted cubic splines analyzed survival trends and dose-response relationships. Sensitivity analyses, including propensity score matching (PSM), inverse probability weighting (IPW), and dropping missing data analysis validated the robustness of findings. The receiver operating characteristic (ROC) curve compared GNRI's predictive ability with SOFA and APSIII scores. A sensitivity analysis was performed using a four-tier GNRI classification: no risk (> 98), low risk (92-98), moderate risk (82-<92), and major risk (< 82) to further explore its gradient relationship with mortality.ResultsPatients with GNRI ≤ 98 showed higher mortality rates for in-hospital (21.8% vs. 10.4%) and 30-day (22.5% vs. 10.7%) outcomes. GNRI displayed an inverse correlation with in-hospital mortality (OR 0.51, 95% CI 0.43-0.60) and 30-day mortality (HR 0.57, 95% CI 0.50-0.66), even after adjusting for confounders. Subgroup analysis emphasized GNRI's reliability as a predictive marker, particularly in patients with eGFR ≥ 90. ROC analysis confirmed GNRI's predictive performance (AUC = 0.64) and its enhancement of SOFA (AUC = 0.72) and APSIII (AUC = 0.66) scores (all p < 0.001). Sensitivity analyses reinforced GNRI's link to mortality.ConclusionGNRI serves as a robust predictor of in-hospital and 30-day mortality among critically ill AMI patients. Its integration with existing scoring systems improves risk stratification in this high-risk population.

Project description:BackgroundBase excess (BE) represents an increase or decrease of alkali reserves in plasma to diagnose acid-base disorders, independent of respiratory factors. Current findings about the prognostic value of BE on mortality of patients with acute myocardial infarction (AMI) are still unclear. The purpose of this study was to explore the prognostic significance of BE for short-term all-cause mortality in patients with AMI.MethodsA total of 2,465 patients diagnosed with AMI in the intensive care unit from the Medical Information Mart for Intensive Care III (MIMIC-III) database were included in our study, and we explored the association of BE with 28-day and 90-day all-cause mortality using Cox regression analysis. We also used restricted cubic splines (RCS) to evaluate the relationship between BE and hazard ratio (HR). The primary outcomes were 28-day and 90-day all-cause mortality.ResultsWhen stratified according to quantiles, low BE levels at admission were strongly associated with higher 28-day and 90-day all-cause mortality. Multivariable Cox proportional hazard models revealed that low BE was an independent risk factor of 28-day all-cause mortality [HR 4.158, 95% CI 3.203-5.398 (low vs. normal BE) and HR 1.354, 95% CI 0.896-2.049 (high vs. normal BE)] and 90-day all-cause mortality [HR 4.078, 95% CI 3.160-5.263 (low vs. normal BE) and HR 1.369, 95% CI 0.917-2.045 (high vs. normal BE)], even after adjustment for significant prognostic covariates. The results were also consistent in subgroup analysis. RCS revealed an "L-type" relationship between BE and 28-day and 90-day all-cause mortality, as well as adjusting for confounding variables. Meanwhile, Kaplan-Meier survival curves were stratified by combining BE with carbon dioxide partial pressure (PaCO2), and patients had the highest mortality in the group which had low BE (< 3.5 mEq/L) and high PaCO2 (> 45 mmHg) compared with other groups.ConclusionOur study revealed that low BE was significantly associated with 28-day and 90-day mortality in patients with AMI and indicated the value of stratifying the mortality risk of patients with AMI by BE.

Project description:Acute myocardial infarction (AMI) is a leading cause of morbidity and mortality worldwide. Early identification of high-risk patients is crucial for timely interventions and improved outcomes. The lactate/albumin ratio (LAR) has been suggest as a significant correlate for assessing the risk of mortality in critically ill patients. This study aimed to utilize the American eICU Collaborative Research Database to explore the association between baseline LAR and all-cause mortality within 28 days in ICU of critically ill patients diagnosed with AMI. We conducted a retrospective cohort study of 989 AMI patients from the eICU Collaborative Research Database. Patients were included based on ICD-9 code 410 and the universal definition of AMI. LAR was calculated as the ratio of baseline lactate to albumin levels within the first 24 h of ICU admission. The outcome was all-cause mortality within 28 days after ICU admission. Multivariable logistic regression models were used to evaluate the independent association between LAR and the risk of death, adjusting for potential confounders including demographics, comorbidities, vital signs, and laboratory parameters. Subgroup analyses and nonlinear modeling were performed to further explore the relationship. Of the 989 AMI patients, 171 (17.3%) died within 28 days after ICU admission. Patients who died had significantly higher LAR compared to survivors (1.66 vs. 0.96, p < 0.001). Multivariable analysis showed that each unit increase in LAR was associated with a 2.15-fold higher risk of all-cause mortality within 28 days after ICU admission (95% CI: 1.64-2.83, p < 0.001). Subgroup analyses confirmed the consistent association across different patient characteristics. Nonlinear modeling revealed a threshold effect, where LAR above 2.15 was no longer significantly associated with mortality. Kaplan-Meier survival analysis demonstrated lower survival probabilities for patients with higher LAR(1.0526-5.8235). The findings suggest that a higher LAR was associated with an increased risk of 28-day all-cause mortality for critically ill patients with AMI after ICU admission.

Dataset Information

The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction.

Background

Methods

Results

Conclusion

Publications

The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction.

Similar Datasets

OmicsDI is part of the ELIXIR infrastructure

Tweets