Association Of Prognosis Nutrition Index With Contrast Induced Acute Kidney Injury In Elderly Patients Undergoing Percutaneous Coronary Intervention

ObjectiveTo explore the association of prognosis nutrition index(PNI)with contrast induced acute kidney injury(CI-AKI)in elderly patients undergoing percutaneous coronary intervention(PCI).MethodsThis study was a single-center retrospective case-control study.We retrospectively enrolled 714 consecutive elderly patients undergoing percutaneous coronary intervention in our hospital between January 2012 and December 2015.All the cases were divided into three groups according to PNI score(normal:PNI>38,moderate malnutrition:35-38,severe malnutrition:<35).CI-AKI was defined as an absolute serum creatinine increase?0.3mg/dl or a relative increase in serum creatinine?50%within 48 h of contrast medium exposure.Multivariable logistic regression and Cox pro-portional hazard regression analyses were performed to identify the independent risk factors for CI-AKI and long-term mortality.The Kaplan-Meier method was used to compare long-term mortality among the above three groups according to PNI score.ResultsOverall,the incidence of preoperative malnutrition was 5.2%and the incidence of postoperative CI-AKI was 13.03%in elderly patients undergoing PCI.The incidence of CI-AKI and in-hospital mortality was significantly higher in patients with a worse nutritional status(11.5%vs 36.0%vs 50.0%,P<0.0001;1.9%vs 8.0%vs 33.3%,P<0.0001).The risk of in-hospital mortality in CI-AKI group was higher than non-CI-AKI group(11.8%vs 1.3%,P<0.0001).Multivariate logistic regression analysis indicated perioperative hypotension[odds ratio(OR)3.227,95%confidence interval(95%CI)1.771-5.879,P<0.001],Left ventricular ejection fraction(LVEF)<45%(OR 4.883,95%CI 2.468-9.464,P<0.001)and moderate to severe malnutrition(moderate malnutrition vs normal,OR=2.815,95%CI 1.116-7.098,P=0.028;severe malnutrition vs normal,OR=5.645,95%CI 1.538-20.713,P=0.009)were independent risk factors for CI-AKI in elderly patients undergoing PCI.Multivariate Cox regression analysis indicated baseline SCr>1.5mg/dL[hazard ratio(HR)2.230,95%CI 1.138-4.369,P=0.019],LVEF<45%(HR 2.321,95%CI 1.202-4.482,P=0.012)and moderate to severe malnutrition(moderate malnutrition vs normal,OR=2.815,95%CI1.116-7.098,P=0.028;severe malnutrition vs normal,OR=5.645,95%CI 1.538-20.713,P=0.009)were independent risk factors for long-term mortality in elderly patients undergoing PCI.Kaplan–Meier analysis showed that the risk of long-term mortality was significantly higher in patients with a worse nutritional status(?~2=57.61,Log Rank P<0.0001).ConclusionThe incidence of CI-AKI,in-ospital mortality and long-term mortality increased with the worsen malnutrition assessed by PNI in elderly patients undergoing PCI.Malnutrition was an independent risk factors for CI-AKI and long-term mortality in elderly patients undergoing PCI.