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Effect of prognostic nutritional index on hospital stay in patients undergoing metallic prosthetic mitral valve surgery

Yıl 2025, EARLY ONLINE, 1 - 9
https://doi.org/10.18621/eurj.1660420

Öz

Objectives: Preoperative malnutrition has been associated with higher rates of morbidity and death, longer hospital admissions, and a worse quality of life after surgery. This study aimed to examine the association between the Prognostic Nutritional Index (PNI) and the duration of hospitalization, in-hospital, and 1-year all-cause mortality among patients having surgery on metallic prosthetic mitral valves.

Methods: The study retrospectively included 90 consecutive patients with metallic prosthetic mitral valve surgery at Dicle University Hospital between January 2021 and December 2023. Patients were split into two groups based on the median length of stay in the hospital (14 days). Those who stayed ≥14 days were included in the longer in-hospital stay group (53 patients), and those who stayed <14 days were included in the shorter in-hospital stay group (37 patients).

Results: The study included patients aged 52.3±15.2 years, 48.9% (n=44) female. Patients with longer hospital stays had wider left atrial diameters, lower albumin levels, and lower PNI values (34.7±6.1 vs. 38±4, P=0.002). Inotropic support was more frequent in this group (18.9% vs. 2.7%, P=0.021). ROC analysis identified PNI <37.2 as predictive of prolonged stays (AUC=0.653, P=0.014). Logistic regression analysis revealed significant associations between prolonged stays and inotropic support, left atrial diameter, albumin, CRP, and PNI values. PNI also predicted in-hospital and 1-year all-cause mortality.

Conclusions: PNI was associated with hospital stay duration, in-hospital, and 1-year all-cause mortality in patients undergoing metallic prosthetic mitral valve surgery. Incorporating PNI into routine preoperative evaluation may enhance perioperative management and outcomes.

Etik Beyan

This study was approved by the University of Health Sciences Gazi Yaşargil Training and Research Hospital Clinical Research Ethics Committee (Decision no.: 322, date: 17.01.2025).

Kaynakça

  • 1. Hannan EL, Racz MJ, Walford G, et al. Long-term outcomes of coronary-artery bypass grafting versus stent implantation. N Engl J Med. 2005;352(21):2174-2183. doi: 10.1056/NEJMoa040316.
  • 2. Fortescue EB, Kahn K, Bates DW. Development and validation of a clinical prediction rule for major adverse outcomes in coronary bypass grafting. Am J Cardiol. 2001;88(11):1251-1258. doi: 10.1016/s0002-9149(01)02086-0.
  • 3. Kulier A, Levin J, Moser R, et al; Investigators of the Multicenter Study of Perioperative Ischemia Research Group; Ischemia Research and Education Foundation. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation. 2007;116(5):471-479. doi: 10.1161/CIRCULATIONAHA.106.653501.
  • 4. Cooper WA, O'Brien SM, Thourani VH, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation. 2006;113(8):1063-1070. doi: 10.1161/CIRCULATIONAHA.105.580084.
  • 5. Daly LE, Lonergan M, Graham I. Predicting operative mortality after coronary artery bypass surgery in males. Q J Med. 1993;86(12):771-8.
  • 6. Koch CG, Li L, Kaplan GA, et al. Socioeconomic position, not race, is linked to death after cardiac surgery. Circ Cardiovasc Qual Outcomes. 2010;3(3):267-276. doi: 10.1161/CIRCOUTCOMES.109.880377.
  • 7. Jeon HG, Choi DK, Sung HH, et al. Preoperative Prognostic Nutritional Index is a Significant Predictor of Survival in Renal Cell Carcinoma Patients Undergoing Nephrectomy. Ann Surg Oncol. 2016;23(1):321-327. doi: 10.1245/s10434-015-4614-0.
  • 8. Larsson J, Akerlind I, Permerth J, Hörnqvist JO. The relation between nutritional state and quality of life in surgical patients. Eur J Surg. 1994;160(6-7):329-334.
  • 9. Allard JP, Keller H, Jeejeebhoy KN, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study. Clin Nutr. 2016;35(1):144-152. doi: 10.1016/j.clnu.2015.01.009.
  • 10. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139(1):160-7. doi: 10.1016/0002-9610(80)90246-9.
  • 11. Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984;85(9):1001-1005. [Article in Japanese]
  • 12. Yoshihisa A, Kanno Y, Watanabe S, et al. Impact of nutritional indices on mortality in patients with heart failure. Open Heart. 2018;5(1):e000730. doi: 10.1136/openhrt-2017-000730.
  • 13. González Ferreiro R, Muñoz-García AJ, López Otero D, et al. Nutritional risk index predicts survival in patients undergoing transcatheter aortic valve replacement. Int J Cardiol. 2019;276:66-71. doi: 10.1016/j.ijcard.2018.11.097.
  • 14. Söner S, Güzel T, Aktan A, et al. Predictive value of nutritional scores in non-valvular atrial fibrillation patients: Insights from the AFTER-2 study. Nutr Metab Cardiovasc Dis. 2025r;35(3):103794. doi: 10.1016/j.numecd.2024.103794.
  • 15. Chen JY, Chen TW, Lu WD. HAT2CH2 Score Predicts Systemic Thromboembolic Events in Elderly After Cardiac Electronic Device Implantation. Front Med (Lausanne). 2021;8:786779. doi: 10.3389/fmed.2021.786779.
  • 16. Tasbulak O, Guler A, Duran M, et al. Association Between Nutritional Indices and Long-Term Outcomes in Patients Undergoing Isolated Coronary Artery Bypass Grafting. Cureus. 2021;13(7):e16567. doi: 10.7759/cureus.16567.
  • 17. Basta G, Chatzianagnostou K, Paradossi U, et al. The prognostic impact of objective nutritional indices in elderly patients with ST-elevation myocardial infarction undergoing primary coronary intervention. Int J Cardiol. 2016;221:987-992. doi: 10.1016/j.ijcard.2016.07.039.
  • 18. Keskin M, Hayıroğlu MI, Keskin T, et al. A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index. Nutr Metab Cardiovasc Dis. 2017;27(5):438-446. doi: 10.1016/j.numecd.2017.01.005.
  • 19. Hayıroğlu Mİ, Keskin M, Keskin T, et al. A Novel Independent Survival Predictor in Pulmonary Embolism: Prognostic Nutritional Index. Clin Appl Thromb Hemost. 2018;24(4):633-639. doi: 10.1177/1076029617703482.
  • 20. Lee SI, Ko KP, Choi CH, Park CH, Park KY, Son KH. Does the prognostic nutritional index have a predictive role in the outcomes of adult cardiac surgery? J Thorac Cardiovasc Surg. 2020;160(1):145-153.e3. doi: 10.1016/j.jtcvs.2019.08.069.
  • 21. Detsky AS, Baker JP, O'Rourke K, Goel V. Perioperative parenteral nutrition: a meta-analysis. Ann Intern Med. 1987;107(2):195-203. doi: 10.7326/0003-4819-107-2-195.
  • 22. Almohammadi AA, Alqarni MA, Alqaidy MY, Ismail SA, Almabadi RM. Impact of the Prognostic Nutritional Index on Postoperative Outcomes in Patients Undergoing Heart Surgery. Cureus. 2023;15(8):e43745. doi: 10.7759/cureus.43745.
  • 23. Karaca B, Esin F, Tiryaki MM, Akkan G, Kiris T. Combining C-reactive protein, procalcitonin, and serum albumin to predict long-term mortality in patients with infective endocarditis. J Int Med Res. 2023;51(10):3000605231208910. doi: 10.1177/03000605231208910.
  • 24. Usalp ZO, Usalp S. Does the eosinophil-to-monocyte ratio predict inflammation in patients with diabetic retinopathy? İJCMBS. 2024;4(1):10-14. doi:10.5281/zenodo.10707773
  • 25. Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38-45.
  • 26. Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82(4):777-783. doi: 10.1093/ajcn/82.4.777.
  • 27. Demal TJ, Arndt N, Bhadra OD, et al. Predictors for Length of Stay after Surgical Aortic Valve Replacement. Thorac Cardiovasc Surg. 2025 Mar 19. doi: 10.1055/a-2466-7245.
  • 28. Augustin P, Tanaka S, Chhor V, et al. Prognosis of Prolonged Intensive Care Unit Stay After Aortic Valve Replacement for Severe Aortic Stenosis in Octogenarians. J Cardiothorac Vasc Anesth. 2016;30(6):1555-1561. doi: 10.1053/j.jvca.2016.07.029.
  • 29. Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017;36(3):623-650. doi: 10.1016/j.clnu.2017.02.013.
  • 30. Drover JW, Dhaliwal R, Weitzel L, Wischmeyer PE, Ochoa JB, Heyland DK. Perioperative use of arginine-supplemented diets: a systematic review of the evidence. J Am Coll Surg. 2011;212(3):385-399, 399.e1. doi: 10.1016/j.jamcollsurg.2010.10.016.
  • 31. Gillis C, Wischmeyer PE. Pre-operative nutrition and the elective surgical patient: why, how and what? Anaesthesia. 2019;74 Suppl 1:27-35. doi: 10.1111/anae.14506.
Yıl 2025, EARLY ONLINE, 1 - 9
https://doi.org/10.18621/eurj.1660420

Öz

Kaynakça

  • 1. Hannan EL, Racz MJ, Walford G, et al. Long-term outcomes of coronary-artery bypass grafting versus stent implantation. N Engl J Med. 2005;352(21):2174-2183. doi: 10.1056/NEJMoa040316.
  • 2. Fortescue EB, Kahn K, Bates DW. Development and validation of a clinical prediction rule for major adverse outcomes in coronary bypass grafting. Am J Cardiol. 2001;88(11):1251-1258. doi: 10.1016/s0002-9149(01)02086-0.
  • 3. Kulier A, Levin J, Moser R, et al; Investigators of the Multicenter Study of Perioperative Ischemia Research Group; Ischemia Research and Education Foundation. Impact of preoperative anemia on outcome in patients undergoing coronary artery bypass graft surgery. Circulation. 2007;116(5):471-479. doi: 10.1161/CIRCULATIONAHA.106.653501.
  • 4. Cooper WA, O'Brien SM, Thourani VH, et al. Impact of renal dysfunction on outcomes of coronary artery bypass surgery: results from the Society of Thoracic Surgeons National Adult Cardiac Database. Circulation. 2006;113(8):1063-1070. doi: 10.1161/CIRCULATIONAHA.105.580084.
  • 5. Daly LE, Lonergan M, Graham I. Predicting operative mortality after coronary artery bypass surgery in males. Q J Med. 1993;86(12):771-8.
  • 6. Koch CG, Li L, Kaplan GA, et al. Socioeconomic position, not race, is linked to death after cardiac surgery. Circ Cardiovasc Qual Outcomes. 2010;3(3):267-276. doi: 10.1161/CIRCOUTCOMES.109.880377.
  • 7. Jeon HG, Choi DK, Sung HH, et al. Preoperative Prognostic Nutritional Index is a Significant Predictor of Survival in Renal Cell Carcinoma Patients Undergoing Nephrectomy. Ann Surg Oncol. 2016;23(1):321-327. doi: 10.1245/s10434-015-4614-0.
  • 8. Larsson J, Akerlind I, Permerth J, Hörnqvist JO. The relation between nutritional state and quality of life in surgical patients. Eur J Surg. 1994;160(6-7):329-334.
  • 9. Allard JP, Keller H, Jeejeebhoy KN, et al. Decline in nutritional status is associated with prolonged length of stay in hospitalized patients admitted for 7 days or more: A prospective cohort study. Clin Nutr. 2016;35(1):144-152. doi: 10.1016/j.clnu.2015.01.009.
  • 10. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg. 1980;139(1):160-7. doi: 10.1016/0002-9610(80)90246-9.
  • 11. Onodera T, Goseki N, Kosaki G. [Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients]. Nihon Geka Gakkai Zasshi. 1984;85(9):1001-1005. [Article in Japanese]
  • 12. Yoshihisa A, Kanno Y, Watanabe S, et al. Impact of nutritional indices on mortality in patients with heart failure. Open Heart. 2018;5(1):e000730. doi: 10.1136/openhrt-2017-000730.
  • 13. González Ferreiro R, Muñoz-García AJ, López Otero D, et al. Nutritional risk index predicts survival in patients undergoing transcatheter aortic valve replacement. Int J Cardiol. 2019;276:66-71. doi: 10.1016/j.ijcard.2018.11.097.
  • 14. Söner S, Güzel T, Aktan A, et al. Predictive value of nutritional scores in non-valvular atrial fibrillation patients: Insights from the AFTER-2 study. Nutr Metab Cardiovasc Dis. 2025r;35(3):103794. doi: 10.1016/j.numecd.2024.103794.
  • 15. Chen JY, Chen TW, Lu WD. HAT2CH2 Score Predicts Systemic Thromboembolic Events in Elderly After Cardiac Electronic Device Implantation. Front Med (Lausanne). 2021;8:786779. doi: 10.3389/fmed.2021.786779.
  • 16. Tasbulak O, Guler A, Duran M, et al. Association Between Nutritional Indices and Long-Term Outcomes in Patients Undergoing Isolated Coronary Artery Bypass Grafting. Cureus. 2021;13(7):e16567. doi: 10.7759/cureus.16567.
  • 17. Basta G, Chatzianagnostou K, Paradossi U, et al. The prognostic impact of objective nutritional indices in elderly patients with ST-elevation myocardial infarction undergoing primary coronary intervention. Int J Cardiol. 2016;221:987-992. doi: 10.1016/j.ijcard.2016.07.039.
  • 18. Keskin M, Hayıroğlu MI, Keskin T, et al. A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index. Nutr Metab Cardiovasc Dis. 2017;27(5):438-446. doi: 10.1016/j.numecd.2017.01.005.
  • 19. Hayıroğlu Mİ, Keskin M, Keskin T, et al. A Novel Independent Survival Predictor in Pulmonary Embolism: Prognostic Nutritional Index. Clin Appl Thromb Hemost. 2018;24(4):633-639. doi: 10.1177/1076029617703482.
  • 20. Lee SI, Ko KP, Choi CH, Park CH, Park KY, Son KH. Does the prognostic nutritional index have a predictive role in the outcomes of adult cardiac surgery? J Thorac Cardiovasc Surg. 2020;160(1):145-153.e3. doi: 10.1016/j.jtcvs.2019.08.069.
  • 21. Detsky AS, Baker JP, O'Rourke K, Goel V. Perioperative parenteral nutrition: a meta-analysis. Ann Intern Med. 1987;107(2):195-203. doi: 10.7326/0003-4819-107-2-195.
  • 22. Almohammadi AA, Alqarni MA, Alqaidy MY, Ismail SA, Almabadi RM. Impact of the Prognostic Nutritional Index on Postoperative Outcomes in Patients Undergoing Heart Surgery. Cureus. 2023;15(8):e43745. doi: 10.7759/cureus.43745.
  • 23. Karaca B, Esin F, Tiryaki MM, Akkan G, Kiris T. Combining C-reactive protein, procalcitonin, and serum albumin to predict long-term mortality in patients with infective endocarditis. J Int Med Res. 2023;51(10):3000605231208910. doi: 10.1177/03000605231208910.
  • 24. Usalp ZO, Usalp S. Does the eosinophil-to-monocyte ratio predict inflammation in patients with diabetic retinopathy? İJCMBS. 2024;4(1):10-14. doi:10.5281/zenodo.10707773
  • 25. Ignacio de Ulíbarri J, González-Madroño A, de Villar NG, et al. CONUT: a tool for controlling nutritional status. First validation in a hospital population. Nutr Hosp. 2005;20(1):38-45.
  • 26. Bouillanne O, Morineau G, Dupont C, et al. Geriatric Nutritional Risk Index: a new index for evaluating at-risk elderly medical patients. Am J Clin Nutr. 2005;82(4):777-783. doi: 10.1093/ajcn/82.4.777.
  • 27. Demal TJ, Arndt N, Bhadra OD, et al. Predictors for Length of Stay after Surgical Aortic Valve Replacement. Thorac Cardiovasc Surg. 2025 Mar 19. doi: 10.1055/a-2466-7245.
  • 28. Augustin P, Tanaka S, Chhor V, et al. Prognosis of Prolonged Intensive Care Unit Stay After Aortic Valve Replacement for Severe Aortic Stenosis in Octogenarians. J Cardiothorac Vasc Anesth. 2016;30(6):1555-1561. doi: 10.1053/j.jvca.2016.07.029.
  • 29. Weimann A, Braga M, Carli F, et al. ESPEN guideline: Clinical nutrition in surgery. Clin Nutr. 2017;36(3):623-650. doi: 10.1016/j.clnu.2017.02.013.
  • 30. Drover JW, Dhaliwal R, Weitzel L, Wischmeyer PE, Ochoa JB, Heyland DK. Perioperative use of arginine-supplemented diets: a systematic review of the evidence. J Am Coll Surg. 2011;212(3):385-399, 399.e1. doi: 10.1016/j.jamcollsurg.2010.10.016.
  • 31. Gillis C, Wischmeyer PE. Pre-operative nutrition and the elective surgical patient: why, how and what? Anaesthesia. 2019;74 Suppl 1:27-35. doi: 10.1111/anae.14506.
Toplam 31 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Kardiyoloji , Anesteziyoloji
Bölüm Original Article
Yazarlar

Hülya Tosun Söner 0000-0003-1524-8685

Serdar Söner 0000-0002-2807-6424

Meral Erdal Erbatur 0000-0001-8970-3359

Mehmet Özbek 0000-0003-2243-6190

Erken Görünüm Tarihi 12 Haziran 2025
Yayımlanma Tarihi
Gönderilme Tarihi 18 Mart 2025
Kabul Tarihi 5 Mayıs 2025
Yayımlandığı Sayı Yıl 2025 EARLY ONLINE

Kaynak Göster

AMA Tosun Söner H, Söner S, Erdal Erbatur M, Özbek M. Effect of prognostic nutritional index on hospital stay in patients undergoing metallic prosthetic mitral valve surgery. Eur Res J. Published online 01 Haziran 2025:1-9. doi:10.18621/eurj.1660420

e-ISSN: 2149-3189 


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