Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease: a cohort study
Abstract Background Malnutrition and inflammation are associated with adverse clinical outcomes in patients with diabetes or coronary artery disease (CAD). Prognostic nutritional index (PNI) is a comprehensive and simple indicator reflecting nutritional condition and immunological status. Whether th...
| Main Authors: | , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2023-03-01
|
| Series: | Diabetology & Metabolic Syndrome |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13098-023-01019-8 |
| _version_ | 1797859870577262592 |
|---|---|
| author | Tianyu Li Deshan Yuan Peizhi Wang Guyu Zeng Sida Jia Ce Zhang Pei Zhu Ying Song Xiaofang Tang Runlin Gao Bo Xu Jinqing Yuan |
| author_facet | Tianyu Li Deshan Yuan Peizhi Wang Guyu Zeng Sida Jia Ce Zhang Pei Zhu Ying Song Xiaofang Tang Runlin Gao Bo Xu Jinqing Yuan |
| author_sort | Tianyu Li |
| collection | DOAJ |
| description | Abstract Background Malnutrition and inflammation are associated with adverse clinical outcomes in patients with diabetes or coronary artery disease (CAD). Prognostic nutritional index (PNI) is a comprehensive and simple indicator reflecting nutritional condition and immunological status. Whether there is a crosstalk between nutritional-immunological status and diabetes status for the impact on the prognosis of coronary artery disease (CAD) is unclear. Methods A total of 9429 consecutive CAD patients undergoing percutaneous coronary intervention were grouped by diabetes status [diabetes (DM) and non-diabetes (non-DM)] and preprocedural PNI level [high PNI (H-PNI) and low PNI (L-PNI)] categorized by the statistically optimal cut-off value of 48.49. The primary endpoint was all-cause death. Results During a median follow-up of 5.1 years (interquartile range: 5.0–5.1 years), 366 patients died. Compared with the non-DM/H-PNI group, the DM/L-PNI group yielded the highest risk of all-cause death (adjusted hazard ratio: 2.65, 95% confidence interval: 1.97–3.56, p < 0.001), followed by the non-DM/L-PNI group (adjusted hazard ratio: 1.44, 95% confidence interval: 1.05–1.98, p = 0.026), while DM/H-PNI was not associated with the risk of all-cause death. The negative effect of L-PNI on all-cause death was significantly stronger in diabetic patients than in nondiabetic patients (p for interaction = 0.037). Preprocedural PNI category significantly improved the Global Registry of Acute Coronary Events (GRACE) risk score for predicting all-cause death in patients with acute coronary syndrome, especially in those with diabetes. Conclusions CAD patients with diabetes and L-PNI experienced the worst prognosis. The presence of diabetes amplifies the negative effect of L-PNI on all-cause death. Poor nutritional-immunological status outweighs diabetes in increasing the risk of all-cause death in CAD patients. Preprocedural PNI can serve as an assessment tool for nutritional and inflammatory risk and an independent prognostic factor in CAD patients, especially in those with diabetes. |
| first_indexed | 2024-04-09T21:36:34Z |
| format | Article |
| id | doaj.art-2d1bc4ab66b9432c80349470e796be5c |
| institution | Directory Open Access Journal |
| issn | 1758-5996 |
| language | English |
| last_indexed | 2024-04-09T21:36:34Z |
| publishDate | 2023-03-01 |
| publisher | BMC |
| record_format | Article |
| series | Diabetology & Metabolic Syndrome |
| spelling | doaj.art-2d1bc4ab66b9432c80349470e796be5c2023-03-26T11:15:06ZengBMCDiabetology & Metabolic Syndrome1758-59962023-03-0115111310.1186/s13098-023-01019-8Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease: a cohort studyTianyu Li0Deshan Yuan1Peizhi Wang2Guyu Zeng3Sida Jia4Ce Zhang5Pei Zhu6Ying Song7Xiaofang Tang8Runlin Gao9Bo Xu10Jinqing Yuan11National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeNational Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeNational Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeNational Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeDepartment of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeCatheterization Laboratories, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeNational Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical CollegeAbstract Background Malnutrition and inflammation are associated with adverse clinical outcomes in patients with diabetes or coronary artery disease (CAD). Prognostic nutritional index (PNI) is a comprehensive and simple indicator reflecting nutritional condition and immunological status. Whether there is a crosstalk between nutritional-immunological status and diabetes status for the impact on the prognosis of coronary artery disease (CAD) is unclear. Methods A total of 9429 consecutive CAD patients undergoing percutaneous coronary intervention were grouped by diabetes status [diabetes (DM) and non-diabetes (non-DM)] and preprocedural PNI level [high PNI (H-PNI) and low PNI (L-PNI)] categorized by the statistically optimal cut-off value of 48.49. The primary endpoint was all-cause death. Results During a median follow-up of 5.1 years (interquartile range: 5.0–5.1 years), 366 patients died. Compared with the non-DM/H-PNI group, the DM/L-PNI group yielded the highest risk of all-cause death (adjusted hazard ratio: 2.65, 95% confidence interval: 1.97–3.56, p < 0.001), followed by the non-DM/L-PNI group (adjusted hazard ratio: 1.44, 95% confidence interval: 1.05–1.98, p = 0.026), while DM/H-PNI was not associated with the risk of all-cause death. The negative effect of L-PNI on all-cause death was significantly stronger in diabetic patients than in nondiabetic patients (p for interaction = 0.037). Preprocedural PNI category significantly improved the Global Registry of Acute Coronary Events (GRACE) risk score for predicting all-cause death in patients with acute coronary syndrome, especially in those with diabetes. Conclusions CAD patients with diabetes and L-PNI experienced the worst prognosis. The presence of diabetes amplifies the negative effect of L-PNI on all-cause death. Poor nutritional-immunological status outweighs diabetes in increasing the risk of all-cause death in CAD patients. Preprocedural PNI can serve as an assessment tool for nutritional and inflammatory risk and an independent prognostic factor in CAD patients, especially in those with diabetes.https://doi.org/10.1186/s13098-023-01019-8Nutritional statusInflammationDiabetes mellitusIschemic heart disease |
| spellingShingle | Tianyu Li Deshan Yuan Peizhi Wang Guyu Zeng Sida Jia Ce Zhang Pei Zhu Ying Song Xiaofang Tang Runlin Gao Bo Xu Jinqing Yuan Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease: a cohort study Diabetology & Metabolic Syndrome Nutritional status Inflammation Diabetes mellitus Ischemic heart disease |
| title | Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease: a cohort study |
| title_full | Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease: a cohort study |
| title_fullStr | Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease: a cohort study |
| title_full_unstemmed | Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease: a cohort study |
| title_short | Association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease: a cohort study |
| title_sort | association of prognostic nutritional index level and diabetes status with the prognosis of coronary artery disease a cohort study |
| topic | Nutritional status Inflammation Diabetes mellitus Ischemic heart disease |
| url | https://doi.org/10.1186/s13098-023-01019-8 |
| work_keys_str_mv | AT tianyuli associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT deshanyuan associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT peizhiwang associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT guyuzeng associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT sidajia associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT cezhang associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT peizhu associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT yingsong associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT xiaofangtang associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT runlingao associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT boxu associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy AT jinqingyuan associationofprognosticnutritionalindexlevelanddiabetesstatuswiththeprognosisofcoronaryarterydiseaseacohortstudy |