Prognostic Nutritional Index (PNI) as a potential predictor and intervention target for perioperative ischemic stroke: a retrospective cohort study
Abstract Background The prognostic nutritional index (PNI) is a nutritional indicator and predictor of various diseases. However it is unclear whether PNI can be a predictor of perioperative ischemic stroke. This study aims to evaluate the association of the preoperative PNI and ischemic stroke in p...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-08-01
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| Series: | BMC Anesthesiology |
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| Online Access: | https://doi.org/10.1186/s12871-023-02216-8 |
| _version_ | 1797451691718606848 |
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| author | Min Liu Miao Sun Ting Zhang Peng Li Jin Liu Yanhong Liu Yuxiang Song Siyuan Liu Huikai Yang Zhikang Zhou Dandan Chang Guyan Wang Weidong Mi Yulong Ma |
| author_facet | Min Liu Miao Sun Ting Zhang Peng Li Jin Liu Yanhong Liu Yuxiang Song Siyuan Liu Huikai Yang Zhikang Zhou Dandan Chang Guyan Wang Weidong Mi Yulong Ma |
| author_sort | Min Liu |
| collection | DOAJ |
| description | Abstract Background The prognostic nutritional index (PNI) is a nutritional indicator and predictor of various diseases. However it is unclear whether PNI can be a predictor of perioperative ischemic stroke. This study aims to evaluate the association of the preoperative PNI and ischemic stroke in patients undergoing non-cardiac surgery. Methods The retrospective cohort study included patients who underwent noncardiac surgery between January 2008 and August 2019. The patients were divided into PNI ≥ 38.8 and PNI < 38.8 groups according to the cut-off value of PNI. Univariate and multivariate logistic regression analyses were performed to explore the association between PNI and perioperative ischemic stroke. Subsequently, propensity score matching (PSM) analysis was performed to eliminate the confounding factors of covariates and further validate the results. Subgroup analyses were completed to assess the predictive utility of PNI for perioperative ischemic stroke in different groups. Results Amongst 221,542 hospitalized patients enrolled, 485 (0.22%) experienced an ischemic stroke within 30 days of the surgery, 22.1% of patients were malnourished according to PNI < 38.8, and the occurrence of perioperative ischemic stroke was 0.34% (169/49055) in the PNI < 38.8 group. PNI < 38.8 was significantly associated with an increased incidence of perioperative ischemic stroke whether in univariate logistic regression analysis (OR = 1.884, 95% CI: 1.559—2.267, P < 0.001) or multivariate logistic regression analysis (OR = 1.306, 95% CI: 1.061—1.602, P = 0.011). After PSM analysis, the ORs of PNI < 38.8 group were 1.250 (95% CI: 1.000–1.556, P = 0.050) and 1.357 (95% CI: 1.077–1.704, P = 0.009) in univariate logistic regression analysis and multivariate logistic regression analysis respectively. The subgroup analysis indicated that reduced PNI was significantly associated to an increased risk of perioperative ischemic stroke in patients over 65 years old, ASA II, not taking aspirin before surgery, without a history of stroke, who had neurosurgery, non-emergency surgery, and were admitted to ICU after surgery. Conclusions Our study indicates that low preoperative PNI is significantly associated with a higher incidence of ischemic stroke in patients undergoing non-cardiac surgery. Preoperative PNI, as a preoperative nutritional status evaluation index, is an independent risk factor useful to predict perioperative ischemic stroke risk, which could be used as an intervenable preoperative clinical biochemical index to reduce the incidence of perioperative ischemic stroke. |
| first_indexed | 2024-03-09T14:58:11Z |
| format | Article |
| id | doaj.art-75212382015540fdae7fb4ef15f2df0c |
| institution | Directory Open Access Journal |
| issn | 1471-2253 |
| language | English |
| last_indexed | 2024-03-09T14:58:11Z |
| publishDate | 2023-08-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Anesthesiology |
| spelling | doaj.art-75212382015540fdae7fb4ef15f2df0c2023-11-26T14:03:17ZengBMCBMC Anesthesiology1471-22532023-08-0123111010.1186/s12871-023-02216-8Prognostic Nutritional Index (PNI) as a potential predictor and intervention target for perioperative ischemic stroke: a retrospective cohort studyMin Liu0Miao Sun1Ting Zhang2Peng Li3Jin Liu4Yanhong Liu5Yuxiang Song6Siyuan Liu7Huikai Yang8Zhikang Zhou9Dandan Chang10Guyan Wang11Weidong Mi12Yulong Ma13Department of Anesthesiology, The First Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, The First Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, The First Medical Center of Chinese PLA General Hospital Department of Anesthesiology, The Sixth Medical Center of PLA General HospitalHangzhou Le9 Healthcare Technology Co., LtdDepartment of Anesthesiology, The First Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, The First Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, Affiliated Hospital of Nantong UniversityDepartment of Anesthesiology, The First Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, The First Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, The First Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, Beijing Tongren Hospital, Capital Medical UniversityDepartment of Anesthesiology, The First Medical Center of Chinese PLA General HospitalDepartment of Anesthesiology, The First Medical Center of Chinese PLA General HospitalAbstract Background The prognostic nutritional index (PNI) is a nutritional indicator and predictor of various diseases. However it is unclear whether PNI can be a predictor of perioperative ischemic stroke. This study aims to evaluate the association of the preoperative PNI and ischemic stroke in patients undergoing non-cardiac surgery. Methods The retrospective cohort study included patients who underwent noncardiac surgery between January 2008 and August 2019. The patients were divided into PNI ≥ 38.8 and PNI < 38.8 groups according to the cut-off value of PNI. Univariate and multivariate logistic regression analyses were performed to explore the association between PNI and perioperative ischemic stroke. Subsequently, propensity score matching (PSM) analysis was performed to eliminate the confounding factors of covariates and further validate the results. Subgroup analyses were completed to assess the predictive utility of PNI for perioperative ischemic stroke in different groups. Results Amongst 221,542 hospitalized patients enrolled, 485 (0.22%) experienced an ischemic stroke within 30 days of the surgery, 22.1% of patients were malnourished according to PNI < 38.8, and the occurrence of perioperative ischemic stroke was 0.34% (169/49055) in the PNI < 38.8 group. PNI < 38.8 was significantly associated with an increased incidence of perioperative ischemic stroke whether in univariate logistic regression analysis (OR = 1.884, 95% CI: 1.559—2.267, P < 0.001) or multivariate logistic regression analysis (OR = 1.306, 95% CI: 1.061—1.602, P = 0.011). After PSM analysis, the ORs of PNI < 38.8 group were 1.250 (95% CI: 1.000–1.556, P = 0.050) and 1.357 (95% CI: 1.077–1.704, P = 0.009) in univariate logistic regression analysis and multivariate logistic regression analysis respectively. The subgroup analysis indicated that reduced PNI was significantly associated to an increased risk of perioperative ischemic stroke in patients over 65 years old, ASA II, not taking aspirin before surgery, without a history of stroke, who had neurosurgery, non-emergency surgery, and were admitted to ICU after surgery. Conclusions Our study indicates that low preoperative PNI is significantly associated with a higher incidence of ischemic stroke in patients undergoing non-cardiac surgery. Preoperative PNI, as a preoperative nutritional status evaluation index, is an independent risk factor useful to predict perioperative ischemic stroke risk, which could be used as an intervenable preoperative clinical biochemical index to reduce the incidence of perioperative ischemic stroke.https://doi.org/10.1186/s12871-023-02216-8Prognostic Nutritional Index (PNI)Perioperative ischemic strokePostoperative complicationPredictorIntervention target |
| spellingShingle | Min Liu Miao Sun Ting Zhang Peng Li Jin Liu Yanhong Liu Yuxiang Song Siyuan Liu Huikai Yang Zhikang Zhou Dandan Chang Guyan Wang Weidong Mi Yulong Ma Prognostic Nutritional Index (PNI) as a potential predictor and intervention target for perioperative ischemic stroke: a retrospective cohort study BMC Anesthesiology Prognostic Nutritional Index (PNI) Perioperative ischemic stroke Postoperative complication Predictor Intervention target |
| title | Prognostic Nutritional Index (PNI) as a potential predictor and intervention target for perioperative ischemic stroke: a retrospective cohort study |
| title_full | Prognostic Nutritional Index (PNI) as a potential predictor and intervention target for perioperative ischemic stroke: a retrospective cohort study |
| title_fullStr | Prognostic Nutritional Index (PNI) as a potential predictor and intervention target for perioperative ischemic stroke: a retrospective cohort study |
| title_full_unstemmed | Prognostic Nutritional Index (PNI) as a potential predictor and intervention target for perioperative ischemic stroke: a retrospective cohort study |
| title_short | Prognostic Nutritional Index (PNI) as a potential predictor and intervention target for perioperative ischemic stroke: a retrospective cohort study |
| title_sort | prognostic nutritional index pni as a potential predictor and intervention target for perioperative ischemic stroke a retrospective cohort study |
| topic | Prognostic Nutritional Index (PNI) Perioperative ischemic stroke Postoperative complication Predictor Intervention target |
| url | https://doi.org/10.1186/s12871-023-02216-8 |
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