Value of prognostic nutritional index for predicting 28-day death risk in intensive care unit patients after cardiopulmonary resuscitation_West China Medical Journal

Authors：

LIN Qingting , ZHANG Nan ,  ZHU Huadong

Emergency Department, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing 100730, P. R. China;

Corresponding author：

ZHU Huadong, Email: zhuhuadong1970@126.com

Keywords：

Prognostic nutritional index; post cardiac arrest; prognosis

DOI：

10.7507/1002-0179.202310007

Video：

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Objective To investigate the relationship between the level of prognostic nutritional index (PNI) and 28-day mortality in patients after cardiopulmonary resuscitation. Methods A total of 955 patients admitted to intensive care unit after cardiopulmonary resuscitation between 2008 and 2019 were selected from the MIMIC-IV database and grouped according to the optimal cut-off value of PNI for retrospective cohort analysis. Primary outcome was defined as 28-day all-cause mortality. After adjusting for confounding factors by propensity score matching, the outcomes between high PNI and low PNI groups were compared. PNI and Sequential Organ Failure Assessment (SOFA) score were incorporated into a Cox proportional risk model to construct a predictive model, and the predictive effect was assessed using the concordance index, the net reclassification index, and the integrated discriminant improvement. Results After propensity score matching, compared with the high PNI group, the low PNI group had lower 28-day survival (P<0.001), higher doses of vasoactive drugs used during intensive care unit stay (P<0.001), higher SOFA score (P<0.001) and higher Logistic Organ Dysfunction System score (P=0.002). The admission PNI and SOFA score had similar predictive effects on 28-day mortality, with the area under the receiver operating characteristic curve of 0.639 and 0.638, respectively. In addition, compared with SOFA score alone, PNI combined with SOFA score improved the predictive performance, with an area under the curve of 0.673, the concordance index increasing from 0.598 to 0.622, and the net reclassification index and the integrated discriminant improvement estimates of 0.144 (P<0.001) and 0.027 (P<0.001), respectively. Conclusions PNI can be used as a new predictor of all-cause death risk within 28 days after cardiopulmonary resuscitation. SOFA score combined with PNI can improve the prediction effect.

Citation： LIN Qingting, ZHANG Nan, ZHU Huadong. Value of prognostic nutritional index for predicting 28-day death risk in intensive care unit patients after cardiopulmonary resuscitation. West China Medical Journal, 2023, 38(11): 1679-1686. doi: 10.7507/1002-0179.202310007 Copy

1.	陈玉国, 徐峰. 中国心脏骤停与心肺复苏报告(2022 年版). 北京: 人民卫生出版社, 2023: 16-21.
2.	Meyer MAS, Bjerre M, Wiberg S, et al. Modulation of inflammation by treatment with tocilizumab after out-of-hospital cardiac arrest and associations with clinical status, myocardial- and brain injury. Resuscitation, 2023, 184: 109676.
3.	Fehler P, Zielińska M, Uchmanowicz B, et al. Do body mass index and nutritional risk score 2002 influence the in-hospital mortality of patients following cardiac arrest?. Nutrients, 2023, 15(2): 436.
4.	Matsuda J, Kato S, Yano H, et al. The Sequential Organ Failure Assessment (SOFA) score predicts mortality and neurological outcome in patients with post-cardiac arrest syndrome. J Cardiol, 2020, 76(3): 295-302.
5.	Wang Z, Zhao L, He S. Prognostic nutritional index and the risk of mortality in patients with hypertrophic cardiomyopathy. Int J Cardiol, 2021, 331: 152-157.
6.	孔钦, 叶长青, 孙赟. 大数据下数据预处理方法研究. 计算机技术与发展, 2018, 28(5): 1-4.
7.	Huang Y, Zhang Q, Li P, et al. The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction. BMC Cardiovasc Disord, 2023, 23(1): 339.
8.	Ryzhov S, May T, Dziodzio J, et al. Number of circulating CD 73-expressing lymphocytes correlates with survival after cardiac arrest. J Am Heart Assoc, 2019, 8(13): e010874.
9.	Cour M, Jahandiez V, Bochaton T, et al. Cyclosporine A prevents ischemia-reperfusion-induced lymphopenia after out-of-hospital cardiac arrest: a predefined sub-study of the CYRUS trial. Resuscitation, 2019, 138: 129-131.
10.	Wang W, Li R, Miao W, et al. Development and evaluation of a novel mouse model of asphyxial cardiac arrest revealed severely impaired lymphopoiesis after resuscitation. J Am Heart Assoc, 2021, 10(11): e019142.
11.	Kong T, Chung SP, Lee HS, et al. The prognostic usefulness of the lactate/albumin ratio for predicting clinical outcomes in out-of-hospital cardiac arrest: a prospective, multicenter observational study (koCARC) study. Shock, 2020, 53(4): 442-451.
12.	Yoon JH, Choi WS, Lim YS, et al. Comparison of prognostic performance between procalcitonin and procalcitonin-to-albumin ratio in post cardiac arrest syndrome. J Clin Med, 2023, 12(14): 4568.
13.	Hong SI, Kim YJ, Cho YJ, et al. Predictive value of pre-arrest albumin level with GO-FAR score in patients with in-hospital cardiac arrest. Sci Rep, 2021, 11(1): 10631.
14.	Lee H, Lee J, Shin H, et al. Association between early phase serum albumin levels and outcomes of post-cardiac arrest patients: a systematic review and meta-analysis. J Pers Med, 2022, 12(11): 1787.
15.	Matsuyama T, Iwami T, Yamada T, et al. Effect of serum albumin concentration on neurological outcome after out-of-hospital cardiac arrest (from the CRITICAL [Comprehensive Registry of Intensive Cares for OHCA Survival] Study in Osaka, Japan). Am J Cardiol, 2018, 121(2): 156-161.
16.	Kalyoncuoğlu M, Katkat F, Biter HI, et al. Predicting one-year deaths and major adverse vascular events with the controlling nutritional status score in elderly patients with non-ST-elevated myocardial infarction undergoing percutaneous coronary intervention. J Clin Med, 2021, 10(11): 2247.
17.	Raposeiras Roubín S, Abu Assi E, Cespón Fernandez M, et al. Prevalence and prognostic significance of malnutrition in patients with acute coronary syndrome. J Am Coll Cardiol, 2020, 76(7): 828-840.
18.	Ferreira FL, Bota DP, Bross A, et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA, 2001, 286(14): 1754-1758.
19.	Cour M, Bresson D, Hernu R, et al. SOFA score to assess the severity of the post-cardiac arrest syndrome. Resuscitation, 2016, 102: 110-115.
20.	Pekkarinen PT, Bäcklund M, Efendijev I, et al. Association of extracerebral organ failure with 1-year survival and healthcare-associated costs after cardiac arrest: an observational database study. Crit Care, 2019, 23(1): 67.
21.	Vaahersalo J, Skrifvars MB, Pulkki K, et al. Admission interleukin-6 is associated with post resuscitation organ dysfunction and predicts long-term neurological outcome after out-of-hospital ventricular fibrillation. Resuscitation, 2014, 85(11): 1573-1579.

1. 陈玉国, 徐峰. 中国心脏骤停与心肺复苏报告(2022 年版). 北京: 人民卫生出版社, 2023: 16-21.
2. Meyer MAS, Bjerre M, Wiberg S, et al. Modulation of inflammation by treatment with tocilizumab after out-of-hospital cardiac arrest and associations with clinical status, myocardial- and brain injury. Resuscitation, 2023, 184: 109676.
3. Fehler P, Zielińska M, Uchmanowicz B, et al. Do body mass index and nutritional risk score 2002 influence the in-hospital mortality of patients following cardiac arrest?. Nutrients, 2023, 15(2): 436.
4. Matsuda J, Kato S, Yano H, et al. The Sequential Organ Failure Assessment (SOFA) score predicts mortality and neurological outcome in patients with post-cardiac arrest syndrome. J Cardiol, 2020, 76(3): 295-302.
5. Wang Z, Zhao L, He S. Prognostic nutritional index and the risk of mortality in patients with hypertrophic cardiomyopathy. Int J Cardiol, 2021, 331: 152-157.
6. 孔钦, 叶长青, 孙赟. 大数据下数据预处理方法研究. 计算机技术与发展, 2018, 28(5): 1-4.
7. Huang Y, Zhang Q, Li P, et al. The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction. BMC Cardiovasc Disord, 2023, 23(1): 339.
8. Ryzhov S, May T, Dziodzio J, et al. Number of circulating CD 73-expressing lymphocytes correlates with survival after cardiac arrest. J Am Heart Assoc, 2019, 8(13): e010874.
9. Cour M, Jahandiez V, Bochaton T, et al. Cyclosporine A prevents ischemia-reperfusion-induced lymphopenia after out-of-hospital cardiac arrest: a predefined sub-study of the CYRUS trial. Resuscitation, 2019, 138: 129-131.
10. Wang W, Li R, Miao W, et al. Development and evaluation of a novel mouse model of asphyxial cardiac arrest revealed severely impaired lymphopoiesis after resuscitation. J Am Heart Assoc, 2021, 10(11): e019142.
11. Kong T, Chung SP, Lee HS, et al. The prognostic usefulness of the lactate/albumin ratio for predicting clinical outcomes in out-of-hospital cardiac arrest: a prospective, multicenter observational study (koCARC) study. Shock, 2020, 53(4): 442-451.
12. Yoon JH, Choi WS, Lim YS, et al. Comparison of prognostic performance between procalcitonin and procalcitonin-to-albumin ratio in post cardiac arrest syndrome. J Clin Med, 2023, 12(14): 4568.
13. Hong SI, Kim YJ, Cho YJ, et al. Predictive value of pre-arrest albumin level with GO-FAR score in patients with in-hospital cardiac arrest. Sci Rep, 2021, 11(1): 10631.
14. Lee H, Lee J, Shin H, et al. Association between early phase serum albumin levels and outcomes of post-cardiac arrest patients: a systematic review and meta-analysis. J Pers Med, 2022, 12(11): 1787.
15. Matsuyama T, Iwami T, Yamada T, et al. Effect of serum albumin concentration on neurological outcome after out-of-hospital cardiac arrest (from the CRITICAL [Comprehensive Registry of Intensive Cares for OHCA Survival] Study in Osaka, Japan). Am J Cardiol, 2018, 121(2): 156-161.
16. Kalyoncuoğlu M, Katkat F, Biter HI, et al. Predicting one-year deaths and major adverse vascular events with the controlling nutritional status score in elderly patients with non-ST-elevated myocardial infarction undergoing percutaneous coronary intervention. J Clin Med, 2021, 10(11): 2247.
17. Raposeiras Roubín S, Abu Assi E, Cespón Fernandez M, et al. Prevalence and prognostic significance of malnutrition in patients with acute coronary syndrome. J Am Coll Cardiol, 2020, 76(7): 828-840.
18. Ferreira FL, Bota DP, Bross A, et al. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA, 2001, 286(14): 1754-1758.
19. Cour M, Bresson D, Hernu R, et al. SOFA score to assess the severity of the post-cardiac arrest syndrome. Resuscitation, 2016, 102: 110-115.
20. Pekkarinen PT, Bäcklund M, Efendijev I, et al. Association of extracerebral organ failure with 1-year survival and healthcare-associated costs after cardiac arrest: an observational database study. Crit Care, 2019, 23(1): 67.
21. Vaahersalo J, Skrifvars MB, Pulkki K, et al. Admission interleukin-6 is associated with post resuscitation organ dysfunction and predicts long-term neurological outcome after out-of-hospital ventricular fibrillation. Resuscitation, 2014, 85(11): 1573-1579.

West China Medical Journal

Value of prognostic nutritional index for predicting 28-day death risk in intensive care unit patients after cardiopulmonary resuscitation

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