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Abstract
Background
The survival of critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT) is highly dependent on their nutritional status.
Objectives
The prognostic nutritional index (PNI) is an indicator used to assess nutritional status and is calculated as: PNI = (serum albumin in g/dL) × 10 + (total lymphocyte count in/mm3) × 0.005. In this retrospective study, we investigated the correlation between this index and clinical outcomes in critically ill patients with AKI receiving CRRT.
Methods
We analyzed data from 2076 critically ill patients admitted to the intensive care unit at Changhua Christian Hospital, a tertiary hospital in central Taiwan, between January 1, 2010, and April 30, 2021. All these patients met the inclusion criteria of the study. The relationship between PNI and renal replacement therapy-free survival (RRTFS) and mortality was examined using logistic regression models, Cox proportional hazard models, and propensity score matching. High utilization rate of parenteral nutrition (PN) was observed in our study. Subgroup analysis was performed to explore the interaction effect between PNI and PN on mortality.
Results
Patients with higher PNI levels exhibited a greater likelihood of achieving RRTFS, with an adjusted odds ratio of 2.43 (95% confidence interval [CI]: 1.98-2.97, p-value < 0.001). Additionally, these patients demonstrated higher survival rates, with an adjusted hazard ratio of 0.84 (95% CI: 0.72-0.98) for 28-day mortality and 0.80 (95% CI: 0.69-0.92) for 90-day mortality (all p-values < 0.05), compared to those in the low PNI group. While a high utilization rate of parenteral nutrition (PN) was observed, with 78.86% of CRRT patients receiving PN, subgroup analysis showed that high PNI had an independent protective effect on mortality outcomes in AKI patients receiving CRRT, regardless of their PN status.
Conclusions
PNI can serve as an easy, simple, and efficient measure of lymphocytes and albumin levels to predict RRTFS and mortality in AKI patients with require CRRT.
Acknowledgments
The authors would like to thank the Changhua Christian Hospital Big Data Center for their research collaboration and the staff working in the field. Additionally, we thank Research Square for preprinting our preliminary findings to increase transparency and accessibility (Doi:https://doi.org/10.21203/rs.3.rs-3026934/v1)
Authors’ contributions
Conceptualization, YFL and CTK; methodology, CTK; software, PRL and CTK; validation, PRL and CTK; formal analysis, PRL and CTK; data curation, PRL; writing—original draft preparation, YFL and CTK; writing—review and editing, SHW, HHH, and ICM; visualization, PRL; funding acquisition, CTK. All authors have read and agreed to the published version of the manuscript.
Disclosure statement
No potential conflict of interest was reported by the author(s).
Ethics approval and consent to participate
The Institutional Review Board of CCH waived the requirement for informed consent and approved the study (IRB No: 220819). All patient records and data were deidentified and anonymized prior to analysis.
Data availability statement
The data that support the findings of this study originate from Changhua Christian Hospital clinical research database. Restrictions apply to the availability of these data and they are therefore not publicly available.