Assessing the Predictive Value of Different Nutritional Indexes for Contrast-Associated Acute Kidney Injury in Patients Undergoing Percutaneous Coronary Intervention

• Published in: Circulation Journal Vol. 88; no. 6; pp. 902 - 910
• Main Authors: Chen, Lichuan, Zhang, Sicheng, Luo, Manqing, He, Chen, You, Zhebin, Zhang, Liwei, Zeng, Jilang, Chen, Junhan, Lin, Kaiyang, Guo, Yansong
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 24.05.2024
• Subjects: Acute Kidney Injury - chemically induced; Acute Kidney Injury - diagnosis; Acute Kidney Injury - etiology; Aged; Aged, 80 and over; Contrast Media - adverse effects; Contrast-associated acute kidney injury; Controlling Nutritional Status score; Female; Geriatric Nutritional Risk Index; Humans; Male; Malnutrition - diagnosis; Middle Aged; Nutrition Assessment; Nutritional Status; Percutaneous coronary intervention; Percutaneous Coronary Intervention - adverse effects; Predictive Value of Tests; Prognostic Nutritional Index; Retrospective Studies; Risk Assessment; Risk Factors; Contrast-associated acute kidney injury; Percutaneous coronary intervention; Prognostic Nutritional Index; Controlling Nutritional Status score; Geriatric Nutritional Risk Index
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-23-0479

Background: The link between malnutrition and poor prognosis in cardiovascular disease has been established but the association between malnutrition and contrast-associated acute kidney injury (CA-AKI), a common complication of coronary procedures, remains poorly understood. In this study we investigated the predictive value of 3 nutritional indexes for CA-AKI in patients undergoing percutaneous coronary intervention (PCI).Methods and Results: The study included a total of 6,049 consecutive patients undergoing PCI between May 2012 and September 2020, among whom 352 (5.8%) developed CA-AKI. We used the Controlling Nutritional Status (CONUT) score, the Geriatric Nutritional Risk Index (GNRI), and the Prognostic Nutritional Index (PNI) to assess the association between malnutrition risk and CA-AKI after PCI. Multivariate logistic regression analysis revealed that malnutrition, as identified by GNRI and PNI, was significantly associated with a higher risk of CA-AKI (moderate-severe malnutrition in GNRI: odds ratio [OR]=1.92, [95% confidence interval (CI), 1.27–2.85]; malnutrition in PNI: OR=1.87, [95% CI, 1.39-2.50]), whereas the CONUT score did not demonstrate a significant difference (P>0.05). Furthermore, GNRI (∆AUC=0.115, P<0.001) and PNI (∆AUC=0.101, P<0.001) exhibited superior predictive ability than the CONUT score for CA-AKI and significantly improved reclassification and discrimination in the fully adjusted model.Conclusions: Malnutrition, especially identified by the GNRI and PNI, was associated with a higher risk of CA-AKI after PCI. GNRI and PNI performed better than the CONUT score in predicting CA-AKI.