# The Effect of Prognostic Nutritional Index in Predicting Clinical Outcomes in Valve Replacement Patients

## TL;DR

This study shows that the Prognostic Nutritional Index (PNI) can predict complications and mortality in patients undergoing valve replacement surgery.

## Contribution

The study demonstrates the clinical utility of PNI in predicting outcomes in valve replacement patients.

## Key findings

- Lower PNI values were associated with postoperative acute kidney injury and mortality.
- PNI values decreased significantly over time in mitral valve replacement patients.
- Preoperative PNI correlated with longer ICU stays and longer surgical durations.

## Abstract

Cardiopulmonary bypass is known to be a cause of systemic inflammatory
response. The systemic inflammatory response affects albumin and lymphocyte
levels and is associated with the development of complications. Serum
albumin and lymphocyte concentrations have been used to create
inflammation-based risk scores, which predict prognosis in different patient
groups. One of these risk scores is called the Prognostic Nutritional Index
(PNI). In this study, our objective was to examine how changes in PNI
values, measured at different times before and after surgery, impact
clinical outcomes and hospital mortality.

One hundred and sixty-four patients were retrospectively scanned and included
in the study. Patients were divided into aortic valve replacement (AVR) and
mitral valve replacement (MVR) groups. The patient's preoperative and
postoperative PNI values were examined. Duration of cross-clamping,
cardiopulmonary bypass time, length of hospital and intensive care unit
stay, postoperative mortality, atrial fibrillation, and acute kidney injury
(AKI) development were evaluated.

Preoperative and second PNI values were lower in the patients that developed
AKI and non-survivors. The PNI cutoff value was ≤ 28.01 in
non-survivors (P=0.001). In the MVR group, the decrease in
PNI value over time was statistically significant
(P<0.001). There was a negative correlation between
preoperative PNI value and length of stay in intensive care unit,
cross-clamping, and cardiopulmonary bypass duration
(P<0.05, P<0.01).

A correlation was determined between the PNI value and development of
postoperative AKI and mortality. PNI value, an easy method to use, can be
used in the follow-up of these patients.