The Relationship Between Prognostic Nutritional Index and Carotid Artery Stenosis in Patients with Diagnosed Carotid Artery Disease

Yıl 2021, , 129 - 134, 31.12.2020

Umut Serhat Sanrı , Kadir Kaan Özsin , Burak Duman Faruk Toktaş , Senol Yavuz

https://doi.org/10.34087/cbusbed.842454

Cited By: 1

Öz

Objective: To investigate the relationship between prognostic nutritional index (PNI) and carotid artery stenosis (CAS).
Material and Methods: This retrospective observational study included patients undergoing carotid endarterectomy (CEA) and patients with non-critical CAS who received medical treatment. All data retrieved retrospectively from the hospital medical files. The values acquired from the patients during acceptance to the hospital were used in the calculation of PNI.
Results: There were 82 patients (68.3 % male, mean age: 70.5±8.9 years) in surgical group, and 79 patients (72.2% male, mean age: 62.0±9.1 years) were recorded in medical group. We detected statistically difference in surgical group in terms of higher BUN (p <0.001), higher CRP (p = 0.037), lower lymphocyte (p <0.001), lower PNI (p = 0.008) and lower LDL-C (p = 0.045). For predicting development of carotid stenosis, in a cut-off level of 47.25 there were 73.4% sensitivity and 46.3% % specificity for PNI (Area under the curve (AUC): 0.619, 95% CI: 0.533-0.706, Log rank p = 0.009).
Conclusion: Although we found that PNI was not an independent variable predicting CAS progression in our study, PNI values were statistically significantly lower in the surgical group. PNI may be a potential marker of CAS in patients. For this, large-scale studies involving healthy individuals are needed.

Anahtar Kelimeler

Carotid Artery Stenosis, Prognostic Nutritional Index, Atherosclerosis

Karotis Arter Hastalığı Tanısı Almış Hastalarda Prognostik Beslenme İndeksi ile Karotis Arter Darlığı Arasındaki İlişki

Öz

Giriş ve Amaç: Prognostik beslenme indeksi (PNI) ile karotis arter stenozu (KAS) arasındaki ilişkiyi araştırmaktır.
Gereç ve Yöntemler: Bu retrospektif gözlemsel çalışma, karotis endarterektomi (CEA) geçiren hastaları ve tıbbi tedavi gören kritik olmayan KAS'lu hastaları içermektedir. Tüm veriler geriye dönük olarak hastanemizin tıbbi dosya kayıtlarından alındı. Hastaneye kabul sırasında hastalardan elde edilen değerler PNI hesaplamasında kullanıldı.
Bulgular: Cerrahi grupta 82 hasta (% 68,3 erkek, ortalama yaş: 70,5 ± 8,9 yıl), medikal grupta 79 hasta (% 72,2 erkek, ortalama yaş: 62,0 ± 9,1 yıl) kaydedildi. Cerrahi grupta anlamlı düzeyde daha yüksek BUN (p <0,001), daha yüksek CRP (p = 0,037), daha düşük lenfosit sayısı (p <0,001), daha düşük PNI (p = 0,008) ve daha düşük LDL-C (p = 0,045) değerleri tespit ettik . Karotis stenoz gelişimini tahmin etmek için, 47,25'lik bir Cut-Off seviyesinde, PNI için% 73,4 duyarlılık ve% 46,3 özgüllük vardı (Eğri altındaki alan (EAA): 0,619, % 95 CI: 0,533-0,706, Log rank p = 0.009). Sonuç: Çalışmamızda PNI'nın KAS progresyonunu öngören bağımsız bir değişken olmadığını bulmamıza rağmen, PNI değerleri cerrahi grupta istatistiksel olarak anlamlı derecede düşüktü. PNI, hastalarda olası bir KAS belirteci olabilir. Bunun için sağlıklı bireyleri içeren geniş çaplı çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Karotis Arter Darlığı, Prognostik Beslenme İndeksi, Ateroskleroz

Kaynakça

• 1. Lutz HJ, Michael R, Gahl B et al. Local versus general anaesthesia for carotid endarterectomy-Improving the gold standard? European Journal of Vascular and Endovascular Surgery. 2008;36(2):145-9.
• 2. Divya KP, Sandeep N, Sarma S et al. Risk of stroke and cardiac events in medically treated asymptomatic carotid stenosis. Journal of Stroke and Cerebrovascular Diseases 2015; 24:2149-53.
• 3. Wong BW, Meredith A, Lin D et al. BM.The biological role of inflammation in atherosclerosis. The Canadian Journal of Cardiology 2012; 28:631-41.
• 4. Wada H, Dohi T, Miyauchi K et al. Relationship between the prognostic nutritional index and long-term clinical outcomes in patients with stable coronary artery disease, Journal of Cardiology, Volume 72, Issue 2, 2018, Pages 155-161, ISSN 0914-5087, https://doi.org/10.1016/j.jjcc.2018.01.012.
• 5. Ozsin KK, Sanri US, Toktas F, Yavuz S. The relationship between fibrinogen to albumin ratio and carotid artery disease in patients with carotid endarterectomy and patients with non-severe carotid artery stenosis. Turkish Journal of Clinics and Laboratory 2018; 4: 321-326.
• 6. Honda Y, Nagai T, Iwakami N et al. Usefulness of Geriatric Nutritional Risk Index for assessing nutritional status and its prognostic impact in patients aged >/=65 years with acute heart failure. American Journal of Cardiology 2016; 118:550–5.
• 7. de Weerd M, Greving JP, Hedblad B et al. Prevalence of asymptomatic carotid artery stenosis in the general population: an individual participant data meta-analysis. Stroke. 2010 Jun;41(6):1294-7. doi: 10.1161/STROKEAHA.110.581058.
• 8. Yuan C, Lai CW, Chan LW et al. Cumulative effects of hypertension, dyslipidemia, and chronic kidney disease on carotid atherosclerosis in Chinese patients with type 2 diabetes mellitus. Journal of Diabetes Research. 2014; 2014:179686. doi:10.1155/2014/179686
• 9. Seo MH, Choa M, You JS et al. “Hypoalbuminemia, low base excess values, and tachypnea predict 28-day mortality in severe sepsis and septic shock patients in the emergency department,” Yonsei Medical Journal 2016: 57; 1361–69.
• 10. Oduncu V, Erkol A, Karabay CY et al. The prognostic value of serum albumin levels on admission in patients with acute STsegment elevation myocardial infarction undergoing a primary percutaneous coronary intervention. Coronary Artery Disease 2013; 24: 88-94.
• 11. Keskin M, Hayıroğlu MI, Keskin T et al. A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index. Nutrition, Metabolism and Cardiovascular Diseases. 2017 May;27(5):438-446. doi: 10.1016/j.numecd.2017.01.005.
• 12. Yang L, Xia L, Wang Y et al. Low Prognostic Nutritional Index (PNI) Predicts Unfavorable Distant Metastasis-Free Survival in Nasopharyngeal Carcinoma: A Propensity Score-Matched Analysis. PLOS One. 2016 Jul 11;11(7): e0158853. doi: 10.1371/journal.pone.0158853.
• 13. Arbel Y, Finkelstein A, Halkin A et.al. 2012. Neutrophil/lymphocyte ratio is related to the severity of coronary artery disease and clinical outcome in patients undergoing angiography. Atherosclerosis 225 (2); 456-460.
• 14. Teker Açıkel ME, Korkut AK. Impact of Controlling Nutritional Status Score (CONUT) and Prognostic Nutritional Index (PIN) on Patients Undergoing Coronary Artery Bypass Graft Surgery. The Heart Surgery Forum. 2019 Jul 25;22(4): E294-E297. doi: 10.1532/hsf.2493.
• 15. Chen QJ, Qu HJ, Li DZ et al. Prognostic nutritional index predicts clinical outcome in patients with acute ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention. Scientific Reports. 2017 Jun 12;7(1):3285. doi: 10.1038/s41598-017-03364-x
• 16. Drakopoulou M, Oikonomou G, Soulaidopoulos S et al. Management of patients with concomitant coronary and carotid artery disease. Expert Review of Cardiovascular Therapy. 2019 Aug;17(8):575-583. doi: 10.1080/14779072.2019.1642106.
• 17. Soeki T, Sata M. Inflammatory Biomarkers and Atherosclerosis. International Heart Journal. 2016;57(2):134-9. doi: 10.1536/ihj.15-346.