Abstract
Our study aimed to evaluate the potential of prognostic nutritional index (PNI) and Brain natriuretic peptide (BNP) in predicting the prognosis of heart transplantation (HTx). We retrospectively investigated 489 patients undergoing HTx between 2015 and 2020 in our center. The relationship between preoperative index and prognosis was analyzed respectively, the optimal cut-off values for preoperative PNI and BNP level were evaluated with receiver operating curve analysis. Uni-variate analysis and multivariate analysis were used to compare baseline data (sex, age, diagnosis, etc.) of groups divided by the level of PNI and BNP. Propensity score matching (PSM) was applied to eliminate bias. We calculated the C-index from the prediction efficiency of PNI and BNP. During the period, 489 recipients undergoing HTx in our center were included according to the inclusion criteria; 383 (78.3%) males and 106 (21.7%) females were included in this study, with a median age of 47.57 years old. The ROC curve showed that the optimal cut-off values of each indicator were verified as 49.345 for PNI, and 4397.500 for BNP. The multivariate analyses indicated that PNI (p = 0.047), BNP (p = 0.024), age (p = 0.0023), and waiting time (p = 0.012) were risk factors for all-cause death after HTx. Propensity score matching generated 116 pairs based on PNI level and 126 pairs based on BNP level, and the results showed that OS (overall survival) was significantly correlated with PNI (n = 232, p = 0.0113) and BNP (n = 252, p = 0.0146). Our study implied that higher PNI and lower BNP level had direct correlation with better survival after HTx. Combining PNI and BNP together would be a potential clinical preoperative instrument to predict the survival of patients after HTx, especially in short-term survival.
Highlights
Heart transplantation (HTx) remains the “gold standard” procedure for patients with end-stage heart failure refractory to other treatments
The prognostic nutritional index (PNI) reflects nutritional conditions of the human body and previous studies have demonstrated that PNI could be utilized as a useful indicator to predict prognosis in some cardiovascular diseases such as acute heart failure, coronary artery disease, and myocardial infarction [2,3,4]
We investigated whether nutritional status and preoperative heart failure were associated with overall survival (OS) in patients undergoing HTx
Summary
Heart transplantation (HTx) remains the “gold standard” procedure for patients with end-stage heart failure refractory to other treatments. The registry of International Society of Heart and Lung Transplantation (ISHLT) demonstrated the median survival in adult recipients between 2002 and 2009 was 12.5 years, and it increased to 14.8 years among. Heart-failure-related inflammation might bring about heart dysfunction including ventricular remodeling, cellular metabolic disorder, and cardiomyocyte necrosis. The prognostic nutritional index (PNI) reflects nutritional conditions of the human body and previous studies have demonstrated that PNI could be utilized as a useful indicator to predict prognosis in some cardiovascular diseases such as acute heart failure, coronary artery disease, and myocardial infarction [2,3,4]. No previous studies have focused on the relationship between PNI and the prognosis of HTx
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