Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Population and Data Source
2.2. Clinical, Demographic, and Laboratory Data
2.3. Outcome Ascertainment
2.4. Statistical Analysis
3. Results
3.1. Characteristics of the Study Population
3.2. Association between Prognostic Nutritional Index and Mortality
3.3. Comparison between Prognostic Nutritional Index and Its Constituents in Predicting Mortality
3.4. Subgroup Analysis
4. Discussion
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Total | Prognostic Nutritional Index | |||||
---|---|---|---|---|---|---|
<39.5 | 39.5–<43.1 | 43.1–<46.6 | ≥46.6 | |||
n = 101,616 | n = 25,523 | n = 24,982 | n = 25,809 | n = 25,302 | p for Trend | |
Age (Mean ± SD) | 63 ± 15 | 65 ± 15 | 65 ± 14 | 63 ± 14 | 59 ± 16 | <0.001 |
Male, % | 56 | 55 | 56 | 57 | 58 | <0.001 |
Race and Ethnicity, % | <0.001 | |||||
Caucasian | 46 | 50 | 49 | 45 | 41 | |
African-American | 31 | 28 | 29 | 33 | 35 | |
Hispanic | 15 | 15 | 15 | 15 | 17 | |
Asian | 3.3 | 3.2 | 3.3 | 3.3 | 3.6 | |
Other | 3.7 | 3.9 | 3.6 | 3.6 | 3.6 | |
Medical insurance, % | <0.001 | |||||
Medicare | 54 | 57 | 57 | 53 | 48 | |
Medicaid | 7.0 | 7.2 | 6.1 | 6.7 | 8.0 | |
Other | 39 | 36 | 37 | 40 | 44 | |
Type of vascular access, % | <0.001 | |||||
CV catheter | 75 | 82 | 77 | 72 | 67 | |
AV fistula/graft | 19 | 12 | 17 | 22 | 26 | |
Unknown | 5.9 | 5.7 | 5.5 | 6.0 | 6.6 | |
Body mass index, kg/m2 | 26.7 (23.0–31.8) | 25.5 (22.2–30.4) | 26.6 (23.0–31.7) | 27.2 (23.4–32.3) | 27.6 (23.7–32.7) | <0.001 |
Single-pool Kt/V (Mean ± SD) | 1.47 ± 0.32 | 1.43 ± 0.32 | 1.47 ± 0.32 | 1.48 ± 0.32 | 1.48 ± 0.33 | <0.001 |
nPCR, g/kg per day (Mean ± SD) | 0.79 ± 0.22 | 0.73 ± 0.21 | 0.79 ± 0.21 | 0.82 ± 0.21 | 0.84 ± 0.21 | <0.001 |
Comobidities, % | ||||||
Diabetes | 59 | 63 | 63 | 59 | 50 | <0.001 |
Hypertension | 50 | 45 | 49 | 51 | 55 | <0.001 |
Dyslipidemia | 24 | 23 | 24 | 25 | 24 | 0.009 |
Atherosclerotic heart disease | 14 | 14 | 15 | 14 | 12 | <0.001 |
Congestive heart failure | 36 | 39 | 38 | 35 | 32 | <0.001 |
Other cardiac disease | 14 | 15 | 15 | 14 | 12 | <0.001 |
COPD | 4.0 | 4.5 | 4.3 | 3.9 | 3.3 | <0.001 |
Alcohol | 0.2 | 0.2 | 0.2 | 0.2 | 0.2 | 0.504 |
Substance abuse | 0.2 | 0.2 | 0.2 | 0.2 | 0.3 | 0.008 |
Laboratory variables | ||||||
Hemoglobin, g/dL (Mean ± SD) | 11.1 ± 1.2 | 10.7 ± 1.2 | 11.1 ± 1.1 | 11.3 ± 1.1 | 11.5 ± 1.1 | <0.001 |
WBC, 103/mm3 | 7.5 (6.2–9.1) | 7.4 (5.9–9.1) | 7.3 (6.0–8.8) | 7.4 (6.2–8.9) | 7.8 (6.6–9.3) | <0.001 |
Total neutrophil, 103/mm3 | 5.1 (4.0–6.4) | 5.3 (4.1–6.9) | 5.1 (4.0–6.4) | 5.0 (4.0–6.2) | 5.0 (4.0–6.2) | <0.001 |
Total lymphocyte, 103/mm3 | 1.5 (1.1–1.9) | 1.2 (0.9–1.5) | 1.3 (1.1–1.6) | 1.5 (1.2–1.8) | 1.9 (1.6–2.3) | <0.001 |
Serum albumin, g/dL (Mean ± SD) | 3.5 ± 0.5 | 3.0 ± 0.4 | 3.4 ± 0.2 | 3.7 ± 0.2 | 4.0 ± 0.3 | <0.001 |
Creatinine, mg/dL (Mean ± SD) | 5.9 ± 2.4 | 5.1 ± 1.9 | 5.5 ± 2.1 | 6.0 ± 2.3 | 6.8 ± 2.7 | <0.001 |
Calcium, mg/dL (Mean ± SD) | 9.1 ± 0.6 | 9.1 ± 0.6 | 9.1 ± 0.6 | 9.1 ± 0.6 | 9.1 ± 0.6 | 0.002 |
Phosphorus, mg/dL (Mean ± SD) | 4.9 ± 1.1 | 4.7 ± 1.2 | 4.9 ± 1.1 | 5.0 ± 1.1 | 5.1 ± 1.2 | <0.001 |
Intact PTH, pg/mL | 315 (198–487) | 273 (168–419) | 310 (197–476) | 331 (213–509) | 352 (223–548) | <0.001 |
Alkaline phosphatase, IU/L | 87 (69–115) | 97 (75–134) | 88 (70–116) | 84 (67–108) | 81 (65–104) | <0.001 |
TIBC, μg/dL (Mean ± SD) | 226.0 ± 48.4 | 194.4 ± 46.5 | 223.5 ± 43.3 | 236.6 ± 42.4 | 249.4 ± 43.1 | <0.001 |
Iron saturation, % (Mean ± SD) | 22.9 ± 8.8 | 23.4 ± 10.3 | 22.3 ± 8.3 | 22.5 ± 8.0 | 23.3 ± 8.2 | <0.001 |
Ferritin, ng/mL | 279 (162–476) | 332 (188–588) | 279 (162–476) | 262 (155–443) | 252 (149–418) | <0.001 |
Bicarbonate, mEq/L (Mean ± SD) | 23.6 ± 2.7 | 24.1 ± 2.8 | 23.8 ± 2.6 | 23.5 ± 2.6 | 23.0 ± 2.6 | <0.001 |
AUROC (95%CI) | ∆AUROC (95%CI) | NRI (95%CI) | IDI (95%CI) | |
---|---|---|---|---|
PNI | 0.747 (0.743, 0.751) | Reference | 0.434 (0.416, 0.452) | 0.033 (0.032, 0.035) |
Serum albumin (g/dL) | 0.744 (0.740, 0.749) | −0.003 (−0.005, −0.001) | 0.409 (0.390, 0.427) | 0.031 (0.030, 0.032) |
Total lymphocyte count (103/mm3) | 0.713 (0.708, 0.717) | −0.034 (−0.037, −0.032) | 0.174 (0.155, 0.192) | 0.003 (0.003, 0.004) |
AUROC (95%CI) | ∆AUROC (95%CI) | NRI (95%CI) | IDI (95%CI) | |
---|---|---|---|---|
Age < 65 years | ||||
PNI | 0.731 (0.723, 0.739) | Reference | 0.479 (0.448, 0.511) | 0.032 (0.030, 0.034) |
Serum albumin (g/dL) | 0.723 (0.715, 0.731) | −0.008 (−0.011, −0.005) | 0.421 (0.389, 0.453) | 0.026 (0.024, 0.028) |
Total lymphocyte count (103/mm3) | 0.685 (0.676, 0.693) | −0.047 (−0.052, −0.041) | 0.207 (0.175, 0.239) | 0.005 (0.004, 0.006) |
Age ≥ 65 years | ||||
PNI | 0.692 (0.686, 0.698) | Reference | 0.392 (0.370, 0.415) | 0.037 (0.035, 0.038) |
Serum albumin (g/dL) | 0.691 (0.685, 0.697) | −0.002 (−0.004, 0.001) | 0.379 (0.357, 0.402) | 0.035 (0.033, 0.037) |
Total lymphocyte count (103/mm3) | 0.644 (0.638, 0.651) | −0.048 (−0.052, −0.044) | 0.148 (0.126, 0.171) | 0.003 (0.003, 0.004) |
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Miyasato, Y.; Hanna, R.M.; Morinaga, J.; Mukoyama, M.; Kalantar-Zadeh, K. Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis. Nutrients 2023, 15, 311. https://doi.org/10.3390/nu15020311
Miyasato Y, Hanna RM, Morinaga J, Mukoyama M, Kalantar-Zadeh K. Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis. Nutrients. 2023; 15(2):311. https://doi.org/10.3390/nu15020311
Chicago/Turabian StyleMiyasato, Yoshikazu, Ramy M. Hanna, Jun Morinaga, Masashi Mukoyama, and Kamyar Kalantar-Zadeh. 2023. "Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis" Nutrients 15, no. 2: 311. https://doi.org/10.3390/nu15020311