Implications of Malnutrition on Contrast-Associated Acute Kidney Injury in Young and Old Patients Undergoing Percutaneous Coronary Intervention: A Multicenter Prospective Cohort

Jingjing Liang; Lingyu Zhang; Zhidong Huang; Yibo He; Yihang Ling; Kai Chen; Ming Ying; Mengfei Lin; Guode Li; Jin Liu; Yong Liu; Yan Liang; Shiqun Chen; Yunzhao Hu

doi:10.3389/fnut.2021.795068

Implications of Malnutrition on Contrast-Associated Acute Kidney Injury in Young and Old Patients Undergoing Percutaneous Coronary Intervention: A Multicenter Prospective Cohort

Front Nutr. 2022 Feb 8:8:795068. doi: 10.3389/fnut.2021.795068. eCollection 2021.

Authors

Jingjing Liang^{1

2}, Lingyu Zhang³, Zhidong Huang⁴, Yibo He⁴, Yihang Ling⁴, Kai Chen⁴, Ming Ying⁴, Mengfei Lin³, Guode Li³, Jin Liu⁴, Yong Liu⁴, Yan Liang³, Shiqun Chen⁴, Yunzhao Hu^{1

2}

Affiliations

¹ Department of Cardiology, Shunde Hospital, Southern Medical University, Foshan, China.
² The Second School of Clinical Medicine, Southern Medical University, Guangzhou, China.
³ Department of Cardiology, Maoming People's Hospital, Maoming, China.
⁴ Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.

Abstract

Background: The relationship between malnutrition and the risk of contrast-associated acute kidney injury (CA-AKI) and the resulting prognosis in patients undergoing percutaneous coronary intervention (PCI) is still not well known.

Methods: Patients undergoing PCI were consecutively enrolled in a multicenter study in China (NCT01402232), categorized by nutritional status (non-malnutrition, malnutrition) based on two different cut-off values (i.e., traditional threshold and the best cut-off value based on the receiver operating characteristic (ROC) curve) for the controlling nutritional status (CONUT) score. The primary endpoint was CA-AKI, diagnosed as a rise in serum creatinine >0.3 mg/dl or >50% than the baseline level occurring within 48 h after the intervention. The secondary endpoint was all-cause mortality. The relationships of malnutrition, CA-AKI, and all-cause mortality were examined using multivariate-adjusted logistic and Cox regression analyses, respectively.

Results: Among 2,083 patients undergoing PCI (age: 62.8 ± 11.1 years; 79.0% men), 1,258 (60.4%) were malnourished. During hospitalization, 80 (3.8%) patients developed CA-AKI events. The incidence of CA-AKI in patients who did not have malnutrition (the non-malnutrition group) and those who did have malnutrition (the malnutrition group) was 1.7% and 5.25%, respectively. Patients with malnutrition had a 2-fold increased adjusted risk of CA-AKI compared to those with no malnutrition [adjusted odds ratio (aOR) (95% confidence interval CI): 2.41 (1.22 to 5.22)]. Malnutrition was associated with a 3-fold increased adjusted risk of CA-AKI in patients aged ≤ 75 years [N = 1,791, aOR (95% CI): 3.39 (1.46-9.25)]. Malnourished patients with CA-AKI had a higher risk of all-cause mortality than the others. Similar results were observed in the grouping of Supplemental Analyses based on the optimal cut-off value of the CONUT score identified by the ROC curve.

Conclusions: Malnutrition is strongly associated with an increased risk of CA-AKI in both young and old patients undergoing PCI. Malnourished patients with CA-AKI had a significantly higher risk of all-cause mortality. Further studies are needed to prospectively assess the efficacy of nutritional interventions on outcomes in patients undergoing PCI.

Keywords: 1-year mortality; contrast-associated acute kidney injury; malnutrition; percutaneous coronary intervention; the controlling nutritional status score.