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Nutrition. 2018 Apr;48:82-86. doi: 10.1016/j.nut.2017.10.024. Epub 2017 Dec 7.

Effect of nutritional status on mortality in patients undergoing coronary artery bypass grafting.

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Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey. Electronic address:
Department of Cardiology, Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital, Istanbul, Turkey.
Department of Cardiovascular Surgery, Istanbul Medeniyet University, Istanbul, Turkey.
Department of Cardiology, Trakya University, Edirne, Turkey.
Department of Cardiology, Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.



The prognostic effects of poor nutritional status and cardiac cachexia on coronary artery disease (CAD) are not clearly understood. A well-accepted nutritional status parameter, the prognostic nutritional index (PNI), which was first demonstrated to be valuable in patients with cancer and those undergoing gastrointestinal surgery, was introduced to patients requiring coronary artery bypass grafting (CABG). The aim of the present study was to evaluate the prognostic value of PNI in patients with CAD undergoing CABG.


We evaluated the in-hospital and long-term (3-y) prognostic effect of PNI on 644 patients with CAD undergoing CABG. Baseline characteristics and outcomes were compared among the patients by PNI and categorized accordingly: Q1, Q2, Q3, and Q4.


Patients with lower PNI had significantly higher in-hospital and long-term mortality. Patients with lower PNI levels (Q1) had higher in-hospital mortality and had 12 times higher mortality rates than those with higher PNI levels (Q4). The higher PNI group had the lower rates and was used as the reference. Long-term mortality was higher in patients with lower PNI (Q1)-4.9 times higher than in the higher PNI group (Q4). In-hospital and long-term mortality rates were similar in the non-lower PNI groups (Q2-4).


The present study demonstrated that PNI, calculated based on serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients undergoing CABG.


Coronary artery bypass grafting; Coronary artery disease; Mortality; Prognosis; Prognostic nutritional index; Surgery

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