Taha Keskin

A novel and useful predictive indicator of prognosis in ST-segment elevation myocardial infarction, the prognostic nutritional index

BACKGROUND AND AIM The prognostic impact of poor nutritional status and cardiac cachexia in myocardial infarction is not clearly understood. Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in colorectal surgeries and postoperative septic complications. The present study aimed to evaluate the prognostic value of PNI in ST-segment elevation myocardial infarction (STEMI) patients. METHODS AND RESULTS We evaluated the in-hospital and long-term (3 years) prognostic impact of PNI on 1823 patients with STEMI undergoing primary percutaneous coronary intervention. Patients with lower PNI had significantly higher in-hospital and long-term mortality and major adverse cardiac events. After adjustment for all confounders, the in-hospital mortality rates were 7.9 times higher at the lower PNI level (95% CI: 5.0-15.8) than those at the higher PNI level. The long-term mortality rates were also 6.4 times higher at the lower PNI level (95% CI: 4.4-12.4) than those at the higher PNI level. CONCLUSION The present study demonstrated that the PNI, calculated based on the serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients with STEMI.

A Novel Independent Survival Predictor in Pulmonary Embolism: Prognostic Nutritional Index

The prognostic impact of nutritional status in patients with pulmonary embolism (PE) is poorly understood. A well-accepted nutritional status parameter, prognostic nutritional index (PNI), which was first demonstrated to be valuable in patients with cancer and gastrointestinal surgery, was introduced to patients with PE. Our aim was to evaluate the predictive value of PNI in outcomes of patients with PE. We evaluated the in-hospital and long-term (53.8 ± 5.4 months) prognostic impact of PNI on 251 patients with PE. During a median follow-up of 53.8 ± 5.4 months, 27 (11.6%) patients died in hospital course and 31 (13.4%) died in out-of-hospital course. The patients with lower PNI had significantly higher in-hospital and long-term mortality. The Cox proportional hazard analyses showed that PNI was associated with an increased risk of all-cause death for both unadjusted model and adjusted for all covariates. Our study demonstrated that PNI, calculated based on serum albumin level and lymphocyte count, is an independent prognostic factor for mortality in patients with PE.

Relation of the Number of Parity to Left Ventricular Diastolic Function in Pregnancy

Left ventricular diastolic dysfunction (LVDD) has been relatively less studied than other cardiac changes during pregnancy. Previous studies revealed a mild diastolic deterioration during pregnancy. However, these studies did not evaluate the long-term effect of parity on left ventricular diastolic function. A comprehensive study evaluating the long-term effect of parity on diastolic function is required. A total of 710 women with various number of parity were evaluated through echocardiography to reveal the status of diastolic function. Echocardiographic parameters were compared among the women by parity number and categorized accordingly: none, 0 to 4 and 4< parity (grand multiparous). In nulliparous group, 19 women (23.2%) had grade 1 LVDD, and only 2 women (2.4%) had grade 2 LVDD. In women with a parity number of 0 to 4, 209 women (38.3%) had grade 1 LVDD, and only 17 women (3.1%) had grade 2 LVDD. In grand multiparous group, only 2 women (2.4%) did not have LVDD, and 12 women (14.6%) had grade 2 LVDD. None of the subjects had grade 3 or grade 4 LVDD. According to hierarchical logistic regression analysis, any grade of LVDD and grade 2 LVDD had the highest rates at parity category of > 4 parity and that had 21 and 5.8 times higher than nulliparous group, respectively. In conclusion, according to the present study, grand multiparity but not multiparity, severely deteriorates left ventricular diastolic function. Further studies are warranted to evaluate the risk of gradual diastolic dysfunction after each pregnancy.

A novel prognostic indicator for in-hospital and 4-year outcomes in patients with pulmonary embolism: TIMI risk index

Background: Thrombolysis in Myocardial Infarction (TIMI) risk index (TRI) was recently evaluated in patients with acute myocardial infarction and found as an important prognostic index. In the current study, we evaluated the prognostic value of TRI in patients with moderate‐high and high risk pulmonary embolism (PE) who were treated with thrombolytic agents. Methods: We retrospectively evaluated the in‐hospital and long‐term (4‐year) prognostic impact of TRI in a total number of 456 patients with moderate‐high and high risk PE. Patients were stratified by quartiles (Q) of admission TRI. Results: In‐hospital analysis revealed significantly higher rates of in‐hospital death for patients with TRI in Q4. After adjustment for confounding baseline variables, TRI in Q4 was associated with 2.8‐fold hazard of in‐hospital death. Upon multivariate analysis, admission TRI in Q4 vs. Q1–3 was associated with 3.1 fold hazard of 4‐year mortality rate. Conclusion: TRI in Q4, as compared to Q1–3, was significantly predictive of short term and long‐term outcomes in PE patients who treated with thrombolytic agents. Our data suggest TRI to be an independent, feasible, and cost‐effective tool for rapid risk stratification in moderate‐high and high risk PE patients who treated with thrombolytic agents. HIGHLIGHTSIn the current study, we evaluated the prognostic importance of TRI in patients with PE.We evaluated the in‐hospital and long‐term (4‐year) prognostic impact of TRI in a total number of 456 patients with PE.In‐hospital analysis revealed significantly higher rates of in‐hospital death for patients with TRI in Q4, as compared to patients with TRI in Q1–3.Our data suggest TRI to be an independent, feasible, and cost‐effective tool for rapid risk stratification in PE patients.