Int J Med Sci 2020; 17(1):82-88. doi:10.7150/ijms.39014

Research Paper

Predictive Impact of Modified-Prognostic Nutritional Index for Acute Kidney Injury within 1-week after Living Donor Liver Transplantation

Ji Young Min1, AMi Woo1, Min Suk Chae2, Sang Hyun Hong2, Chul Soo Park2, Jong Ho Choi2, Hyun Sik Chung1✉

1. Department of Anesthesiology and Pain Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
2. Department of Anesthesiology and Pain Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.

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Citation:
Min JY, Woo A, Chae MS, Hong SH, Park CS, Choi JH, Chung HS. Predictive Impact of Modified-Prognostic Nutritional Index for Acute Kidney Injury within 1-week after Living Donor Liver Transplantation. Int J Med Sci 2020; 17(1):82-88. doi:10.7150/ijms.39014. Available from http://www.medsci.org/v17p0082.htm

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Abstract

Background. Acute kidney injury (AKI) is one of the common complications after living donor liver transplantation (LDLT) and is associated with increased mortality and morbidity. The prognostic nutritional index (PNI) has been used as a predictive model for postoperative complications. Here, we create a new predictive model based on the PNI and compared its predictive accuracy to other models in patients who underwent LDLT. Material and Methods: The data from 423 patients were collected retrospectively. The patients were dichotomized into the non-AKI and the AKI groups. Multivariate adjustment for significant postoperative variables based on univariate analysis was performed. A new predictive model was created using the results from logistic regression analysis, dubbed the modified-PNI model (mPNI). The area under the receiver operating characteristic curve (AUC) was generated to determine the diagnostic accuracy and cutoff value of individual models. The net reclassification improvement (NRI) and integrated discrimination improvement (IDI) were calculated to investigate diagnostic improvement by the mPNI. Results: Fifty-four patients (12.7 %) were diagnosed with AKI within 1-week after LDLT. The mPNI had the highest predictive accuracy (AUC = 0.823). The model of end-stage liver disease (MELD) scores and PNI were 0.793 and 0.749, respectively, and the INR and serum bilirubin were 0.705 and 0.637, respectively. The differences in the AUCs were statistically significant among the mPNI, PNI, INR, and serum bilirubin. The cutoff value for mPNI was 8.7. The NRI was 10.4% and the IDI was 3.3%. Conclusions: The mPNI predicted AKI within 1-week better than other scoring systems in patients who underwent LDLT. The recommended cutoff value of mPNI is 8.7.

Keywords: Nutritional Assessment, Living donors, Liver transplantation, acute kidney injury, Prognosis.