Predictive Value of Nutritional Scores for Contrast-Induced Acute Kidney Injury in Patients with Type 2 Diabetes Mellitus

Abstract

The present study aimed to evaluate the predictive value of 3 nutritional scores—the Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), and Prognostic Nutritional Index (PNI)—for contrast-induced acute kidney injury (CI-AKI) in patients with type 2 diabetes mellitus (T2DM). A total of 2043 T2DM patients undergoing coronary angiography or intervention at Nanjing First Hospital (2021-2023) were retrospectively analyzed. Multivariable logistic regression identified independent risk factors, and receiver operating characteristic curves assessed predictive performance. CI-AKI occurred in 13.4% of patients. Female sex, elevated systolic blood pressure, increased neutrophil count, hyperglycemia, hematuria, diuretic use, and lower GNRI and PNI were independently associated with CI-AKI. Among the nutritional indices, PNI had the highest predictive value (AUC = .871), outperforming GNRI (AUC = .755) and CONUT (AUC = .547). Combining PNI or GNRI with clinical variables further improved predictive accuracy (AUC = .899 and .818, respectively). Restricted cubic spline analysis revealed nonlinear risk thresholds (PNI <38, GNRI < 92). GNRI and PNI are effective predictors of CI-AKI and may aid in early risk stratification and clinical intervention among T2DM patients, with PNI demonstrating superior performance.