Comment on: “Comparison on the predictive value of four preoperative nutritional assessment tools for acute kidney injury after major surgery: a retrospective cohort study”
Year: 2026
Type: letter
Abstract: Dear Editor, We hereby comment on the article “Comparison on the predictive value of four preoperative nutritional assessment tools for acute kidney injury after major surgery: a retrospective cohort study”[1]. This study’s retrospective cohort design is a major drawback, despite its solid sample size and use of both internal and external validation. Particularly in the MIMIC-IV database, where patients showed high illness severity and abnormally high acute kidney injury (AKI) rates in comparison to the single-hospital group, this method is unable to completely account for bias resulting from missing data and inconsistent preoperative laboratory testing. The interpretation of predicted values from different nutritional assessment techniques may be impacted by this clinical contextual variation, which may therefore restrict the capacity to compare results across cohorts. The conceptual overlap between inflammation or serious sickness and nutritional state is another important drawback. Serum albumin, in instance, is more affected by acute phase response, fluid overload, and liver function than by dietary status alone, while having the best predictive performance. The fact that only serum albumin is still independently correlated in categorical analysis may indicate sensitivity to the severity of the condition rather than a genuine depiction of malnutrition, which could result in a misconception of the cause. The idea of “nutrition” in the context of postoperative AKI may need to be reevaluated from being merely a persistent underlying problem, according to a thorough analysis. The use of albumin as a measure of a patient’s physiologic reserve, frailty, and metabolic stress response is growing. The idea that albumin may represent endothelial dysfunction or microvascular susceptibility and contribute more to AKI than dietary status alone is supported by the stronger correlation seen in diabetic patients. This viewpoint contributes to the explanation of the great sensitivity but low specificity of other composite instruments like CONUT or GNRI. Prospective studies are required for future study in order to evaluate dynamic changes in albumin and other biomarkers before and after surgery, as well as to clearly distinguish the impacts of inflammation, diet, and disease severity. Additionally, combining serum albumin with markers of inflammation or renal function may aid in the creation of more precise AKI prediction models. In order to change the role of albumin from a predictor to an objective of evidence-based preventative intervention, more clinical research should assess if advanced preoperative hypoalbuminemia treatment or nutritional assistance can actually lower the incidence of AKI. Ethical approval Not applicable. Consent Not applicable.
Source: International Journal of Surgery
Authors: Hinpetch Daungsupawong, Viroj Wiwanitkit
Institution: Saveetha University
Language: English
Topic: Acute Kidney Injury Research
Subfield: Nephrology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,450
OpenAlex ID: W7154690831