Preoperative Naples Prognostic Score and outcomes after isolated coronary artery bypass grafting: a retrospective cohort study

Abstract

Inflammatory and nutritional status may refine risk assessment before coronary artery bypass grafting (CABG). This study evaluated the association between preoperative Naples Prognostic Score (NPS) and early and follow-up outcomes after isolated CABG. This single-center retrospective cohort included adults who underwent isolated CABG between 2020 and 2023. Patients without a recorded preoperative NPS were excluded. The recorded NPS (0–4) was categorized as low (score 0), intermediate (scores 1–2), or high (scores 3–4). Outcomes were institutionally recorded binary event indicators. Logistic regression evaluated associations with 30-day major adverse cardiac and cerebrovascular events (MACCE), follow-up MACCE, and follow-up all-cause death. The analytic cohort included 332 patients: 16 low-NPS, 193 intermediate-NPS, and 123 high-NPS patients. Follow-up all-cause death occurred in 25 patients (7.5%) and was more frequent in the high-, intermediate-, and low-NPS groups, respectively (15.4%, 3.1%, and 0.0%; exact P < 0.001). Any follow-up MACCE occurred in 45 patients (13.6%; 18.7%, 11.4%, and 0.0% across the same groups; exact P = 0.050). Thirty-day MACCE occurred in 11 patients (3.3%); its analyses were exploratory. Per 1-point increase in NPS, the adjusted odds ratio for follow-up all-cause death was 1.69 (95% CI 1.00-2.84; P = 0.048) in the clinical model and 2.06 (95% CI 1.25–3.39; P = 0.005) in the EuroSCORE II complete-case model. Higher preoperative NPS was associated with greater follow-up all-cause mortality after isolated CABG. Associations with composite MACCE were less consistent after adjustment. NPS may support inflammatory-nutritional risk interpretation alongside established surgical risk assessment, but the findings require confirmation in cohorts with standardized follow-up and time-to-event data.