Background: Coronary anatomical complexity is commonly used for perioperative risk assessment in patients undergoing coronary artery bypass grafting (CABG), although it may not fully reflect systemic biological vulnerability. This study aimed to evaluate the association between the Prognostic Nutritional Index (PNI), a nutritional–immune marker derived from serum albumin and lymphocyte counts, and in-hospital mortality after CABG in relation to coronary anatomical complexity and established surgical risk scores. Methods: In this single-center retrospective cohort study, 324 consecutive patients who underwent isolated CABG between April 2024 and April 2025 were analyzed. The PNI was calculated according to the standard Onodera formula using preoperative serum albumin and total lymphocyte count. Associations with in-hospital mortality were evaluated using univariable and multivariable logistic regression analyses. Discriminative performance was assessed using receiver operating characteristic curve analysis, while exploratory analyses evaluating the additional prognostic contribution of the PNI beyond surgical risk scores were performed using nested model comparison and reclassification analyses. Internal validation and calibration analyses were also performed. Results: In-hospital mortality occurred in 26 patients. Preoperative and postoperative PNI values were significantly lower in patients who experienced in-hospital mortality. In multivariable analysis, the postoperative PNI remained independently associated with in-hospital mortality, whereas the preoperative PNI lost statistical significance after adjustment for clinical, renal, and surgical risk parameters. Receiver operating characteristic analysis demonstrated modest discriminative ability for the preoperative PNI (AUC: 0.742, 95% CI: 0.661–0.823). Exploratory analyses suggested a modest improvement in model discrimination and risk classification after the addition of the PNI to STS-based models; however, the overall incremental prognostic contribution remained limited. Calibration and internal validation analyses demonstrated acceptable agreement between predicted and observed mortality risk. Conclusions: The postoperative PNI demonstrated a stronger and independent association with in-hospital mortality than the preoperative PNI, suggesting that early postoperative nutritional–immune deterioration may reflect the magnitude of perioperative physiological stress and evolving clinical deterioration after CABG. Although lower preoperative PNI values were associated with mortality in univariable analyses, this association was no longer statistically significant after adjustment for clinical, renal, and surgical risk parameters. These findings indicate that postoperative nutritional–immune status may provide complementary biological information beyond conventional risk models; however, its clinical utility requires confirmation in larger prospective multicenter studies.

Giriş Hayvan ısırıkları sık görülmesine rağmen boyun bölgesini içeren ve vasküler yaralanmayla komplike olan olgular nadirdir. Deve ısırıkları, yüksek basınçlı diş yapısı nedeniyle derin dokularda ciddi hasara yol açabilir. Bu sunumda deve ısırığı sonrası gelişen nadir bir common karotis arter disseksiyonu olgusu ele alınmıştır. Olgu Sunumu 29 yaşında erkek hasta, deve ısırığından 8 saat sonra başvurdu. Fizik muayenede boyunda çoklu delinme yaraları, mandibula kırığı, fasiyal paralizi ve sağ karotis nabzında azalma saptandı. BT anjiyografide sağ common karotis arterde disseksiyon izlendi. Cerrahi eksplorasyon ve greft interpozisyonu uygulandı. Postoperatif dönemde antibiyotik, antikoagülan ve antiplatelet tedavi verildi. Hasta komplikasyonsuz taburcu edildi. Tartışma Literatürde deve ısırığına bağlı karotis arter yaralanmaları oldukça sınırlıdır. Yaralanma mekanizması diş basıncı ve künt travmadır. Stabil hastalarda BT anjiyografi tanıda kritik öneme sahiptir. Nabız azalması ve adventisyal hematom varlığı intimal disseksiyon açısından uyarıcı olmalıdır. Sonuç Boyun bölgesi hayvan ısırıklarında kanama olmasa dahi vasküler yaralanma olasılığı göz önünde bulundurulmalı, şüpheli durumlarda cerrahi eksplorasyon geciktirilmemelidir.