Association of Prognostic Nutritional Index with Severity and Mortality of Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

Abstract

The associations of prognostic nutritional index (PNI) with disease severity and mortality in patients with coronavirus disease 2019 (COVID-19) remain unclear. Electronic databases, including MEDLINE, EMBASE, Google scholar, and Cochrane Library, were searched from inception to 10 May 2022. The associations of PNI with risk of mortality (primary outcome) and disease severity (secondary outcome) were investigated. Merged results from meta-analysis of 13 retrospective studies (4204 patients) published between 2020 and 2022 revealed a lower PNI among patients in the mortality group [mean difference (MD): −8.65, p < 0.001] or severity group (MD: −5.19, p < 0.001) compared to those in the non-mortality or non-severity groups. A per-point increase in PNI was associated with a reduced risk of mortality [odds ratio (OR) = 0.84, 95% CI: 0.79 to 0.9, p < 0.001, I2 = 67.3%, seven studies] and disease severity (OR = 0.84, 95% CI: 0.77 to 0.92, p < 0.001, I2 = 83%, five studies). The pooled diagnostic analysis of mortality yielded a sensitivity of 0.76, specificity of 0.71, and area under curve (AUC) of 0.79. Regarding the prediction of disease severity, the sensitivity, specificity, and AUC were 0.8, 0.61, and 0.65, respectively. In conclusion, this study demonstrated a negative association between PNI and prognosis of COVID-19. Further large-scale trials are warranted to support our findings.

Prognostic Nutritional Index, Controlling Nutritional Status (CONUT) Score, and Inflammatory Biomarkers as Predictors of Deep Vein Thrombosis, Acute Pulmonary Embolism, and Mortality in COVID-19 Patients

“…In regard to the predictive role of nutritional markers, in the meta-analysis published by Hung et al [ 52 ], in which 13 studies were included, and a total number of 4204 COVID-19 patients, it was demonstrated that PNI is a predictor of mortality. Moreover, research by Bodolea et al [ 53 ] resulted in PNI > 28.05 (HR:0.91; p = 0.01), and a CONUT Score > 7.5 (HR:1.15; p = 0.01) becoming associated with mortality, in the case of 90 COVID-19 patients with the severe form.…”

“…In terms of nutritional status, the prognostic nutritional index (PNI) and controlling nutritional status (CONUT) scores are associated with disease severity and have a predictive role in COVID-19 patient mortality [ 52 , 53 , 54 , 55 , 56 , 57 ]…”

Elevated Surgical Pleth Index at the End of Surgery Is Associated with Postoperative Moderate-to-Severe Pain: A Systematic Review and Meta-Analysis

“…The statistical analysis was previously reported in our studies [ 27 , 28 ]. The conversion of sensitivity/specificity or PPV/NPV into TP/TN/FP/FN was conducted with Review Manager version 5.3.…”

Impact of parental rheumatoid arthritis on risk of autism spectrum disorders in offspring: A systematic review and meta-analysis

“…Leave-one-out sensitivity analysis was conducted to examine the reliability and the soundness of the available evidence. The potential publication bias for an outcome reported in 10 or more studies was evaluated by visual inspection of a funnel plot and the Egger’s test as previously reported ( 28 , 29 ). A p -value of <0.05 was judged to be statistically significant in the current meta-analysis.…”