Is prognostic nutritional index a predictive marker for estimating all-cause in-hospital mortality in COVID-19 patients with cardiovascular risk factors?

Abstract

Background: This study examined the possible association between the prognostic nutritional index (PNI) and in-hospital mortality rates in cases with a high cardiovascular risk burden and hospitalized with the diagnosis of coronavirus disease 2019 . Material and Methods: This retrospective and cross-sectional study included 294 COVID-19 patients hospitalized in a tertiary referral pandemic center. The study cohort was grouped into tertiles based on the initial PNI values as T1, T2, and T3. The PNI was calculated for each case and the prognostic value of this index was compared to CURB-65 and 4C mortality risk scores in predicting in-hospital mortality. Results: Patients stratified into the T1 tertile had a lower lymphocyte count, serum albumin level, and PNI values. In a multivariate analysis, the PNI (OR: 0.688,%95CI: 0.586À0.808, p < 0.001) was an independent predictor for all-cause in-hospital death. After adjusting for confounding independent parameters, patients included in the T1 tertile were found to have 11.2 times higher rates of in-hospital mortality compared to the T3 group, which was presumed as the reference group. In addition, we found that the area under curve (AUC) value of PNI was significantly elevated than that of serum albumin level and total lymphocyte counts alone. [(AUC):0.79 vs AUC:0.75 vs AUC:0.69; respectively). Conclusion: This study demonstrated that the PNI is independently related with in-hospital mortality in patient with COVID-19 and cardiovascular risk factors. The power of the PNI was also validated using wellaccepted risk scores of COVID-19 such as CURB-65 and 4C mortality risk scores.

Clinical significance of prognostic nutrition index in hospitalized patients with COVID‐19: Results from single‐center experience with systematic review and meta‐analysis

“… 32 Finally, eight observational studies, with a total of 2002 patients, were included. 8 , 16 , 17 , 33 , 34 , 35 , 36 , 37 However, one study did not report the adjusted OR of PNI as a continuous variable 33 and thus was not included in the meta‐analysis (Figure S1 ).…”

“…[13][14][15] When integrating the effects of both albumin and lymphocyte, it can be intuitive to hypothesize that the PNI could serve as a simplified means of rapid prognosis assessment in COVID-19 patients. 16,17 Consistent with this concept, a recent study demonstrated that the PNI was an essential discrimination indicator for the severity of COVID-19. 16 Additionally, in a study conducted by Çınar et al, 17 the PNI was an independent predictor for in-hospital mortality in patients with COVID-19.…”

“…16,17 Consistent with this concept, a recent study demonstrated that the PNI was an essential discrimination indicator for the severity of COVID-19. 16 Additionally, in a study conducted by Çınar et al, 17 the PNI was an independent predictor for in-hospital mortality in patients with COVID-19. Thus, integrating the PNI into the overall therapeutic strategy is of utmost importance given that effective management of patients with COVID-19 necessitates an accurate risk assessment.…”

“…Owing to the findings of previous efforts, early risk stratification with an accurate and easily calculated parameter is crucial to prevent the progression of COVID‐19. 16 , 17 However, it seems difficult to arrive at the best evidence‐based decision with respect to the current literature, as no prior study had been conducted systematically regarding the impact of the PNI on outcomes and prognosis among COVID‐19 patients. In this study, first, we report the results of our patients to investigate the indicators of in‐hospital mortality and severity in patients with COVID‐19.…”

Predictive Significance of the Prognostic Nutritional Index (PNI) in Patients with Severe COVID-19

“…Therefore, the prognostic value of the PNI in patients with COVID-19 is worth further investigation. However, to date, the relevant studies have mainly focused on crude analyses rather than establishing a systematic, quantified model; hence, the application value of the present PNI is extremely limited [14,15].…”