Prognostic nutritional index and prognosis of patients with coronary artery disease: A systematic review and meta-analysis

Abstract

BackgroundThis review assessed if prognostic nutritional index (PNI) can predict mortality and major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.MethodsPubMed, Web of Science, Scopus, and Embase were searched up to 1st November 2022 for all types of studies reporting adjusted associations between PNI and mortality or MACE in CAD patients. A random-effect meta-analysis was conducted for PNI as categorical or continuous variable. Subgroup analysis were conducted for multiple confounders.ResultsFifteen studies with 22,521 patients were included. Meta-analysis found that low PNI was a significant predictor of mortality in CAD patients as compared to those with high PNI (HR: 1.67 95% CI: 1.39, 2.00 I2 = 95% p < 0.00001). Increasing PNI scores were also associated with lower mortality (HR: 0.94 95% CI: 0.91, 0.97 I2 = 89% p = 0.0003). Meta-analysis demonstrated that patients with low PNI had significantly higher incidence of MACE (HR: 1.57 95% CI: 1.08, 2.28 I2 = 94% p = 0.02) and increasing PNI was associated with lower incidence of MACE (HR: 0.84 95% CI: 0.72, 0.92 I2 = 97% p = 0.0007). Subgroup analyses showed mixed results.ConclusionMalnutrition assessed by PNI can independently predict mortality and MACE in CAD patients. Variable PNI cut-offs and high inter-study heterogeneity are major limitations while interpreting the results. Further research focusing on specific groups of CAD and taking into account different cut-offs of PNI are needed to provide better evidence.Systematic Review RegistrationNo CRD42022365913 https://www.crd.york.ac.uk/prospero/.

Relationship between immune nutrition index and all-cause and cause-specific mortality in U.S. adults with chronic kidney disease

“…The PNI is a reliable indicator of the immunonutritional status of individuals, which is based on lymphocyte and albumin levels. Recent findings have not only substantiated the potential of the PNI as a prognostic indicator for various malignancies (19)(20)(21)(22), COVID-19 (9,23), coronary artery disease (24), and acute renal dysfunction (25), but also shown that a lower PNI has been linked to increased mortality risk in elderly individuals with CKD (26), and diabetic kidney disease (DKD) (27). In this study, we further corroborated the significant correlation between the PNI and CKD in the general population.…”

Establishment and evaluation of a nomogram for in-hospital new-onset atrial fibrillation after percutaneous coronary intervention for acute myocardial infarction

“…Recently, an increasing number of studies have found that malnutrition was closely associated with poor prognosis in patients with cardiovascular disease ( 20 – 22 ). Data from Europe and the Americas showed that up to one-third of hospitalized patients were at risk of malnutrition or were malnourished upon admission, especially in acutely ill patients.…”

The combination effect of RDW and PNI on the prognosis for CAD patients undergoing PCI

“…In ammation was a key mediator on the impact of malnutrition for the prognosis of cardiovascular disease 3 . In recent years, many studies have showed that PNI was an adverse predictor in cardiovascular disease 4,5 . Prognostic nutritional index (PNI) was calculated from serum albumin levels and absolute lymphocyte counts, which was a comprehensive index re ected not only protein stores but also the immunological status.…”