Prognostic Nutritional Index as a Novel Predictor of Long-Term Prognosis in Patients with Coronary Artery Disease After Percutaneous Coronary Intervention

Liu, Tian-Ding; Zheng, Ying-Ying; Tang, Junnan; Wang, Wei; Dai, Xin-Ya; Zhang, Jianchao; Guo, Qianqian; Cheng, Meng-Die; Song, Feng-Hua; Fan, Lei; Liu, Zhiyu; Zhang, Zeng-Lei; Wang, Kai; Yue, Xiao-Ting; Zheng, Rujie; Zhang, Jinying

doi:10.1177/10760296221103271

Cited by 4 publications

(6 citation statements)

References 26 publications

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“…Similarly, a prospective study from China showed that PNI was a new biomarker to predict long-term outcome of CAD patients after PCI 22 . Our study found that the PNI level was lower in the non-survival and MACCE group, which is in line with previous studies.…”

Section: Discussionmentioning

confidence: 95%

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

Huo,

Jiang,

Chen

et al. 2023

Preprint

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Background：Inflammation and malnutrition are related to adverse clinical outcomes in patients with coronary artery disease (CAD). Nutritional status is an important condition that affects inflammation. However, it is yet unclear whether there is a joint between PNI(prognostic nutritional index) and RDW(red blood cell distribution width) for the impact on the prognosis in patients with CAD undergoing percutaneous coronary intervention（PCI）. Methods ：A total of 5605 consecutive CAD patients undergoing PCI were selected retrospectively, and stratified by combination of PNI and RDW level. The cutoff values of RDW and PNI for predicting 1-year all-cause mortality (ACM) were calculated using receiver operating characteristic curves analysis. The primary endpoint was 1-year ACM. Results ：During 1-year follow-up, 235 (4.19%) patients died. In multivariate regression analysis, the L-PNI/H-RDW group [hazard ratio (HR): 8.85, 95% confidence interval (CI) : 5.96,13.15, p＜0.001] was found to be the highest risk of ACM with H-PNI/L-RDW group as the reference, followed by the L-PNI/L-RDW group (HR:3.96, 95%CI: 2.60,6.00) and H-RDW/H-PNI group(HR:3.00,95%CI:1.99–4.50).The combination of PNI and RDW was a strong predictor of 1- year ACM. Conclusions CAD patients with L-PNI and H-RDW experienced the worst prognosis. The coexistence of PNI and RDW appears to have a synergistic effect, providing further information for the risk stratiﬁcation of CAD patients.

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Section: Discussionmentioning

confidence: 95%

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

Huo,

Jiang,

Chen

et al. 2023

Preprint

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“…Twenty studies were eligible for full-text analysis. Finally, 15 were eligible for this review ( 14 – 18 , 21 – 30 ).…”

Section: Resultsmentioning

confidence: 99%

“…Further variation in the use of PNI as categorical and continuous variable reduced the availability of studies in the meta-analysis thereby decreasing the statistical power. Also, the definition of MACE were not exactly the same amongst included studies with difference in the cause of death included (all-cause, or cardiac only), and inclusion of other variables like heart failure, bleeding and readmission in some studies ( 14 , 27 ). Such variation could directly affect the results and lead to heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

“…PNI was initially described to check the nutritional status of gastrointestinal surgery, but over the years it has been recognized as an important prognostic factor in several cancers (11)(12)(13). Over the past years, many studies have also used PNI to predict prognosis of CAD patients but with inconsistent results (14)(15)(16)(17)(18). However, no systematic review has been attempted to summarize the available evidence.…”

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confidence: 99%

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

et al. 2023

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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/.

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“…Previous studies reported that more than 50% of CAD patients with diabetes had malnutrition, and the mortality rate of those patients with severe malnutrition was nearly doubled [ 5 ]. The prognostic nutritional index (PNI) is an important tool for objective malnutrition screening of the cardiovascular disease population and may become a new biomarker to predict long-term outcomes of CAD patients after PCI [ 6 ]. Another study showed that a low level of PNI was closely associated with increased acute kidney injury and mortality after PCI [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of the prognostic nutritional index for patients with acute myocardial infarction undergoing percutaneous coronary intervention with variable glucose metabolism statuses: a retrospective cohort study

Ling,

Lin,

Liu

et al. 2023

Diabetol Metab Syndr

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Background The prognostic nutritional index (PNI) and different glucose metabolisms have been separately reported to be correlated with long-term prognosis in patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI). However, PNI application in patients with an impaired glucose metabolism has not been well validated, especially in pre-diabetic patients. This study evaluated whether PNI influences a long-term risk of mortality along different glucose metabolism statuses. Methods A total of 17,697 patients with AMI and a history of PCI were enrolled in this retrospective observational cohort study from January 2007 to December 2020. Three subgroups with different glucose metabolism statuses, including normal glucose regulation (NGR), pre-diabetes mellitus (pre-DM), and diabetes mellitus (DM), were divided into three groups according to the tertiles of PNI, respectively. Results All-cause mortality occurred in 2613 (14.8%) patients within a median of 4.1 years of follow-up. Upon analyzing the Kaplan–Meier plots for the NGR, pre-DM, and DM groups, the incidence of all-cause or cardiovascular mortality in the low PNI (PNI-L, ≤ 42.7) subgroup was significantly higher than that in the median PNI (PNI-M, > 42.7 and ≤ 48.2) and high PNI (PNI-H, > 48.2) subgroups (all, P < 0.001). After adjusting for confounding factors, the hazard ratio (HR) for all-cause mortality in the PNI-L group significantly increased compared to that in the PNI-H subgroups of the NGR group (HR, 1.35; 95% CI 1.14–1.66; P < 0.001), pre-DM group (HR, 1.29; 95% CI 1.02–1.62; P < 0.001), and DM group (HR, 1.36; 95% CI 1.13–1.63; P < 0.001). Given that there was evidence of interactions between PNI and different glucose statuses (P for interaction < 0.001), patients were divided into nine subgroups, and we found that DM patients with PNI-L statuses had the highest risk of all-cause mortality compared to NGR patients with PNI-H statuses (HR, 1.69; 95% CI 1.42–2.01; P < 0.001). Conclusion Lower PNI is a significant and independent risk factor for all-cause mortality in AMI patients undergoing PCI with different glucose metabolism statuses, and this risk further increases with DM compared to NGR or pre-DM statuses.

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Prognostic Nutritional Index as a Novel Predictor of Long-Term Prognosis in Patients with Coronary Artery Disease After Percutaneous Coronary Intervention

Cited by 4 publications

References 26 publications

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

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

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

Prognostic value of the prognostic nutritional index for patients with acute myocardial infarction undergoing percutaneous coronary intervention with variable glucose metabolism statuses: a retrospective cohort study

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