Prognostic nutritional index as the predictor of long‐term mortality among HFrEF patients with ICD

Abstract

Background The benefit of implantable cardiac defibrillator (ICD) in patients with heart failure and reduced ejection fraction (HFrEF) could be limited in a particular group of patients. Low prognostic nutritional index (PNI) indicates malnutrition and proinflammatory condition. We sought to investigate the value of PNI in predicting long‐term mortality among HFrEF patients with ICD. Methods Electronic database was searched for identifying patients with HFrEF who were implanted ICD in our institution between 2009 and 2019. Demographic and clinical characteristics of included patients were recorded. PNI was calculated according to the formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). Patients were divided into the quartiles according to PNI values. Differences between the groups were analyzed by the log‐rank test. A forward Cox proportional regression model was used for multivariable analysis. Results One thousand and hundred patients were included to the study. The underlying heart failure etiology was ischemic and nonischemic in 77.3% and 22.7% of patients, respectively. Mortality rate in Q1 (5.1%) was considered as the reference. In the unadjusted model the mortality rate was 9.5% (hazard ratio [HR] 1.76, 95% confidence interval [95% CI] [0.92‐3.38]) in Q2, 10.2% (HR 1.88, 95% CI 0.99‐3.58) in Q3, and 39.6% (HR 8.12, 95% CI 4.65‐14.17) in Q4. The same trend was consistent in the age‐ and sex‐adjusted, comorbidities‐adjusted, and covariates‐adjusted models. Conclusion Among patients who were implanted with ICD secondary to HFrEF, lower PNI value predicted all‐cause mortality during long‐term follow‐up. This is the first study demonstrating the value of PNI in this population.

Low Prognostic Nutritional Index Predicts Adverse Outcomes in Patients With Heart Failure: A Systematic Review and Meta-analysis

“…Of these, 43 articles were excluded after application of the predefined inclusion and exclusion criteria. Thus, 12 studies [8][9][10][11][12][13][14][20][21][22][23][24] were ultimately included in this meta-analysis (Figure 1).…”

“…Table 1 describes the basic characteristic of the included studies. These eligible studies were published from 2013 to 2023 and conducted in China, 23,24 Japan, 8,11 Taiwan, 9,12 Turkey, 13,21,22 UK, 10,14 , and Italy. 20 These 12 studies included a total of 9365 HF patients, with sample sizes ranging between 285 and 2282.…”

“…Seven studies 9,10,12,14,[22][23][24] investigated the association between PNI and long-term all-cause mortality by categorical analysis. As shown in Figure 2, there was significant heterogeneity between studies (I 2 = 76.5%; P < .001).…”

Association Between Prognostic Nutritional Index and Prognosis in Patients With Heart Failure: A Meta-Analysis

“…Recently, a novel and simple metric, the prognostic nutritional index (PNI), had been proposed to evaluate the nutritional status in multiple clinical settings, including cancers, and post-operative pneumonia (12,13). Recent studies also showed that lower PNI is associated with an increased risk of mortality or major adverse cardiac events (MACEs) in patients with acute or chronic HF (14)(15)(16)(17)(18). However, whether PNI can serve as a potential biomarker for the prognosis of HF upon those established risk factors were still controversial.…”

Relationship Between Prognostic Nutritional Index and Contrast-Associated Acute Kidney Injury in Patients With Non-ST Segment Elevation Myocardial Infarction Undergoing Coronary Angiography

“…14 Prognostic nutritional index is a nutritional and inflammatory scoring system based on serum albumin level and lymphocyte count that has been evaluated in the context of many areas, particularly in the fields of surgery and cancer. 15,16 Given the effects of malnutrition on cardiovascular disease and the relationship of inflammation with atherosclerosis and acute conditions, the use of PNI has also attracted the attention of cardiology researchers.…”