Prognostic nutritional index in elderly patients hospitalized for acute heart failure

Abstract

Aims Acute heart failure (AHF) represents a frequent cause of hospitalization and is associated with significant mortality among elderly patients. Risk assessment models like the prognostic nutritional index (PNI) have been proposed to stratify the risk of death and identify patients requiring more intensive levels of care. We evaluated the predictive value of PNI for in-hospital and overall mortality in a cohort of consecutive elderly patients hospitalized for AHF. Methods and results Prognostic nutritional index, laboratory, and clinical parameters were collected upon admission. PNI values were calculated from albumin concentration and lymphocyte count and reported on a continuous scale with lower values indicating worse prognosis. The primary outcome was overall all-cause mortality defined as death from any cause occurring during hospitalization up to 6 months after discharge. Cox proportional regression analysis was used to calculate hazard ratios (HRs) and the relative 95% confidence intervals (CIs). The study population included 344 patients (median age 84 years, range 65 to 101). During a median follow-up of 158 days (range 2 to 180 days), 75 patients (21.8%) died of whom 28 (8.1%) died during hospitalization. The median PNI was 34 (range 17 to 55). In univariable analysis, PNI was inversely associated with overall mortality (HR 0.90; 95% CI, 0.87 to 0.94) and in-hospital mortality (HR 0.91; 95% CI, 0.85 to 0.98). In multivariable analysis, PNI remained a significant predictor of overall mortality (HR 0.93; 95% CI, 0.89 to 0.98) after adjustment for age, anaemia, NT-proBNP values, and bedridden status. PNI values ≤34 were associated with a twofold higher risk of overall mortality (HR 2.54; 95% CI, 1.52 to 4.24) and threefold higher risk of in-hospital mortality (HR 3.37; 95% CI, 1.14 to 9.95). Conclusions Low PNI values are associated with short-term and long-term mortality among elderly patients hospitalized for acute decompensated heart failure. Future studies are warranted to confirm these findings and evaluate the use of PNI to guide therapeutic decisions.

Cerebral Ischemic Complications After Surgical Revascularization for Moyamoya Disease: Risk Factors and Development of a Predictive Model Based on Preoperative Nutritional Blood Parameters

“…The clinical values of PNI were generally explained by the two components of serum albumin concentration and total lymphocyte count in the peripheral blood ( 41 ). Low PNI might indicate lower cellular immune system activity that cannot function properly to decrease the patients' vulnerability to pathological noxae ( 42 , 43 ). Since aberrant immune response can contribute to the pathogenesis of ischemic stroke ( 44 ), we hypothesized that patients with MMD with a relatively low WBC level had a relationship with aberrant immunomodulation around vessel walls, leading to altered vascular activity or disruption of the blood supply.…”

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

“…They found that patients who were in the lowest tertile for PNI (<39.3) were more likely to die during a mean of 31.5 months follow‐up. Similarly, Candeloro et al reported that in patients who presented with acute heart failure, PNI < 34 were associated with two‐fold higher risk of all‐cause mortality and three‐fold higher risk for in‐hospital mortality 15 . In patients with HFpEF, Agus et al suggested that lower PNI at admission predicted all‐cause mortality or heart failure hospitalization at 1 year 11 .…”

“…Similarly, Candeloro et al reported that in patients who presented with acute heart failure, PNI < 34 were associated with twofold higher risk of all-cause mortality and three-fold higher risk for inhospital mortality. 15 In patients with HFpEF, Agus et al suggested that lower PNI at admission predicted all-cause mortality or heart failure hospitalization at 1 year. 11 Finally, Narumi et al demonstrated that the risk of cardiovascular adverse events were higher in chronic heart failure patients who were malnourished as evaluated by different nutritional indexes including PNI.…”

How Can Malnutrition Affect Autophagy in Chronic Heart Failure? Focus and Perspectives

“…In a study of 1673 patients hospitalized with acute heart failure (either reduced or preserved ejection fraction), the prognostic nutritional index was independently associated with cardiovascular mortality and all-cause mortality [ 32 ]. The low prognostic nutritional index was also associated with higher in-hospital all-cause mortality and post-hospitalization 6-month mortality in elderly patients hospitalized with acute decompensated HF [ 33 ].…”