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

Baseline and changes in prognostic nutritional index associate with heart failure hospitalization and all-cause death in patients with cardiac pacemaker

OBJECT

The study evaluated prognostic nutritional index (PNI) levels and changes as predictors of heart failure hospitalization (HFH) and mortality in cardiac pacemaker patients.

METHODS

PNI was calculated on admission and at the end of the 1-month follow-up, and their net changes (Δ) were calculated by PNI at follow-up minus the corresponding PNI on admission. The optimal cutoff value of baseline PNI was determined by the ROC curve. Based on this optimal cutoff value or the change in PNI during follow-up, patients were divided into high-PNI and low-PNI groups, or into improved PNI group (ΔPNI > 0) and deteriorated group (ΔPNI ≤ 0). The crude and adjusted cox proportional hazard models were used to analyze the associations between adverse events and PNI or ΔPNI. Restricted cubic splines were used to model the association of the PNI-endpoint events.

RESULTS

A total of 927 patients were enrolled in the study. The risk of HFH and all-cause death remained significantly higher in patients with low PNI, even after adjusting for other risk factors (hazard ratio [HR]: 1.997, 95% confidence interval [CI]: 1.220 - 3.203, P = 0.006; HR: 2.501, 95% CI: 1.392 - 4.494, P = 0.002, respectively). Patients with ΔPNI ≤ 0 faced higher risks of HFH and mortality compared to those with ΔPNI > 0(HR: 3.146, 95% CI: 2.024 - 4.892, P < 0.001, HR: 2.082, 95% CI: 1.223 - 3.544; P = 0.007, respectively) CONCLUSION: Low baseline PNI and ΔPNI ≤ 0 during follow-up effectively predicted HFH and mortality in cardiac pacemaker patients.

CLINICAL TRIAL NUMBER

Not applicable.

One-Year Mortality After Percutaneous Endoscopic Gastrostomy: The Prognostic Role of Nutritional Biomarkers and Care Settings

Background/Objectives: This study aimed to evaluate the clinical outcomes, complications, and one-year mortality of patients undergoing percutaneous endoscopic gastrostomy (PEG) in different care settings (hospital, nursing home, and home). Additionally, we investigated the comparative prognostic role of the prognostic nutritional index (PNI) and the CRP-to-albumin ratio (CAR) in predicting mortality among these patients. Methods: A retrospective analysis of 236 adult patients who underwent PEG placement between January 2022 and December 2023 was performed. Demographic, clinical, and laboratory data were collected. The PNI was calculated according to the following formula: PNI = 10 × (albumin) + 0.005 × (lymphocyte count). The CAR was obtained by the ratio of the CRP level to the albumin level. Patients were categorized based on their post-PEG care settings. Results: Neurologic disorders were the most common indication for PEG (69.9%). The one-year mortality was 32.2%, with a median survival of 38 weeks (95% CI: 35-41). In the multivariable model, a lower PNI (HR = 0.93, 95% CI: 0.89-0.97, p < 0.001), as well as being followed in a hospital setting, emerged as independent predictors of mortality. Patients with timely PEG tube replacement showed a reduced mortality risk. The ROC analysis showed that the PNI had a higher AUROC (0.78 ± 0.04) compared to the CAR (0.69 ± 0.04), indicating superior prognostic accuracy for predicting one-year mortality. Conclusions: Care settings significantly influence survival outcomes, with better mortality rates observed in nursing homes and home environments. The PNI was superior to the CAR in predicting one-year mortality, emphasizing its clinical utility in risk stratification for PEG patients. Proactive tube management and individualized care strategies are critical for improving the prognosis in this population.

Nonlinear Association Between Geriatric Nutritional Risk Index and Cardiovascular Disease in the Elderly Based on the NHANES Database

There is growing evidence that body nutritional status influences the development of cardiovascular disease, particularly in the elderly population. The Geriatric Nutritional Risk Index (GNRI), as a tool for assessing the nutritional status and nutritional risk of elderly individuals, is applied in clinical practice. This study aimed to elucidate the relationship between GNRI and cardiovascular disease in the elderly and to assess the impact of nutritional status on cardiovascular disease.This study is a cross-sectional study based on the National Health and Nutrition Examination Survey (NHANES) database. The data for this investigation were obtained from the NHANES database from 2007 to 2018, which included 10,277 individuals aged 60 years and older. The relationship between GNRI and cardiovascular disease in the elderly was investigated using weighted multivariable logistic regression models, and smooth fitting curves were drawn to explore their association. In addition, subgroup analyses were used to explore population differences.In this study, after adjusting for all confounding variables, the odds ratio and 95% confidence intervals (CI) of the model were 0.98 (0.96, 1.00), with no statistically significant association. Smooth fitting curves showed a nonlinear correlation between GNRI and cardiovascular disease. We found an inflection point (GNRI = 139.55). Moreover, GNRI was negatively associated with cardiovascular disease in the elderly before the inflection point and not statistically significant after the inflection point.In this large cross-sectional study, we found a nonlinear correlation between GNRI and cardiovascular disease in the general elderly population in the United States.

Clinical Characteristics and Outcomes of Patients With Heart Failure With Preserved Ejection Fraction and With Reduced Ejection Fraction According to the Prognostic Nutritional Index: Findings From PARADIGM-HF and PARAGON-HF

BACKGROUND

The importance of nutritional status is underappreciated in patients with heart failure (HF). This study aimed to describe the range of the prognostic nutrition index (PNI), and the clinical characteristics and outcomes according to PNI, in patients with HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF). The primary outcome was the composite of HF hospitalization or cardiovascular death.

METHODS AND RESULTS

Individual patient data from the PARAGON-HF (Prospective Comparison of ARNI [Angiotensin Receptor-Neprilysin Inhibitor] with ARB [Angiotensin Receptor Blocker] Global Outcomes in HFpEF) and PARADIGM-HF (Prospective Comparison of ARNI With ACEI [Angiotensin-Converting Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in HF) trials were used to examine patient characteristics and outcomes according to quartiles of PNI. Cox regression was used to analyze clinical outcomes, and multivariable fractional polynomial interaction analysis to examine the effects of sacubitril-valsartan, according to PNI. Patients with lower PNI (poorer nutrition) were older, frailer, and had more comorbidities and worse HF status, with greater congestion. Patients with lower PNI had biomarker abnormalities indicating inflammation, bone marrow suppression, and increased collagen turnover, among other physiologic perturbations. Lower PNI was associated with worse outcomes; that is, the rate of the primary end point among patients in the first quartile was 11.31 (10.20-12.54) compared with 7.09 (6.17-8.14) per 100 person-years in the fourth quartile. These associations persisted after adjustment for other prognostic variables. PNI did not modify the effects of sacubitril-valsartan in HFrEF although sacubitril/valsartan seemed to have a greater benefit in patients with HFpEF with a higher PNI.

CONCLUSIONS

Nutritional status, assessed using PNI, is an independent predictor of poor outcomes in HF. Evaluation of nutritional status in clinical practice, the causes of undernutrition, and whether undernutrition should be a therapeutic target, are all worthy of further investigation in HF.

The ability of the prognostic nutritional index to predict short-term mortality in geriatric acute heart failure

BACKGROUND

Heart failure is a critical cardiovascular condition, necessitating comprehensive treatment approaches and contributing to elevated mortality rates. This study aimed to evaluate the effect of the prognostic nutritional index (PNI) on the prognosis of geriatric patients diagnosed with acute heart failure.

RESULTS

A total of 104 patients were included and evaluated retrospectively in this study; 57.7% of them were females, and 19.24% of the patients died. A statistically significant difference was identified between high (≥ 35.6) and low PNI (< 35.6) groups in terms of lymphocyte count, neutrophil-lymphocyte ratio, C-reactive protein, and albumin (p values: < 0.001, < 0.001, 0.011, and < 0.001, respectively). The area under the curve (AUC) value for albumin was 0.53 (95% CI: 0.30-0.83) with a cutoff value of 3.1 g/dL; for lymphocyte count, it was 0.61 (95% CI: 0.57-0.84) with a cutoff value of 0.34 × 103/µL; and for PNI, it was 0.58 (95% CI: 41.18-85.06) with a cutoff value of 34.6.

CONCLUSION

The low PNI group exhibited a significantly higher mortality rate; nonetheless, PNI alone does not hold clinical significance as a prognostic marker. However, when combined with other clinical parameters, it can contribute to a more comprehensive assessment of patients.

Prognostic Value of Four Objective Nutritional Indices in Predicting Long-Term Prognosis in Elderly Patients with Atrial Fibrillation: A Retrospective Cohort Study

Background

Several objective and comprehensive nutritional assessment methods have been used for predicting adverse outcomes in elderly patients with various diseases. However, their predictive value for long-term adverse outcomes in elderly patients with atrial fibrillation (AF) is unclear. This study aimed to explore the prognostic significance of the four nutritional indices, namely Prognostic Nutritional Index (PNI), Geriatric Nutritional Risk Index (GNRI), Controlling Nutritional Status (CONUT), and High-Sensitivity Modified Glasgow Prognostic Score (HS-mGPS), in evaluating the long-term prognosis in elderly patients with AF.

Methods

This retrospective study was conducted at a single center and included a total of 261 elderly patients with AF from December 2015 to December 2021. Patients were divided into all-cause death and survival groups based on the follow-up results. Kaplan-Meier analysis and COX regression were conducted to explore the relationship between all-cause mortality and nutritional scores. In addition, Receiver Operating Characteristic (ROC) curves were used to compare the predictive value of the four nutritional screening tools for the endpoint event.

Results

During the follow-up period, 119 cases (45.59%) of all-cause mortality were recorded. The cumulative incidence of all-cause death was significantly higher in participants with a lower PNI, lower GNRI, higher CONUT, and higher HS-mGPS levels. And the low PNI (HR 1.325, 95% CI 1.032-2.857, P=0.025) and the high HS-mGPS (HR 2.166, 95% CI 1.281-4.326, P=0.023) groups were independently and significantly associated with increased risk of all-cause death analyzed by multivariate COX regression. Additionally, PNI showed the best area under the curve value (AUC: 0.696, 95% CI 0.632-0.760 P < 0.001) for the prediction of all-cause mortality compared with the other nutritional indices.

Conclusion

Among the four nutritional risk screening tools, PNI might be a simple and useful indicator in predicting the long-term prognosis of elderly patients with AF.

Development and validation of a multifactorial nomogram to predict 48 month mortality in decompensated heart failure

BACKGROUND AND AIMS

As the incidence of heart failure (HF) increases, the need for practical tools to evaluate the long-term prognosis in these patients remains critical. Our study aimed to develop a 48 month prediction model for all-cause mortality in decompensated HF patients using available clinical indicators.

METHODS

HF patients (n = 503), 60 years or older, were divided into a training cohort (n = 402) and a validation cohort (n = 101). Data on demographics, comorbidities, laboratory results and medications were gathered. Prediction models were developed using the Prognostic Nutritional Index (PNI), cholinesterase (ChE) and a multifactorial nomogram incorporating clinical variables. These models were constructed using the least absolute shrinkage and selection operator algorithm and multivariate logistic regression analysis. The performance of the model was assessed in terms of calibration, discrimination and clinical utility.

RESULTS

The mean age was 77.11 ± 8.85 years, and 216 (42.9%) were female. The multifactorial nomogram included variables of ChE, lymphocyte count, albumin, serum creatinine and N-terminal pro-brain natriuretic peptide (all P < 0.05). In the training cohort, the nomogram's C-index was 0.926 [95% confidence interval (CI) 0.896-0.950], outperforming the PNI indices at 0.883 and ChE at 0.804 (Z-tests, P < 0.05). The C-index in the validation cohort was 0.913 (Z-tests, P < 0.05). Calibration and decision curve analysis confirmed model reliability, indicating a more significant net benefit than PNI and ChE alone.

CONCLUSIONS

Both the ChE- and PNI-based prediction models effectively predict the long-term prognosis in patients over 60 years of age with decompensated HF. The multifactorial nomogram model shows superior performance, improving clinical decision-making and patient outcomes.

Long-term outcomes of endoscopic resection of superficial esophageal squamous cell carcinoma in late-elderly patients

BACKGROUND AND AIM

As the population ages, the number of elderly patients with superficial esophageal squamous cell carcinoma (ESCC) is increasing. We aimed to clarify the indications for endoscopic resection (ER) in late-elderly patients with ESCC in terms of life expectancy.

METHODS

Patients aged ≥75 years who underwent ER for ESCC at our institution from January 2005 to December 2018 were enrolled. Clinical data, including the Eastern Cooperative Oncology Group performance status, American Society of Anesthesiologists physical status (ASA-PS), Charlson comorbidity index, and prognostic nutritional index (PNI), were collected at the time of ER. The main outcome measure was overall survival (OS).

RESULTS

Two hundred eight consecutive patients were enrolled. The patients' median age was 78 years (range, 75-89 years). The 5-year follow-up rate was 88.5% (median follow-up period, 6.6 years). The 5-year OS rate was 79.2% (95% confidence interval [CI], 72.2-84.8), and 5-year net survival standardized for age, sex, and calendar year was 1.04 (95% CI, 0.98-1.09). In the multivariate analysis, an ASA-PS of 3 (hazard ratio, 2.45; 95% CI, 1.16-5.17) and PNI of <44.0 (hazard ratio, 2.73; 95% CI, 1.38-5.40) were independent prognostic factors. When neither of these factors was met, the 5-year OS rate was 87.8% (95% CI, 80.0-92.9), and 5-year net survival was 1.08 (95% CI, 1.02-1.14).

CONCLUSIONS

ER for ESCC in late-elderly patients may improve life expectancy. ER is recommended in patients with a good ASA-PS and PNI.

Malnutrition is associated with severe outcome in elderly patients hospitalised with COVID-19

Some studies have identified influencing factors of COVID-19 illness in elderly, such as underlying diseases, but research on the effect of nutritional status is still lacking. This study retrospectively examined the influence of nutritional status on the outcome of elderly COVID-19 inpatients. A retrospective analysis of the clinical data of 4241 COVID-19 patients who were admitted to a third-class hospital of Nanchang between November 1, 2022 and January 31, 2023 was conducted. Nutritional status was assessed using the prognostic nutritional index (PNI) and controlling nutritional status score (CONUT). The influence of nutritional status on the outcome of COVID-19 patients was determined through multivariate adjustment analysis, restrictive cubic spline, and receiver operating characteristic curve (ROC). Compared with mild/no malnutrition, severe malnutrition substantially increased the critical outcome of COVID-19. A linear relationship was observed between the odds ratio (OR) and PNI and CONUT (P > 0.05). The area under the ROC curve indicated that PNI was the better predictor. The optimal cutoff value of PNI was 38.04 (95%CI: 0.797 ~ 0.836, AUC = 0.817), with a sensitivity of 70.7% and a specificity of 79.6%. The critical illness of elderly COVID-19 patients shows a linear relationship with malnutrition at admission. The use of PNI to assess the prognosis of COVID-19 eldeely patients is reliable, highlighting the importance for doctors to closely pay attention to the nutritional status of COVID-19 patients. Focusing on nutritional status in clinical practice can effectively reduce the critical illness of elderly COVID-19 patients.

Effects of malnutrition on disease severity and adverse outcomes in idiopathic pulmonary arterial hypertension: a retrospective cohort study

BACKGROUND

Malnutrition is common in patients with chronic cardiovascular disease and is associated with significantly higher all-cause mortality. Approximately one-third of patients with heart failure are malnourished. However, the relationship between malnutrition and idiopathic pulmonary arterial hypertension (IPAH) remains unclear. This study aimed to clarify the prognostic value of malnutrition in patients with IPAH.

METHODS

A total of 432 consecutive participants with IPAH were included in this study between March 2013 and August 2021. Three common malnutrition assessment tools, including the geriatric nutritional risk index (GNRI), prognostic nutritional index (PNI), and controlling nutritional status (CONUT) score, were used to evaluate the nutritional status of patients with IPAH. The relationships between the malnutrition tools and long-term adverse outcomes were determined using restricted cubic splines and multivariate Cox regression models.

RESULTS

During a mean follow-up of 3.1 years, 158 participants experienced clinical worsening or all-cause death. Patients were stratified into the low-, intermediate- and high-risk groups based on the European Society of Cardiology (ESC) risk stratification, and the PNI (55.9 ± 5.7 vs. 54.4 ± 7.2 vs. 51.1 ± 7.1, P = 0.005) and CONUT score (2.1 ± 0.9 vs. 2.5 ± 1.2 vs. 3.3 ± 1.1, P < 0.001) identified these patient groups better than the GNRI. All three malnutrition tools were associated with well-validated variables that reflected IPAH severity, such as the World Health Organization functional class, 6-min walk distance, and N-terminal pro-brain natriuretic peptide level. The CONUT score exhibited better predictive ability than both the GNRI (ΔAUC = 0.059, P < 0.001) and PNI (ΔAUC = 0.095, P < 0.001) for adverse outcomes and significantly improved reclassification and discrimination beyond the ESC risk score. Multivariable Cox regression analysis indicated that only the CONUT score (hazard ratio = 1.363, 95% confidence interval 1.147, 1.619 per 1.0-standard deviation increment, P < 0.001) independently predicted adverse outcomes.

CONCLUSIONS

The malnutrition status was associated with disease severity in patients with IPAH. The CONUT score provided additional information regarding the risk of clinically worsening events, making it a meaningful risk stratification tool for these patients.

The effect of prognostic nutritional index on diabetic patients with myocardial infarction

BACKGROUND

The prognostic nutritional index (PNI), a simple and comprehensive predictor of nutritional and immunological health, is connected to cancer and cardiovascular disease. The effects of PNI on myocardial infarction (MI) in individuals with diabetes remain unclear. Thus, we aim to investigate the correlation of PNI with predictive outcomes in this specific population group to inform therapeutic decision-making.

METHODS

This prospective observational study included 417 diabetic patients with MI who underwent coronary angiography intervention at Fujian Medical University Union Hospital from May 2017 to May 2020. We collected follow-up and prognostic data from these patients at 6, 12, 18, and 24 months post-procedure via outpatient visits or phone interviews. The main focus of the study was on major adverse cardiovascular events (MACE) in the two years after surgery. Based on the median PNI, patients were categorized into two groups: high PNI (H-PNI) and low PNI (L-PNI). Data were analyzed using IBM SPSS 25.0. Kalpan-Meier survival curves and Cox proportional hazards regression analysis were utilized to examine the associations between preoperative PNI and the prognosis of diabetic patients with MI.

RESULTS

In the study, 417 participants were observed for two years. Of these patients, 159 (38.1%) had MACE. According to the Kaplan-Meier curves, patients in the L-PNI group had more MACE than those in the H-PNI group (log-rank p < 0.001) and had a heightened susceptibility to all categories of MACE. After adjusting for confounding variables, the corrected hazard ratio for developing unstable angina in the L-PNI group was 2.55 (95% CI 1.57-4.14, p < 0.001).

CONCLUSION

Low PNI levels are associated with MACE after coronary angiography intervention in diabetic patients with myocardial infarction. This highlights the prognostic value of PNI and broadens its potential use in larger populations.

TRIAL REGISTRATION

Not applicable.

Frailty, Sarcopenia, Cachexia, and Malnutrition in Heart Failure

With global aging, the number of patients with heart failure has increased markedly. Heart failure is a complex condition intricately associated with aging, organ damage, frailty, and cognitive decline, resulting in a poor prognosis. The relationship among frailty, sarcopenia, cachexia, malnutrition, and heart failure has recently received considerable attention. Although these conditions are distinct, they often exhibit a remarkably close relationship. Overlapping diagnostic criteria have been observed in the recently proposed guidelines and position statements, suggesting that several of these conditions may coexist in patients with heart failure. Therefore, a comprehensive understanding of these conditions is essential, and interventions must not only target these conditions individually, but also provide comprehensive management strategies. This review article provides an overview of the epidemiology, diagnostic methods, overlap, and prognosis of frailty, sarcopenia, cachexia, and malnutrition in patients with heart failure, incorporating insights from the FRAGILE-HF study data. Additionally, based on existing literature, this article discusses the impact of these conditions on the effectiveness of guideline-directed medical therapy for patients with heart failure. While recognizing these conditions early and promptly implementing interventions may be advantageous, further data, particularly from well-powered, large-scale, randomized controlled trials, are necessary to refine personalized treatment strategies for patients with heart failure.

Changes in nutritional status and the development of obesity and metabolic syndrome following pediatric heart transplantation

BACKGROUND

Nutritional status in pediatric patients undergoing heart transplantation (HT) is frequently a focus of clinical management and requires high resource utilization. Pre-operative nutrition status has been shown to affect post-operative mortality but no studies have been performed to assess how nutritional status may change and the risk of developing nutritional comorbidities long-term in the post-transplant period.

METHODS

A single-center retrospective chart review of patients ≥2 years of age who underwent heart transplantation between 1/1/2005 and 4/30/2020 was performed. Patient data were collected at listing, time of transplant, 1-year, and 3-year follow-up post-transplant. Nutrition status was classified based on body mass index (BMI) percentile in the primary analysis. Alternative nutritional indices, namely the nutrition risk index (NRI), prognostic nutrition index (PNI), and BMI z-score, were utilized in secondary analyses.

RESULTS

Of the 63 patients included, the proportion of patients with overweight/obese status increased from 21% at listing to 41% at 3-year follow-up. No underweight patients at listing became overweight/obese at follow-up. Of patients who were overweight/obese at listing, 88% maintained that status at 3-year follow-up. Overweight/obese status at listing, 1-year, and 3-year post-transplantation were significantly associated with developing metabolic syndrome. In comparison to the alternative nutritional indices, BMI percentile best predicted post-transplant metabolic syndrome.

CONCLUSIONS

The results suggest that pediatric patients who undergo heart transplantation are at risk of developing overweight/obesity and related nutritional sequelae (ie, metabolic syndrome). Improved surveillance and interventions targeted toward overweight/obese HT patients should be investigated to reduce the burden of associated comorbidities.

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

The association of low prognostic nutritional index (PNI) with adverse outcomes remains conflicting in heart failure patients. To address these knowledge gaps, we performed this meta-analysis to investigate the predictive value of PNI in patients with heart failure (HF). PubMed and Embase databases were comprehensively searched until January 19, 2023, to identify studies that evaluated the predictive role of PNI in HF patients. Outcomes of interest included all-cause mortality and/or combined endpoint of mortality and re-hospitalization. Twelve studies involving 9365 patients with HF were included and analyzed. Comparison of the lowest with the highest PNI, the pooled multivariate adjusted risk ratio (RR) was 1.79 (95% confidence interval [CI] 1.40-2.30) and 2.67 (95% CI 1.92-3.71) for long-term all-cause mortality and combined endpoint of mortality and re-hospitalization, respectively. Furthermore, per unit reduction in PNI was associated with 8% higher risk of all-cause mortality. However, there was no clear association of low PNI with in-hospital mortality. Low PNI may be an independent predictor of long-term all-cause mortality and re-hospitalization in patients with HF. Estimation of nutritional state using the PNI may provide an important clue for risk stratification in these patients.

Prognostic nutritional index during hospitalization correlates with adverse outcomes in elderly patients with acute myocardial infarction: a single-center retrospective cohort study

BACKGROUND AND AIMS

Acute myocardial infarction (AMI) is one of the most prevalent illnesses endangering the elderly's health. The predictive nutritional index (PNI) has been shown in several studies to be a good predictor of nutritional prognosis. In this study, we explored the correlation between PNI during hospitalization and the outcome of elderly AMI patients.

METHODS

Elderly AMI patients in the Cardiac Intensive Care Unit of Huadong Hospital from September 2017 to April 2020 were recruited for analysis. The clinical and laboratory examination data of subjects were retrieved. All enrolled patients were monitored following discharge. The primary clinical endpoints encompass major adverse cardiovascular events (MACEs) and Composite endpoint (MACEs and all-cause mortality). Survival analyses were conducted via the Kaplan-Meier and the log-rank analyses, and the Cox, proportional hazards model, was employed for hazard rate (HR) calculation.

RESULTS

307 subjects were recruited for analysis. The optimal PNI threshold is 40.923. Based on the Kaplan-Meier analysis, the elevated PNI group experienced better prognosis (P < 0.001). Cox analysis demonstrated that the PNI group was a stand-alone predictor for elderly AMI patient prognosis (HR = 1.674, 95% CI 1.076-2.604, P = 0.022). Subgroup analysis showed that the HR of the PNI group was the highest in the ST-segment elevation myocardial infarction (STEMI) subgroup (HR = 3.345, 95% CI 1.889-5.923, P = 0.05), but no discernible difference was observed in the non-ST-segment elevation myocardial infarction (NSTEMI) subgroup.

CONCLUSION

Based on our analyses, the PNI during hospitalization can accurately predict the prognosis of elderly STEMI patients but not that of elderly NSTEMI patients.

Association between the prognostic nutritional index (PNI) and all-cause mortality in patients with chronic kidney disease

BACKGROUND

Nutrition and immunity play an important role in many chronic diseases. The prognostic nutritional index (PNI) has been proposed as a comprehensive indicator of an individual's immune and nutritional status. However, there is a lack of evidence regarding the association between the PNI and mortality in patients with chronic kidney disease (CKD).

METHODS

We used National Health and Nutrition Examination Survey (NHANES) data from 2001-2014 for participants with CKD. Mortality data were obtained from the National Death Index and matched to NHANES participants. Cox proportional hazards models were used to estimate hazard ratios for all-cause mortality.Results: The patients were 72.5 ± 9.8 years old, and 47.57% were male. The median follow-up was 58 months, and the mortality rate in patients with CKD was 30.27%. A higher PNI protected against all-cause mortality in patients with CKD, with an adjusted hazard ratio (aHR) of 0.98 (95% confidence interval (CI): 0.97-0.99). After grouping according to PNI quartiles, statistically significant between-group differences were observed in survival probabilities. The aHR for the lowest PNI quartile compared to the highest PNI quartile was 1.64 (95% CI: 1.26-2.14). Sensitivity analysis further supported this association. Restricted cubic spline analysis revealed an L-shaped association between the PNI and all-cause mortality in patients with CKD, with a critical value of 50.5.

CONCLUSIONS

The PNI is a protective factor in patients with CKD, with an L-shaped decrease in all-cause mortality with an increasing PNI.

Prognostic nutritional index with postoperative complications and 2-year mortality in hip fracture patients: an observational cohort study

BACKGROUND

The prognostic nutritional index (PNI) has been proposed as a useful prognostic tool in multiple populations. However, its prognostic value has not been fully evaluated in the hip fracture population. We aimed to assess the relationship between PNI and postoperative complications as well as 2-year all-cause mortality in the hip fracture population.

MATERIALS AND METHODS

We included patients aged 45 or older who underwent surgery for hip fracture between 2000 and 2022. The baseline serum albumin and total lymphocyte count were used to calculate PNI with the following formula: 10×serum albumin level (g/dl)+0.005×total lymphocyte count (per mm 3 ). Patients were classified into low, medium, and high categories based on tertiles of PNI (≤43.23, 43.23-47.35, and >47.35, respectively). Logistic regression and Cox proportional hazards models were used to calculate the odds ratio (OR) for postoperative compilations and the hazard ratio (HR) for mortality, adjusting for potential confounders.

RESULTS

Of 3351 hip patients, 236 (7.04%) developed postoperative complications, and 305 (9.10%) died during the 2-year follow-up. Compared to the low-category patients, the medium-category and high-category patients showed lower odds of postoperative complications (ORs 0.69, 95% CI 0.48-0.98; and 0.61, 95% CI 0.40-0.93, respectively), and lower hazards of 2-year mortality (HRs 0.66, 95% CI 0.49-0.88; and 0.61, 95% CI 0.42-0.88, respectively). These associations were robust across a series of analyses, including subgroup analyses and dose-response sensitivity analyses.

CONCLUSION

PNI is an independent predictor of postoperative complications and 2-year all-cause mortality in hip fracture patients. PNI can be used to identify patients who may be at high risk of a poor prognosis.

Nutritional Status Indices and Monoclonal Gammopathy of Undetermined Significance Risk in the Elderly Population: Findings from the National Health and Nutrition Examination Survey

OBJECTIVE

Although several studies have found dietary intake is related to multiple myeloma (MM) and its precursor status risks, the role of one's nutritional status has been ignored and its role in plasma cell neoplasm development is still unclear. This study aimed to explore the relationship between various clinical indices of nutritional status and the risk of monoclonal gammopathy of undetermined significance (MGUS) in the population.

METHODS

We selected 9520 participants from the NHANES III and NHANES 1999-2004 studies. Controlling nutritional status index (CONUT), prognostic nutritional index (PNI), geriatric nutritional risk index (GNRI) and body mass index (BMI) were calculated as indices of nutritional status of the participants. Associations between nutritional indices and MGUS were investigated using multiple logistic regression, subgroup analysis, and an RCS model.

RESULTS

In our study, 266 participants had MGUS, with a prevalence of 2.79%. This study found that CONUT and PNI identified populations with poor nutritional status and had a significant positive correlation with the risk of MGUS. In multivariate logistic regression, compared with the lower CONUT score (<3) group, the OR for the group with higher scores (≥3) was 1.805 (95%CI: 1.271, 2.564). Compared with the lowest quartile group, the highest quartile PNI score group had an OR of 0.509 (95%CI: 0.290, 0.896). GNRI had no significant correlation with the risk of MGUS, with an OR of 0.737 (95%CI: 0.443, 1.227).

CONCLUSION

This study found that older adults with CONUT and PNI scores indicating poorer nutrition had a higher risk of MGUS.

Comorbidity and nutritional status in adult with advanced chronic kidney disease influence the decision-making choice of renal replacement therapy modality: A retrospective 5-year study

Background

Nutritional and inflammation status are significant predictors of morbidity and mortality risk in advanced chronic kidney disease (ACKD). To date, there are a limited number of clinical studies on the influence of nutritional status in ACKD stages 4-5 on the choice of renal replacement therapy (RRT) modality.

Aim

This study aimed to examine relationships between comorbidity and nutritional and inflammatory status and the decision-making on the choice of RRT modalities in adults with ACKD.

Methods

A retrospective cross-sectional study was conducted on 211 patients with ACKD with stages 4-5 from 2016 to 2021. Comorbidity was assessed using the Charlson comorbidity index (CCI) according to severity (CCI: ≤ 3 and >3 points). Clinical and nutritional assessment was carried out by prognosis nutritional index (PNI), laboratory parameters [serum s-albumin, s-prealbumin, and C-reactive protein (s-CRP)], and anthropometric measurements. The initial decision-making of the different RRT modalities [(in-center, home-based hemodialysis (HD), and peritoneal dialysis (PD)] as well as the informed therapeutic options (conservative treatment of CKD or pre-dialysis living donor transplantation) were recorded. The sample was classified according to gender, time on follow-up in the ACKD unit (≤ 6 and >6 months), and the initial decision-making of RRT (in-center and home-RRT). Univariate and multivariate regression analyses were carried out for evaluating the independent predictors of home-based RRT.

Results

Of the 211 patients with ACKD, 47.4% (n = 100) were in stage 5 CKD, mainly elderly men (65.4%). DM was the main etiology of CKD (22.7%) together with hypertension (96.6%) as a CV risk factor. Higher CCI scores were significantly found in men, and severe comorbidity with a CCI score > 3 points was 99.1%. The mean time of follow-up time in the ACKD unit was 9.6 ± 12.8 months. A significantly higher CCI was found in those patients with a follow-up time > 6 months, as well as higher mean values of eGFR, s-albumin, s-prealbumin, s-transferrin, and hemoglobin, and lower s-CRP than those with a follow-up <6 months (all, at least p < 0.05). The mean PNI score was 38.9 ± 5.5 points, and a PNI score ≤ 39 points was found in 36.5%. S-albumin level > 3.8 g/dl was found in 71.1% (n = 150), and values of s-CRP ≤ 1 mg/dl were 82.9% (n = 175). PEW prevalence was 15.2%. The initial choice of RRT modality was higher in in-center HD (n = 119 patients; 56.4%) than in home-based RRT (n = 81; 40.5%). Patients who chose home-based RRT had significantly lower CCI scores and higher mean values of s-albumin, s-prealbumin, s-transferrin, hemoglobin, and eGFR and lower s-CRP than those who chose in-center RRT (p < 0.001). Logistic regression demonstrated that s-albumin (OR: 0.147) and a follow-up time in the ACKD unit >6 months (OR: 0.440) were significantly associated with the likelihood of decision-making to choose a home-based RRT modality (all, at least p < 0.05).

Conclusion

Regular monitoring and follow-up of sociodemographic factors, comorbidity, and nutritional and inflammatory status in a multidisciplinary ACKD unit significantly influenced decision-making on the choice of RRT modality and outcome in patients with non-dialysis ACKD.

Significance of preoperative evaluation of skeletal muscle index and immune-nutritional status for patients with early-stage non-small cell lung cancer

OBJECTIVES

Sarcopenia involves several mechanisms, including age-related changes, nutritional deficiencies, and inflammation, and is associated with unfavorable clinical outcomes. However, the significance of skeletal muscle index (SMI) and immune-nutritional status for patients with early-stage non-small cell lung cancer (NSCLC) remains unclear. This retrospective study was performed to investigate associations between preoperative SMI based on computed tomography (CT) at the L1 level and immune-nutritional status, and whether these factors correlated with surgical outcomes.

METHODS

We retrospectively investigated 386 patients with stage I-II NSCLC who underwent curative anatomical pulmonary resection. SMI was assessed on CT at the L1 level and patients were divided into low-SMI (n = 97) and high-SMI (n = 289) groups. We examined the significance of SMI for postoperative outcomes and evaluated correlations between SMI and clinical characteristics, including immune-nutritional status.

RESULTS

Low SMI was significantly associated with body mass index and geriatric nutritional risk index. Five-year overall survival rate was significantly lower in the low-SMI group (66.0%) than in the high-SMI group (82.2%, P = 0.004). Multivariate analysis revealed SMI (hazard ratio [HR] 1.850; 95% confidence interval [CI] 1.091-3.135; P = 0.022) and prognostic nutritional index (PNI) (HR 2.031; 95% CI 1.231-3.352; P = 0.006) as independent predictors of overall survival. Low SMI correlated significantly with postoperative complications (P = 0.024).

CONCLUSIONS

Low preoperative SMI based on CT at the L1 level appears associated with poor prognosis and postoperative complications among patients with early-stage NSCLC. PNI is also an independent prognostic factor for surgical outcomes.