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

Chen, Meiyu; Wen, Jiang-Xiong; Lu, Mei-Ting; Jian, Xiang-Yu; Wan, Xiao-Liang; Xu, Zhiyong; Liang, Jian-Qiu; Wu, Jie

doi:10.3389/fcvm.2022.918566

Cited by 19 publications

(12 citation statements)

References 38 publications

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“…Furthermore, patients with deviating TSH (IFCC) levels had decreased serum albumin and hemoglobin levels, increased CRP levels and decreased total lymphocyte counts. In addition, we calculated the PNI and NLR, which are parameters of nutritional status or prognostic factors identified in previous studies 21–24 . Although there is no defined reference range, 25–27 patients with deviating TSH (IFCC) levels tended to exhibit a decreased PNI and an increased NLR.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, we calculated the PNI and NLR, which are parameters of nutritional status or prognostic factors identified in previous studies. [21][22][23][24] Although there is no defined reference range, [25][26][27] patients with deviating TSH (IFCC) levels tended to exhibit a decreased PNI and an increased NLR. These results suggested the possibility of a poor nutritional status and general condition in patients with deviating TSH (IFCC) levels.…”

Section: Clinical Characteristics Of Patients With Deviating Tsh (Ifc...mentioning

confidence: 99%

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Instability of harmonized thyroid‐stimulating hormone immunoassays in clinical practice

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Fukuoka

et al. 2023

Clinical Endocrinology

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Objective: Thyroid-stimulating hormone (TSH) harmonization is effective in minimizing differences between the results of immunoassays in healthy subjects.However, the effectiveness of TSH harmonization in clinical practice has not been investigated. The aim of this study was to evaluate the instability of TSH harmonization in clinical practice. Methods:We compared the reactivities of four harmonized TSH immunoassays using combined difference plots of 431 patients. We selected patients with statistically significant deviations in TSH levels and analyzed their thyroid hormone levels and clinical characteristics. Results:The combined difference plots showed that one harmonized TSH immunoassay exhibited markedly different reactivity even after TSH harmonization compared with the other three immunoassays. Among 109 patients with mild-tomoderate elevation of TSH levels, we selected 15 patients with statistically significant deviations in TSH levels according to the difference plots of three harmonized TSH immunoassays, excluding one immunoassay that showed different reactivity. The thyroid hormone levels of three patients were misclassified as hypothyroidism or normal due to deviating TSH levels. In terms of clinical characteristics, these patients were in poor nutritional status and general condition, possibly due to their severe illness (e.g., advanced metastatic cancer). Conclusion:We have confirmed that TSH harmonization in clinical practice is relatively stable. However, some patients showed deviating TSH levels in the harmonized TSH immunoassays, indicating the need for caution, particularly in poorly nourished patients. This finding suggests the presence of factors that contribute to the instability of TSH harmonization in such cases. Further investigation is warranted to validate these results.

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Section: Resultsmentioning

confidence: 99%

Section: Clinical Characteristics Of Patients With Deviating Tsh (Ifc...mentioning

confidence: 99%

Instability of harmonized thyroid‐stimulating hormone immunoassays in clinical practice

Uto

Bando

Fukuoka

et al. 2023

Clinical Endocrinology

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“…Nutritional disorders are a common condition in ACKD associated with multimorbidity and worse survival outcomes ( 12 ). The PNI score is an indicator of immune and nutritional status that has been shown as an independent predictive risk factor in different disease conditions ( 14 – 18 ) as well as in older patients with ACKD ( 19 , 20 ). A case–control study in older patients with ACKD stages 4–5 demonstrates that the median PNI score value was 48.37 points in an elderly Mediterranean cohort of patients with ACKD who had an adequate nutritional status when compared to age-sex matched with their controls ( 20 ).…”

Section: Discussionmentioning

confidence: 99%

“…The prognostic nutritional index (PNI) is a novel score that has previously been used under several disease conditions and patients with CKD ( 14 – 20 ). The PNI score was calculated as follows: [10 × serum albumin (g/dl) + (0.005 × total lymphocyte count (cells x 10 3 mm 3 ] ( 13 ).…”

Section: Methodsmentioning

confidence: 99%

“…The prognostic nutritional index (PNI) score is a new composite indicator that includes a combination of serum albumin (s-albumin) and total lymphocyte count (TLC) ( 13 ). Previous studies ( 14 – 18 ) demonstrated that the PNI is related to poor clinical outcomes and predicts survival in a variety of solid tumors, postoperative complications, and other disease states. A cut-off point of the PNI score < 39 points has been recognized as an independent prognostic marker of clinical and mortality outcomes in older patients with CKD ( 19 , 20 ) and patients with dialysis ( 21 , 22 ).…”

Section: Introductionmentioning

confidence: 99%

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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

Álvarez-García

Pérez²,

Alaguero³

et al. 2023

Front. Nutr.

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BackgroundNutritional 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.AimThis 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.MethodsA 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.ResultsOf 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).ConclusionRegular 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.

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

Zhuang,

Chen,

Weng

et al. 2024

ESC Heart Failure

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Background and aimsAs 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.MethodsHF 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.ResultsThe 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.ConclusionsBoth 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.

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

Cited by 19 publications

References 38 publications

Instability of harmonized thyroid‐stimulating hormone immunoassays in clinical practice

Instability of harmonized thyroid‐stimulating hormone immunoassays in clinical practice

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

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

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