Prognostic Nutritional Index and the Risk of Mortality in Patients With Acute Heart Failure

Abstract

BackgroundNutritional status has been related to clinical outcomes in patients with heart failure. We assessed the association between nutritional status, indexed by prognostic nutritional index (PNI), and survival in patients hospitalized for acute heart failure.Methods and ResultsA total of 1673 patients (age 76±13 years, 68% men) hospitalized for acute heart failure in a tertiary medical center were analyzed. PNI was calculated as 10×serum albumin (g/dL)+0.005×total lymphocyte count (per mm3). National Death Registry was linked to identify the clinical outcomes of all‐cause and cardiovascular death. With increasing tertiles of PNI, age and N‐terminal probrain natriuretic peptide decreased, and body mass index, estimated glomerular filtration rate, and hemoglobin increased. During a mean follow‐up duration of 31.5 months, a higher PNI tertile was related to better survival free from all‐cause and cardiovascular mortality in the total study population and in participants with either reduced or preserved left ventricular ejection fraction. After accounting for age, sex, estimated glomerular filtration rate, left ventricular ejection fraction, serum sodium level, and on‐admission systolic blood pressure, PNI was independently associated with cardiovascular death and total mortality (hazard ratio per 1 SD of the natural logarithm of the PNI: 0.76 [95% CI, 0.66–0.87] and 0.79 [95% CI, 0.73–0.87], respectively). In subgroup analyses stratified by age, sex, left ventricular ejection fraction, body mass index, or estimated glomerular filtration rate, PNI was consistently related to mortality.Conclusions PNI is independently associated with long‐term survival in patients hospitalized for acute heart failure with either reduced or preserved left ventricular ejection fraction.

Prognostic nutritional index is associated with disease severity and relapse in ANCA‐associated vasculitis

“…The PNI is an index which was initially proposed by Onodera et al to predict the risk of postoperative complications in patients undergoing gastrointestinal surgeries . However, a growing amount of evidence also suggests that PNI is associated with the prognosis of patients with non‐operable malignancies and chronic diseases . Furthermore, in a previous study, we have demonstrated that PNI is associated with disease activity in patients with systemic lupus erythematosus, which is a prototypical autoimmune disease .…”

Which factors are associated with length of stay in older patients with acute decompensated heart failure with preserved ejection fraction?: AURORA study

“…Low serum albumin on admission might be a significant factor correlating with long stays for the following reason: Cheng et al . reported that up to 50% of patients with HF are thought to be malnourished, and 15% are overtly cachetic . Cardiac cachexia due to muscle wasting, inflammation, insulin resistance, weight loss and anorexia is an independent risk factor for morality in patients with HF .…”

“…Low serum albumin on admission might be a significant factor correlating with long stays for the following reason: Cheng et al reported that up to 50% of patients with HF are thought to be malnourished, and 15% are overtly cachetic. 17 Cardiac cachexia due to muscle wasting, inflammation, insulin resistance, weight loss and anorexia is an independent risk factor for morality in patients with HF. 18 Several reports have shown hypoalbuminemia in HF patients, reflecting malnutrition and inflammation, which are associated with worse HF outcomes, [19][20][21] including prolonged hospital stay 22 especially for older patients.…”

Malnutrition in acute heart failure with preserved ejection fraction: clinical correlates and prognostic implications

“…Prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) scores, and g eriatric n utritional r isk i ndex (GNRI) were adopted to assess the individual's nutritional status, where PNI = 10 × serum albumin (SA) (g/dL)+0.005 × total lymphocyte count (TLC) (×10 3 /µL). CONUT score was determined by assessing the circulating levels of three laboratory markers, SA, TLC, and total cholesterol, and GNRI was calculated by the following formula: GNRI = [1.489 × albumin (g/L)]+[41.7 × (weight/WLo)], where WLo represents ideal weight calculated by the Lorentz formula . Patients were categorized as having either better nutrition or malnutrition status according to the level of each nutritional index using previously reported cut‐offs of 3.5 g/dL for SA level, 38 for PNI, 3 for CONUT score, and 92 for GNRI .…”

“…Patients with HFpEF, however, exhibit ‘sarcopenic’ obesity, which is characterized by excessive BMI and low muscle mass with multiple co‐morbidities, excessive visceral adiposity, and heightened systemic inflammation . On the other hand, BMI alone fails to incorporate information that accurately describes a condition of protein‐energy wasting and relevant harmful biological effects, which are known to be highly prognostic in HF . While it has been recently proposed that poor nutritional status in the context of hypoalbuminaemia is associated with a risk of death for patients with HFpEF, the beneficial effects of albumin level over the course of HF syndrome (e.g.…”