The prognostic nutritional index predicts all-cause mortality in critically ill patients with acute myocardial infarction

Abstract

Background Malnutrition is common in patients with acute myocardial infarction (AMI) and is associated with a poor prognosis. The prognostic value of the prognostic nutritional index (PNI) in patients with AMI remains controversial. We aimed to explore the relationship between PNI and all-cause mortality in critically ill patients with AMI and evaluate the incremental prognostic value of PNI to commonly used prognostic assessment tools. Methods The Medical Information Mart for Intensive Care-IV (MIMIC-IV) database was used to conduct a retrospective cohort analysis on 1180 critically ill patients with AMI. The primary endpoints were defined as 6-month and 1-year all-cause mortality. Cox regression analysis was used to investigate the relationship between admission PNI and all-cause mortality. The effect of adding PNI to sequential organ failure assessment (SOFA) score, or charlson comorbidity index (CCI) on its discriminative ability was assessed using C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results Multivariate cox regression analysis demonstrated that the low PNI was regarded as an independent predictor of 1-year all-cause mortality in AMI patients admitted to ICU (adjusted Hazard Ratio: 95% CI = 1.75 (1.22–2.49)). The ROC test showed that admission PNI had a moderate predictive ability to predict all-cause mortality of critically ill patients with AMI. Furthermore, the net reclassification and integrated discrimination of the CCI alone model improved significantly with PNI. [C-statistic increased from 0.669 to 0.752, p < 0.001; NRI = 0.698, p < 0.001; IDI = 0.073, p < 0.001]. When PNI was added to the SOFA score, the C-statistic significantly improved from 0.770 to 0.805 (p < 0.001), and the NRI and IDI were estimated at 0.573 (p < 0.001) and 0.041 (p < 0.001), respectively. Conclusion PNI could be a novel predictor for identifying patients at high risk of 1-year all-cause mortality in critically ill patients with AMI. The addition of PNI to the SOFA score or CCI may be useful for very early risk stratification.

The combination effect of RDW and PNI on the prognosis for CAD patients undergoing PCI

“…In a retrospective study, lower PNI was associated with an increased risk of all-cause mortality in AMI patients admitted to the ICU, after adjusting for potential risk factors. PNI was a convincing predictor of 6-month and 1-year all-cause mortality 19 . A study conducted 309 patients with STEMI undergoing PCI, showed that PNI was a signi cant independent predictor of mortality.…”

Predictive value of systemic immune inflammation index (SII) and prognostic nutritional index (PNI) on mortality after below-knee amputation

“…For below-knee amputations, nutrition plays an important role in both the success of the treatment and quality of life quality. [15][16][17] In the research conducted In the literature, there has been no study related to PNI after below-knee amputation. However, cardiovascular and cancer studies have suggested its prognostic value for PNI.…”

“…Yu et al [ 15 ] concluded in their research on radical cystectomy patients that preoperative PNI predicts postoperative pulmonary complications. In another study, Huang et al [ 16 ] stated that PNI had a 1-year mortality prediction value for patients with acute myocardial infarction. Wang et al [ 17 ] reported that the PNI, PLR, NLR, and monocyte lymphocyte ratio had prognostic predictive values in patients with cervical cancer.…”

“…[ 15 ] The PNI was first introduced in 1980 and is used for cardiovascular diseases and other cancer types. [ 16 ] It is also argued to be an indicator of the quality of life of patients. [ 17 ] Nutrition is an important treatment and quality of life indicator in below-knee amputation, cancer, and other cardiovascular diseases.…”

Factors Associated With Mortality During the First Year Post Infarction: Survival Analysis of Patients With Acute Myocardial Infarction in Colombia

“…On the other hand, the nutritional index could serve as a predictor to identify patients at high risk of all-cause mortality one year after experiencing an AMI [ 7 ]. Likewise, it is relevant to note that there is a gender disparity in this context, with this disease burden trend being more pronounced in women compared to men [ 8 ].…”