Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Mar 16:10:1114053.
doi: 10.3389/fnut.2023.1114053. eCollection 2023.

Prognostic nutritional index and prognosis of patients with coronary artery disease: A systematic review and meta-analysis

Shengjing Zhang  1 , Huanfen Wang  1 , Saiya Chen  1 , Shengsheng Cai  1 , Shigeng Zhou  2 , Congling Wang  2 , Xiuyuan Ni  2
Affiliations

Prognostic nutritional index and prognosis of patients with coronary artery disease: A systematic review and meta-analysis

Shengjing Zhang et al. Front Nutr. .

Abstract

Background: This review assessed if prognostic nutritional index (PNI) can predict mortality and major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.

Methods: PubMed, Web of Science, Scopus, and Embase were searched up to 1st November 2022 for all types of studies reporting adjusted associations between PNI and mortality or MACE in CAD patients. A random-effect meta-analysis was conducted for PNI as categorical or continuous variable. Subgroup analysis were conducted for multiple confounders.

Results: Fifteen studies with 22,521 patients were included. Meta-analysis found that low PNI was a significant predictor of mortality in CAD patients as compared to those with high PNI (HR: 1.67 95% CI: 1.39, 2.00 I 2 = 95% p < 0.00001). Increasing PNI scores were also associated with lower mortality (HR: 0.94 95% CI: 0.91, 0.97 I 2 = 89% p = 0.0003). Meta-analysis demonstrated that patients with low PNI had significantly higher incidence of MACE (HR: 1.57 95% CI: 1.08, 2.28 I 2 = 94% p = 0.02) and increasing PNI was associated with lower incidence of MACE (HR: 0.84 95% CI: 0.72, 0.92 I 2 = 97% p = 0.0007). Subgroup analyses showed mixed results.

Conclusion: Malnutrition assessed by PNI can independently predict mortality and MACE in CAD patients. Variable PNI cut-offs and high inter-study heterogeneity are major limitations while interpreting the results. Further research focusing on specific groups of CAD and taking into account different cut-offs of PNI are needed to provide better evidence.

Systematic review registration: No CRD42022365913 https://www.crd.york.ac.uk/prospero/.

Keywords: PCI; acute coronary syndrome; mortality; myocardial infarction; nutrition; prognosis.

PubMed Disclaimer

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Study flowchart.
Figure 2
Figure 2
Meta-analysis of mortality with PNI as a categorical variable.
Figure 3
Figure 3
Funnel plot for the meta-analysis of mortality with PNI as a categorical variable.
Figure 4
Figure 4
Meta-analysis of MACE with PNI as a categorical variable.
Figure 5
Figure 5
Funnel plot for the meta-analysis of MACE with PNI as a categorical variable.
Figure 6
Figure 6
Meta-analysis of mortality with PNI as a continuous variable.
Figure 7
Figure 7
Meta-analysis of MACE with PNI as a continuous variable.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Bauersachs R, Zeymer U, Brière JB, Marre C, Bowrin K, Huelsebeck M. Burden of coronary artery disease and peripheral artery disease: A literature review. Cardiovasc Ther. (2019) 2019:1–9. doi: 10.1155/2019/8295054, PMID: - DOI - PMC - PubMed
    1. Hay SI, Abajobir AA, Abate KH, Abbafati C, Abbas KM, Abd-Allah F, et al. . Global, regional, and national disability-adjusted life-years (DALYs) for 333 diseases and injuries and healthy life expectancy (HALE) for 195 countries and territories, 1990-2016: A systematic analysis for the global burden of disease study 2016. Lancet. (2017) 390:1260–344. doi: 10.1016/S0140-6736(17)32130-X, PMID: - DOI - PMC - PubMed
    1. Fox KAA, Metra M, Morais J, Atar D. The myth of “stable” coronary artery disease. Nat Rev Cardiol. (2020) 17:9–21. doi: 10.1038/S41569-019-0233-Y, PMID: - DOI - PubMed
    1. Malakar AK, Choudhury D, Halder B, Paul P, Uddin A, Chakraborty S. A review on coronary artery disease, its risk factors, and therapeutics. J Cell Physiol. (2019) 234:16812–23. doi: 10.1002/JCP.28350 - DOI - PubMed
    1. Wolf D, Ley K. Immunity and inflammation in atherosclerosis. Circ Res. (2019) 124:315–27. doi: 10.1161/CIRCRESAHA.118.313591, PMID: - DOI - PMC - PubMed

Publication types