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. 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.

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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

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