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. 2025 Jan 6:11:1465379.
doi: 10.3389/fcvm.2024.1465379. eCollection 2024.

Prognostic nutritional index as a predictor of cardiovascular and all-cause mortality in American adults with hypertension: results from the NHANES database

Jing Tang #  1   2 , Long Yang #  3 , Guan-Ying Yang  4 , Yan-Hong Li  2 , You-Sen Zhu  2 , Hui Li  2 , Xiao-Ming Gao  1   5   6
Affiliations

Prognostic nutritional index as a predictor of cardiovascular and all-cause mortality in American adults with hypertension: results from the NHANES database

Jing Tang et al. Front Cardiovasc Med. .

Abstract

Background: Few studies have examined the relationship between nutritional status, as assessed by the Prognostic Nutrition Index (PNI), and incident cardiovascular mortality and all-cause mortality, particularly in hypertensive patients. This study aimed to examine the association between PNI and cardiovascular mortality and all-cause mortality in Americans with hypertension.

Methods: Data from this retrospective cohort study were obtained from the National Health and Nutrition Examination (NHANES) 1999-2016. Using data of The NHANES Public-Use Linked Mortality Files to assess all-cause mortality (ACM) and cardiovascular mortality (CVM). After excluding participants younger than 18 years, without hypertension, and with missing follow-up data, a total of 18,189 cases were included in this study. Persons with hypertension were divided by PNI into 4 groups: Q1 (PNI < 49.0), Q2 (PNI: 49.0-52.5), Q3 (PNI: 52.5-55.5), and Q4 (PNI > 55.5). We used the Cox proportional hazard regression model to explore the predictive role of PNI on ACM and CVM in American adults with hypertension. Restricted cubic spline (RCS) curves to investigate the existence of a dose-response linear relationship between them.

Result: During a median follow-up period of 89 months, a total of 1,444 (7.94%) cardiovascular deaths occurred and 5,171 (28.43%) all-cause deaths occurred. Multifactorial COX regression analysis showed all-cause mortality [hazard ratio (HR): 0.584, 95% CI: 0.523-0.652, p < 0.001] and cardiovascular mortality (HR: 0.435, 95% CI: 0.349-0.541, p < 0.001) associated with Q4 group risk of malnutrition in PNI compared to Q1 group. RCS curves showed a nonlinear relationship between PNI and all-cause mortality and cardiovascular mortality (both non-linear p < 0.001).

Conclusions: Lower PNI levels are associated with mortality in patients with hypertension. PNI may be a predictor of all-cause mortality and cardiovascular mortality risk in patients with hypertension.

Keywords: all-cause mortality; cardiovascular mortality; cohort study; hypertension; prognostic nutritional index.

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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
Flow diagram of patient selection.
Figure 2
Figure 2
Kaplan–Meier survival curve for mortality across the PNI. (A) All-cause mortality. (B) Cardiovascular mortality.
Figure 3
Figure 3
Non-linear relationship between PNI and mortality. (A) All-cause mortality. (B) Cardiovascular mortality. Adjust for age, gender, ethnicity, marital status, physical activity, smoking, drinking, diabetes mellitus, cardiovascular disease, chronic kidney disease, diastolic blood pressure, systolic blood pressure, serum uric acid, triglycerides, HDL-C, LDL-C, C-reactive protein, and medication (beta-blockers, ACEI/ARB, calcium channel blockers, diuretics, statins).
Figure 4
Figure 4
Stratified analysis of the effect of PNI on all-cause mortality and cardiovascular mortality in different populations. Adjusted for Race, marital status, education, consumption and medication (betablockers, ACEI/ARB, calcium channel blockers, diuretics, statins).
Figure 5
Figure 5
ROC plot of PNI predicting the occurrence of all-cause mortality in participants with hypertension.
See this image and copyright information in PMC

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