AUTHOR=Zhang Shengjing , Wang Huanfen , Chen Saiya , Cai Shengsheng , Zhou Shigeng , Wang Congling , Ni Xiuyuan 

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

JOURNAL=Frontiers in Nutrition

VOLUME=10

YEAR=2023

URL=https://www.frontiersin.org/journals/nutrition/articles/10.3389/fnut.2023.1114053

DOI=10.3389/fnut.2023.1114053

ISSN=2296-861X

ABSTRACT=<sec><title>Background</title><p>This review assessed if prognostic nutritional index (PNI) can predict mortality and major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.</p></sec><sec><title>Methods</title><p>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.</p></sec><sec><title>Results</title><p>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 <italic>I</italic><sup>2</sup> = 95% <italic>p</italic> &lt; 0.00001). Increasing PNI scores were also associated with lower mortality (HR: 0.94 95% CI: 0.91, 0.97 <italic>I</italic><sup>2</sup> = 89% <italic>p</italic> = 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 <italic>I</italic><sup>2</sup> = 94% <italic>p</italic> = 0.02) and increasing PNI was associated with lower incidence of MACE (HR: 0.84 95% CI: 0.72, 0.92 <italic>I</italic><sup>2</sup> = 97% <italic>p</italic> = 0.0007). Subgroup analyses showed mixed results.</p></sec><sec><title>Conclusion</title><p>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.</p></sec><sec><title>Systematic Review Registration</title><p>No CRD42022365913 <ext-link xlink:href="https://www.crd.york.ac.uk/prospero/" ext-link-type="uri" xmlns:xlink="http://www.w3.org/1999/xlink">https://www.crd.york.ac.uk/prospero/</ext-link>.</p></sec>