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Correlation between the prognostic nutritional index and outcomes in older patients aged ≥ 60 years with chronic heart failure

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Abstract

Background

Nutritional status is related to clinical outcomes in patients with chronic heart failure (CHF). The prognostic nutritional index (PNI) is a simple tool to assess nutrition.

Aim

To evaluate the association between the PNI score and clinical outcomes in patients (60 years and older) hospitalized due to an acute exacerbation of CHF.

Method

This was a retrospective observational study. Patients hospitalized for acute CHF exacerbation between July 2015 and May 2020 were analyzed. Patients were followed until January 31, 2021. The primary end point was cardiovascular-related readmissions and all-cause mortality after hospital discharge. Secondary outcomes were factors associated with all-cause mortality. Patients were divided into normal nutrition (PNI > 38), moderate malnutrition (PNI = 35–38), and severe malnutrition (PNI < 35) groups.

Results

The study included 355 patients (mean age 78 ± 9 years). The median follow-up was 769 days. Compared to survivors (n = 214), patients who expired (n = 133) were (1) older; (2) had lower PNI scores, lymphocyte counts, hemoglobin, albumin, total cholesterol, and serum sodium level; but (3) had higher serum creatinine levels, log(N-terminal-pro-B-type natriuretic peptide), and cardiac troponin I (P < 0.05). Multivariate analyses revealed that PNI was independently associated with all-cause mortality. The hazard ratio (HR) for moderate malnutrition versus normal nutrition was 1.624 (95% confidence interval [CI] 1.011–2.609, P = 0.045), while HR for severe malnutrition versus normal nutrition was 1.892 (95%CI 1.119–3.198, P = 0.017). Malnourished patients had significantly higher rates of cardiovascular readmissions and all-cause mortality.

Conclusion

Lower PNI (malnutrition) was associated with worse clinical outcomes and was independently associated with all-cause mortality in patients with CHF.

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Acknowledgements

None

Funding

The study was supported by the China National Natural Science Foundation [Grant Number 81873515], and the High-level Hospital Foster Grants from Fujian Provincial Hospital [Grant Number 2020HSJJ03]. The sponsors had no role in study design, data collection, analysis, decision to publish or preparation of the manuscript.

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Author notes

  1. Chenlin Zhuang and Yudai Chen have contributed equally to this work.

Authors and Affiliations

  1. Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China

    Chenlin Zhuang

  2. Department of Medicine, Fujian Provincial Hospital South Branch, Fuzhou, 350028, China

    Chenlin Zhuang & Huizhen Yu

  3. Department of Digestive Endoscopy, Fujian Provincial Hospital South Branch, Fuzhou, 350028, China

    Yudai Chen

  4. Department of Pharmacy, Fujian Provincial Hospital, Provincial Clinical College of Fujian Medical University, Fuzhou, China

    Junshan Ruan

  5. Key Laboratory of Geriatrics, Fujian Institute of Clinical Geriatrics, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, 350001, China

    Huizhen Yu & Pengli Zhu

  6. Department of Family Medicine, University Hospital, Macau University of Science and Technology, Macau, China

    YiZhun Zhu

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  1. Chenlin Zhuang
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Correspondence to Huizhen Yu.

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Zhuang, C., Chen, Y., Ruan, J. et al. Correlation between the prognostic nutritional index and outcomes in older patients aged ≥ 60 years with chronic heart failure. Int J Clin Pharm 45, 163–173 (2023). https://doi.org/10.1007/s11096-022-01501-9

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