Changes in prognostic nutritional index during hospitalization and outcomes in patients with acute heart failure

Area of Science:

• Cardiology
• Internal Medicine
• Clinical Nutrition

Background:

• The prognostic nutritional index (PNI) is a known predictor of outcomes in heart failure (HF).
• Previous studies typically assessed PNI at a single time point, neglecting its dynamic changes during hospitalization.
• Understanding how PNI changes during acute HF treatment is crucial for refining prognostic assessments.

Purpose of the Study:

• To investigate the association between changes in PNI during hospitalization and clinical outcomes in patients with acute HF.
• To determine if PNI trends, not just baseline values, offer independent prognostic information.

Main Methods:

• 141 patients admitted for acute HF were enrolled.
• PNI was calculated on admission and at discharge.
• Patients were categorized into 'improved' (PNI at discharge ≥ PNI on admission) or 'deteriorated' (PNI at discharge < PNI on admission) groups.
• Primary outcomes included all-cause death or unplanned HF hospitalization within one year.

Main Results:

• The 'improved' PNI group demonstrated significantly higher event-free survival rates (log-rank test, P < 0.0001).
• This survival benefit was observed irrespective of the PNI value upon admission.
• Multivariate analysis identified younger age, higher BMI, and belonging to the 'improved' PNI group as independent predictors of favorable outcomes.

Conclusions:

• Changes in nutritional status, as reflected by PNI fluctuations during hospitalization, are independently linked to 1-year outcomes in acute HF patients.
• Monitoring and potentially improving PNI during hospitalization may be a valuable strategy for enhancing patient prognosis.