Predictive Value of the Prognostic Nutritional Index for Long-Term Mortality in Patients with Advanced Heart Failure.

ABSTRACT

Background: Malnutrition is common in patients with advanced heart failure (HF), and both conditions have a poor prognosis. Objectives: We sought to determine the predictive value of nutritional status using the prognostic nutritional index (PNI) for long-term mortality in patients with advanced HF. Methods: This is a retrospective observational study. The optimal PNI cut-off value for predicting all-cause mortality was determined to be 50.5 using receiver operating characteristic curve analysis. Patients were divided into two groups the low PNI (≤ 50.5) and high PNI (> 50.5) group. Results: A total of 217 patients (age 48.9 ± 9.9 years, 82.5% male) with advanced HF were included in this study. The mean follow-up duration was 28.6 ± 19.4 months. The high PNI group had higher 5-year all-cause and cardiovascular death-free survival rates compared to the low PNI group (86.7% vs. 24.6%, log-rank p < 0.001) and (89.6% vs. 36.1%, log-rank p < 0.001), respectively. In multivariable Cox regression analyses, low PNI [hazard ratio (HR) 4.70; 95% confidence interval (CI) 2.19-10.11, p < 0.001] and high sensitivity C-reactive protein (hsCRP) (HR 1.02; 95% CI 1.01-1.03, p = 0.04) were found to be independent predictors of long-term all-cause mortality. Low PNI (HR 4.52; 95% CI 1.99-10.24, p < 0.001), hsCRP (HR 1.01; 95% CI 1.00-1.03, p = 0.04), and New York Heart Association class IV vs. III (HR 2.56; 95% CI 1.36-4.82, p = 0.03) were also found to be independent predictors of long-term cardiovascular mortality. Conclusions: PNI was found to be an independent predictor of long-term all-cause and cardiovascular mortality in patients with advanced HF, and it can be used as an objective and simple tool for risk stratification.