Abstract
The prognostic nutritional index (PNI) has been applied in acute myocardial infarction (AMI) recently.However, the application of PNI in AMI needs verification. This was a prospective cohort study. Patients diagnosed with AMI were enrolled. PNI was calculated as (serum albumin (SA in g/L)) + (5 × total lymphocyte count (TLC) × 109/L). Modified PNI (mPNI) was analyzed by logistic regression analysis to reset the proportion of SA and TLC. The primary outcome was all-cause death. A total of 598 patients were enrolled; 73 patients died during follow-up. The coefficient of SA and TLC in the mPNI formula was approximately 2:1. The area under the receiver operating characteristic curve of SA, TLC, PNI, mPNI and GRACE in predicting death for patients with AMI was 0.718, 0.540, 0.636, 0.721 and 0.825, respectively. Net reclassification improvement (NRI) between PNI and mPNI was 0.230 (p < 0.001). Integrated discrimination improvement (IDI) was 0.042 (p = 0.001). Decision curve analysis revealed that mPNI had better prognostic value for patients with AMI than PNI; however, it was not superior to SA. Thus, PNI may not a reliable prognostic predictor of AMI; after resetting the formula, the value of PNI in predicting prognosis of AMI is almost entirely due to SA.
Highlights
Ischemic cardiovascular disease is the most common cause of death, and its frequency is increasing worldwide
We investigated the prognostic value of prognostic nutritional index (PNI) in patients with acute myocardial infarction (AMI) and reset the PNI formula to see if this would improve its prognostic value in patients with AMI
Results showed that PNI may not be a reliable prognostic predictor of AMI
Summary
Ischemic cardiovascular disease is the most common cause of death, and its frequency is increasing worldwide. PNI was mostly used to predict prognosis of cancer patients and has been applied in AMI in some recent studies[18,19]. P Value of AMI patients, the application of PNI in assessing prognosis of AMI patients has not been verified and neither compared with traditional risk score such as Global Registry of Acute Coronary Events (GRACE) in these studies[18,19]. The aims of this study were 1) to investigate whether Onodera’s PNI calculation is applicable to patients with AMI and 2) to adjust the PNI formula and determine if it improves the prognosticating value of PNI for AMI, and compared with traditional GRACE risk score
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