LVEF-defined septic cardiomyopathy modifies the association between the prognostic nutritional index and mortality in adults with sepsis: a 72-h landmark analysis.
- 1Department of Emergency, Linyi People's Hospital, Linyi, Shandong, China.
- 2Department of Emergency Surgery, Linyi People's Hospital, Linyi, Shandong, China.
- 3Department of Critical Care Medicine, Linyi People's Hospital, Linyi, Shandong, China.
Abstract
Background
The prognostic nutritional index (PNI) combines albumin and lymphocyte count and may capture nutrition-related immune-inflammatory status in sepsis. Whether its association with mortality differs by left ventricular ejection fraction (LVEF)-defined septic cardiomyopathy (SCM) is unclear.Methods
We conducted a retrospective 72-h landmark study of MIMIC-IV adults with Sepsis-3 who survived to the landmark, had clinically indicated pre-landmark echocardiographic LVEF assessment, and had calculable early PNI. The prespecified primary analysis tested the lower-PNI-by-LVEF-defined-SCM interaction for 28-day mortality in an adjusted Cox model. Ninety-day and sensitivity analyses were supportive or exploratory. A single-center cohort was examined separately, not as formal validation.Results
Among 1,976 patients, 240 had LVEF-defined SCM; 506 and 633 died by 28 and 90 days, respectively. Each 5-point lower PNI was associated with higher 28-day mortality without SCM (adjusted hazard ratio [HR], 1.18; 95% CI, 1.11-1.24) but not with LVEF-defined SCM (HR, 0.96; 95% CI, 0.87-1.05); the ratio of HRs was 0.82 (95% CI, 0.73-0.91; p < 0.001). The secondary 90-day ratio was 0.84 (95% CI, 0.76-0.94; nominal p = 0.001). Absolute-risk and restricted-mean-survival-time analyses supported attenuation, whereas same-calendar-day PNI pairing and some alternative LVEF definitions attenuated the interaction estimates toward the null. The external estimate was imprecise and statistically inconclusive (ratio of odds ratios, 0.89; 95% CI, 0.51-1.55).Conclusion
Among selected 72-h survivors with clinically indicated pre-landmark echocardiography, the association between lower PNI and 28-day mortality was attenuated with LVEF-defined SCM. PNI should not be used alone for nutritional or clinical decision-making.
Related
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- Association Between the Naples Prognostic Score and In-Hospital Mortality in Patients with Type 2 Cardiorenal Syndrome: A Retrospective Cohort Study
BibTeX
@article{wang2026lvefdefined,
title = {{LVEF-defined septic cardiomyopathy modifies the association between the prognostic nutritional index and mortality in adults with sepsis: a 72-h landmark analysis.}},
author = {Xianju Wang and Min Cheng and Fengqi Ruan and Chong Chen and Shuai Wang},
journal = {Frontiers in nutrition},
year = {2026},
month = oct,
doi = {10.3389/fnut.2026.1903225},
url = {https://europepmc.org/article/MED/42903086},
note = {CC BY},
}
RIS
TY - JOUR
TI - LVEF-defined septic cardiomyopathy modifies the association between the prognostic nutritional index and mortality in adults with sepsis: a 72-h landmark analysis.
AU - Xianju Wang
AU - Min Cheng
AU - Fengqi Ruan
AU - Chong Chen
AU - Shuai Wang
PY - 2026
DA - 2026/10/06
JO - Frontiers in nutrition
DO - 10.3389/fnut.2026.1903225
UR - https://europepmc.org/article/MED/42903086
AB - Background The prognostic nutritional index (PNI) combines albumin and lymphocyte count and may capture nutrition-related immune-inflammatory status in sepsis. Whether its association with mortality differs by left ventricular ejection fraction (LVEF)-defined septic cardiomyopathy (SCM) is unclear.Methods We conducted a retrospective 72-h landmark study of MIMIC-IV adults with Sepsis-3 who survived to the landmark, had clinically indicated pre-landmark echocardiographic LVEF assessment, and had calculable early PNI. The prespecified primary analysis tested the lower-PNI-by-LVEF-defined-SCM interaction for 28-day mortality in an adjusted Cox model. Ninety-day and sensitivity analyses were supportive or exploratory. A single-center cohort was examined separately, not as formal validation.Results Among 1,976 patients, 240 had LVEF-defined SCM; 506 and 633 died by 28 and 90 days, respectively. Each 5-point lower PNI was associated with higher 28-day mortality without SCM (adjusted hazard ratio [HR], 1.18; 95% CI, 1.11-1.24) but not with LVEF-defined SCM (HR, 0.96; 95% CI, 0.87-1.05); the ratio of HRs was 0.82 (95% CI, 0.73-0.91; p < 0.001). The secondary 90-day ratio was 0.84 (95% CI, 0.76-0.94; nominal p = 0.001). Absolute-risk and restricted-mean-survival-time analyses supported attenuation, whereas same-calendar-day PNI pairing and some alternative LVEF definitions attenuated the interaction estimates toward the null. The external estimate was imprecise and statistically inconclusive (ratio of odds ratios, 0.89; 95% CI, 0.51-1.55).Conclusion Among selected 72-h survivors with clinically indicated pre-landmark echocardiography, the association between lower PNI and 28-day mortality was attenuated with LVEF-defined SCM. PNI should not be used alone for nutritional or clinical decision-making.
SN - 2296-861X
ER -