Association of the prognostic nutritional index with in-hospital adverse cardiovascular events among emergency department patients with acute heart failure
- 1Department of Emergency Medicine, Xinxiang Central Hospital, The Fourth Clinical College of Henan Medical University , ,
Abstract
Background: Acute heart failure (AHF) is prone to early clinical deterioration. The prognostic nutritional index (PNI), derived from serum albumin and lymphocyte count, is readily available. We evaluated the association of early PNI with incident in-hospital adverse cardiovascular events and its incremental prognostic value.
Methods: This retrospective cohort included consecutive adults presenting to the emergency department with AHF from March 2022 through March 2026. PNI was calculated from measurements obtained within 24 h and classified as low (<45) or high (≥45). The primary outcome was a post-index composite of all-cause death, cardiogenic shock, sustained ventricular arrhythmia, cardiac arrest, acute myocardial infarction, or worsening AHF requiring treatment escalation. Multivariable logistic regression evaluated associations; missing covariates were handled using multiple imputation. Discrimination was quantified by the area under the receiver operating characteristic curve (AUC).
Results: Of 367 patients (156 low PNI; 211 high PNI), 112 (30.5%) experienced the primary outcome. Events occurred in 43.6% and 20.9%, respectively (P < 0.001). After adjustment, low PNI remained associated with higher odds of the primary outcome (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.10–3.35; P = 0.022). Each 5-point PNI increase was associated with lower odds (OR, 0.70; 95% CI, 0.56–0.90; P = 0.003). PNI alone yielded an AUC of 0.714. Adding PNI increased the conventional model AUC from 0.776 to 0.829 (increase, 0.053; 95% CI, 0.021–0.085; P = 0.001); bootstrap-corrected AUCs were 0.752 and 0.803, respectively.
Conclusions: Low PNI was associated with higher adjusted odds of in-hospital adverse cardiovascular events. PNI provided modest incremental prognostic information and may serve as a complementary marker for early risk stratification.
Related
- The Prognostic Value of Venous Base Excess in Emergency Department Patients with and without Renal Dysfunction
- The relationship between endothelial activation and stress index (EASIX) and the incidence of major adverse cardiovascular events in acute myocardial infarction patients admitted in emergency department.
- Integrating structured and unstructured EHR data to characterize social and behavioral factors associated with frequent emergency department use among patients with cardiovascular disease
- PO001 | EMERGENCY DEPARTMENT MANAGEMENT OF PULMONARY EMBOLISM IN CANCER PATIENTS: PROGNOSTIC STRATIFICATION AND OUTCOMES
- Orthopaedic Consultation Versus No Consultation for Clavicle, Radial Head, and Proximal Humerus Fractures: Association with Post-Imaging Emergency Department Length of Stay
BibTeX
@article{zhang2026association,
title = {{Association of the prognostic nutritional index with in-hospital adverse cardiovascular events among emergency department patients with acute heart failure}},
author = {Xiao-Peng Zhang and Wei-Wei Guo and Bin Li},
journal = {Frontiers in nutrition},
year = {2026},
month = oct,
doi = {10.3389/fnut.2026.1949478},
url = {https://europepmc.org/article/PMC/PMC13727417},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of the prognostic nutritional index with in-hospital adverse cardiovascular events among emergency department patients with acute heart failure
AU - Xiao-Peng Zhang
AU - Wei-Wei Guo
AU - Bin Li
PY - 2026
DA - 2026/10/20
JO - Frontiers in nutrition
DO - 10.3389/fnut.2026.1949478
UR - https://europepmc.org/article/PMC/PMC13727417
AB - Background: Acute heart failure (AHF) is prone to early clinical deterioration. The prognostic nutritional index (PNI), derived from serum albumin and lymphocyte count, is readily available. We evaluated the association of early PNI with incident in-hospital adverse cardiovascular events and its incremental prognostic value. Methods: This retrospective cohort included consecutive adults presenting to the emergency department with AHF from March 2022 through March 2026. PNI was calculated from measurements obtained within 24 h and classified as low (<45) or high (≥45). The primary outcome was a post-index composite of all-cause death, cardiogenic shock, sustained ventricular arrhythmia, cardiac arrest, acute myocardial infarction, or worsening AHF requiring treatment escalation. Multivariable logistic regression evaluated associations; missing covariates were handled using multiple imputation. Discrimination was quantified by the area under the receiver operating characteristic curve (AUC). Results: Of 367 patients (156 low PNI; 211 high PNI), 112 (30.5%) experienced the primary outcome. Events occurred in 43.6% and 20.9%, respectively (P < 0.001). After adjustment, low PNI remained associated with higher odds of the primary outcome (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.10–3.35; P = 0.022). Each 5-point PNI increase was associated with lower odds (OR, 0.70; 95% CI, 0.56–0.90; P = 0.003). PNI alone yielded an AUC of 0.714. Adding PNI increased the conventional model AUC from 0.776 to 0.829 (increase, 0.053; 95% CI, 0.021–0.085; P = 0.001); bootstrap-corrected AUCs were 0.752 and 0.803, respectively. Conclusions: Low PNI was associated with higher adjusted odds of in-hospital adverse cardiovascular events. PNI provided modest incremental prognostic information and may serve as a complementary marker for early risk stratification.
SN - 2296-861X
ER -