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. 2021 Mar-Apr;50(2):307-312.
doi: 10.1016/j.hrtlng.2021.01.006. Epub 2021 Jan 13.

Is prognostic nutritional index a predictive marker for estimating all-cause in-hospital mortality in COVID-19 patients with cardiovascular risk factors?

Tufan Çınar  1 , Mert İlker Hayıroğlu  2 , Vedat Çiçek  3 , Şahhan Kılıç  3 , Süha Asal  3 , Samet Yavuz  3 , Murat Selçuk  3 , Emre Yalçınkaya  3 , Nurgül Keser  3 , Ahmet Lütfullah Orhan  3
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Is prognostic nutritional index a predictive marker for estimating all-cause in-hospital mortality in COVID-19 patients with cardiovascular risk factors?

Tufan Çınar et al. Heart Lung. 2021 Mar-Apr.

Abstract

Background: This study examined the possible association between the prognostic nutritional index (PNI) and in-hospital mortality rates in cases with a high cardiovascular risk burden and hospitalized with the diagnosis of coronavirus disease 2019 (COVID-19).

Material and methods: This retrospective and cross-sectional study included 294 COVID-19 patients hospitalized in a tertiary referral pandemic center. The study cohort was grouped into tertiles based on the initial PNI values as T1, T2, and T3. The PNI was calculated for each case and the prognostic value of this index was compared to CURB-65 and 4C mortality risk scores in predicting in-hospital mortality.

Results: Patients stratified into the T1 tertile had a lower lymphocyte count, serum albumin level, and PNI values. In a multivariate analysis, the PNI (OR: 0.688,%95CI: 0.586-0.808, p < 0.001) was an independent predictor for all-cause in-hospital death. After adjusting for confounding independent parameters, patients included in the T1 tertile were found to have 11.2 times higher rates of in-hospital mortality compared to the T3 group, which was presumed as the reference group. In addition, we found that the area under curve (AUC) value of PNI was significantly elevated than that of serum albumin level and total lymphocyte counts alone. [(AUC):0.79 vs AUC:0.75 vs AUC:0.69; respectively).

Conclusion: This study demonstrated that the PNI is independently related with in-hospital mortality in patient with COVID-19 and cardiovascular risk factors. The power of the PNI was also validated using well-accepted risk scores of COVID-19 such as CURB-65 and 4C mortality risk scores.

Keywords: COVID-19; Cardiovascular risk factors; In-hospital mortality; Prognostic nutrition index.

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Conflict of interest statement

Declaration of Competing Interest All authors declare that they do not have conflict of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later versions. This article does not contain any studies with animal subjects performed by any of the authors.

Figures

Fig 1
Fig. 1
Flowchart of the enrolled patients.
Fig 2
Fig. 2
A receiver operating curve analysis comparison for area under curve values of prognostic nutritional index (PNI), serum albumin, and lymphocytes count.
Fig 3
Fig. 3
A receiver operating curve analysis for the comparison of the area under curve values of prognostic nutritional index (PNI), CURB-65 and 4C mortality risk scores.
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