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Higher prognostic nutritional index is associated with lower all-cause mortality risk in heart failure patientsHigher nutritional levels may link to lower risk in heart failure

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Key Takeaway
Note that a higher prognostic nutritional index is associated with lower all-cause mortality risk in heart failure patients.

This meta-analysis synthesized data from 14,166 patients to evaluate the prognostic value of the prognostic nutritional index (PNI) in individuals with heart failure. The analysis focused on all-cause mortality as the primary outcome, with secondary outcomes including cardiovascular mortality and the rate of first hospitalization for heart failure.

The meta-analysis found that patients with a higher PNI had a significantly lower risk of all-cause mortality compared to those with a lower PNI (HR = 0.72; 95% CI: 0.66–0.79). These findings suggest that nutritional status, as measured by the PNI, may serve as a relevant prognostic indicator in heart failure populations.

Because the underlying data are derived from observational studies, these results indicate an association rather than a direct causal link between PNI and mortality. No specific limitations or safety data were reported in the analysis. Clinical application of this finding should be weighed against the inherent limitations of observational evidence.

How this fits prior evidence

This meta-analysis addresses a gap in identifying prognostic markers for heart failure by evaluating the prognostic nutritional index (PNI). While previous coverage has identified clinical risks such as delirium occurring in 18.5% of hospitalized patients and explored therapeutic interventions like digoxin or engineered extracellular vesicles, this study specifically provides evidence on how nutritional status correlates with all-cause mortality.

Living with heart failure is a constant challenge, and doctors are always looking for better ways to understand which patients might face the highest risks. A large study involving over 14,000 people looked at something called the prognostic nutritional index (PNI). This tool helps measure a patient's nutritional status to see how it relates to their overall health.

The researchers found that patients with a higher PNI had a lower risk of dying from any cause compared to those with a lower score. Specifically, the data showed a significant link between better nutritional markers and survival. While this is a large amount of data, it is important to remember that these were observational studies. This means the results show an association between nutrition and health, rather than proving that one directly causes the other.

Because the study only shows how these factors move together, we cannot say for certain that changing a patient's diet alone will change their outcome. However, it does highlight how important nutritional status is when managing heart failure. Patients should talk to their doctors about what these findings mean for their specific care plan.

What this means for you:
Patients with higher nutritional scores showed a lower risk of death from any cause in this large study.

Common questions

What is the prognostic nutritional index (PNI)?

The prognostic nutritional index, or PNI, is a tool used to measure a patient's nutritional status. In this study of 14,166 people with heart failure, it was used to see if there was a link between these nutritional markers and the risk of death from any cause.

Does a better nutritional score mean a lower risk of death?

The study found that patients with a higher PNI had a lower risk of all-cause mortality compared to those with a lower PNI. The data showed an HR of 0.72, which suggests a significant link between better nutritional markers and survival in heart failure patients.

Does this mean improving nutrition will cure heart failure?

Not necessarily. Because these were observational studies, the results show an association rather than a direct cause. While the data shows a link between higher nutritional scores and lower risk, you should talk to your doctor about how to manage your specific treatment.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedJun 2026
View Original Abstract ↓
BackgroundAccording to the latest research data, the prognostic nutritional index (PNI) is closely associated with the prognosis of patients suffering from heart failure (HF). However, there remains controversy regarding the findings of existing studies.MethodsA systematic search was conducted up to March 27, 2025, across multiple databases, including PubMed, Embase, Web of Science, and the Cochrane Library. Observational studies assessing the prognostic value of PNI in patients with HF were identified. The main outcomes included all-cause mortality, cardiovascular mortality, and the rate of first hospitalization for HF. Among these outcomes, all-cause mortality and cardiovascular mortality were analyzed using hazard ratios (HRs) and 95% confidence intervals (95% CIs), while the rate of first hospitalization for HF was evaluated using odds ratios (ORs) and 95% CIs. Additionally, sensitivity and subgroup analyses were conducted to assess the robustness of the results and explore potential sources of heterogeneity.ResultsA total of 14 cohort studies were included, involving 14,166 patients with HF. The pooled data showed that, compared with HF patients with lower PNI, those with higher PNI had lower risks of all-cause mortality (HR = 0.72, 95% CI: 0.66–0.79; p 
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