Higher PNI scores are associated with lower short-term mortality in patients with sepsisNutritional scores help identify patients at risk from sepsis

Frontiers in Medicine Published August 30, 2026 DOI ↗ Editorial oversight: Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

AI-generated summary of the cited source, checked by automated accuracy review. How we work

Key Takeaway

Note that higher PNI scores are associated with lower short-term mortality in sepsis, but results are limited by study design.

This meta-analysis synthesized data from 34,810 patients to evaluate the utility of various nutritional assessment tools, including PNI, NUTRIC, mNUTRIC, CONUT, GNRI, NRS 2002, and BAR, in predicting mortality-related outcomes in patients with sepsis. The primary finding indicates that higher PNI scores are associated with lower short-term mortality (HR 0.57; 95% CI: 0.51-0.64).

The authors note several limitations, including the fact that most included studies were retrospective and single-center. Furthermore, direct quantitative comparisons among all nutritional assessment tools were not possible. The study also notes that the NUTRIC score's favorable predictive performance is based on a narrative summary due to limited data for meta-analysis.

Clinically, early nutritional assessment may assist in identifying patients at increased risk of poor outcomes and support risk stratification. However, because the data are derived from observational studies, these findings do not demonstrate that the use of these tools or subsequent nutritional interventions improve patient outcomes. The evidence is considered limited due to the study designs.

How this fits prior evidence

This meta-analysis addresses a gap in identifying prognostic markers for sepsis mortality. While previous evidence has identified biomarkers like butyrylcholinesterase activity, syndecan-1 levels, and mitochondrial dysfunction as indicators of severity or mortality, this finding adds nutritional assessment tools to the clinical toolkit. Specifically, higher PNI scores are associated with lower short-term mortality (HR 0.57; 95% CI: 0.51-0.64). These findings complement existing markers but do not prove that nutritional interventions improve outcomes.

When a patient develops sepsis, every moment counts. Doctors need ways to quickly identify who is at the highest risk for serious complications. A large review of data from over 34,000 patients suggests that using specific nutritional assessment tools can help with this early risk sorting.

One specific tool, called PNI, showed a clear link to better outcomes. Patients with higher PNI scores had a lower risk of short-term mortality. While these tools help doctors categorize risk, it is important to remember that these are observational findings. This means the study shows a link between the scores and survival, but it does not prove that giving extra nutrition improves the outcome.

Because most of the original studies were conducted at single locations and looked back at past records, the evidence is still limited. However, these tools may offer a helpful way for medical teams to spot high-risk patients early in their treatment.

What this means for you:

Nutritional assessment tools can help doctors identify sepsis patients at higher risk of death.

Common questions

How do these nutritional tools help patients with sepsis?

These tools help doctors perform risk stratification. By using scores like PNI, medical teams can more quickly identify which patients are at a higher risk of poor outcomes. This helps them focus their attention on the patients who need the most intensive monitoring during the early stages of sepsis.

Does a better nutrition score mean a patient will definitely survive?

Not necessarily. The study shows an association between higher PNI scores and a lower risk of short-term mortality. However, because these were observational studies, the data does not prove that nutritional interventions or the use of these specific tools directly improve a patient's chance of survival.

How reliable is the data regarding these nutritional tools?

The evidence is currently limited. Most of the studies included in this review were retrospective, meaning they looked at past records, and many were conducted at only one hospital. Because of these factors, the results should be viewed as a way to identify risk rather than a definitive guarantee of outcome.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedAug 2026

View Original Abstract ↓

BackgroundMalnutrition is common in patients with sepsis and is associated with prolonged hospitalization and increased mortality. Early assessment of nutritional status using standardized nutritional assessment tools may be important for risk stratification and outcome prediction.MethodsWe searched PubMed, Embase, Web of Science, and the Cochrane Library from database inception to November 2025. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment, with disagreements resolved through discussion. Cohort and case-control studies evaluating nutritional assessment tools in patients with sepsis and reporting mortality-related outcomes were included.ResultsA total of 11 studies involving 34,810 patients were included. All included studies had a Newcastle-Ottawa Scale (NOS) score of ≥7. Seven nutritional assessment tools were evaluated: the Prognostic Nutritional Index (PNI), Nutrition Risk in the Critically Ill (NUTRIC) score, modified NUTRIC (mNUTRIC) score, Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), Nutritional Risk Screening 2002 (NRS 2002), and blood urea nitrogen-to-albumin ratio (BAR). Quantitative synthesis was feasible only for PNI and GNRI because of the limited number and heterogeneity of studies evaluating the other tools. A random-effects meta-analysis of studies evaluating PNI showed a pooled hazard ratio (HR) of 0.57 (95% CI: 0.51–0.64), indicating that higher PNI scores were associated with lower short-term mortality in patients with sepsis. The remaining tools were therefore summarized narratively.ConclusionsAmong the nutritional assessment tools included, the NUTRIC score appeared to have favorable predictive performance and may be one of the more promising tools based on currently available evidence. Early nutritional assessment may help identify patients at increased risk of poor outcomes and support clinical risk stratification. However, the evidence remains limited because most studies were retrospective and single-center, and direct quantitative comparisons among all nutritional assessment tools were not possible. The included observational studies do not demonstrate that use of these tools or subsequent nutritional interventions improves patient outcomes. Further prospective, multicenter studies are required to validate their prognostic utility in sepsis research.

Higher PNI scores are associated with lower short-term mortality in patients with sepsisNutritional scores help identify patients at risk from sepsis

How this fits prior evidence

Common questions

Study Details

Sitagliptin and liraglutide superior for CGM targets in type 2 diabetes

Two diabetes drugs outperform others in long-term glucose control

Clinical research that matters. Delivered to your inbox.

Higher PNI scores are associated with lower short-term mortality in patients with sepsisNutritional scores help identify patients at risk from sepsis

How this fits prior evidence

Common questions

More on Sepsis

Study Details

Sitagliptin and liraglutide superior for CGM targets in type 2 diabetes

Two diabetes drugs outperform others in long-term glucose control

Clinical research that matters. Delivered to your inbox.

Related in Nutrition & Obesity Medicine

From Other Specialties