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Higher baseline Prognostic Nutritional Index reduces mortality risk in sepsis and pneumonia patientsNutritional status helps predict survival in patients with severe infections

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Key Takeaway
Consider higher baseline PNI as a protective factor for mortality in sepsis and pneumonia patients.

This meta-analysis evaluated the association between the Prognostic Nutritional Index (PNI) at baseline and mortality or unfavorable outcomes in a population of 28,757 patients with sepsis, pneumonia, and tuberculosis. The study aimed to determine if PNI serves as a viable tool for risk stratification and nutritional monitoring in these clinical contexts.

The analysis found that a higher PNI was significantly associated with a lower risk of mortality in both sepsis (HR: 0.63; 95% CI: 0.44, 0.90) and pneumonia (HR: 0.47; 95% CI: 0.30, 0.73). Overall, a higher PNI was identified as a significant protective factor against mortality or unfavorable clinical outcomes (pooled HR: 0.52; 95% CI: 0.39, 0.71). However, the association between PNI and mortality in tuberculosis patients did not reach statistical significance (HR: 0.38; 95% CI: 0.04, 3.82).

Clinicians may consider PNI for early risk stratification and to inform nutritional monitoring in patients with sepsis and pneumonia. The results are observational, and the association between PNI and mortality in the tuberculosis subgroup was not statistically significant.

How this fits prior evidence

This meta-analysis addresses a gap in identifying clinical markers for risk stratification in infectious diseases. While machine learning models have been shown to achieve a pooled AUROC of 0.913 for sepsis prediction, this finding provides a nutritional metric for risk assessment. Additionally, while LLM-derived embeddings have been shown to outperform tabular models for end-of-therapy outcome prediction in tuberculosis patients, the PNI association in the tuberculosis subgroup in this meta-analysis did not reach statistical significance.

When a patient is fighting a severe infection like sepsis or pneumonia, every moment counts. Doctors need ways to quickly identify who is at the highest risk for a poor outcome so they can provide the best care possible. A large review of data from over 28,000 patients suggests that a specific nutritional score, called the Prognostic Nutritional Index (PNI), can help with this early risk assessment.

For patients with sepsis and pneumonia, a higher PNI score at the start of treatment was linked to a much lower risk of death. In fact, the study showed a significant protective effect for both conditions. However, the data for patients with tuberculosis was not strong enough to show a clear link, and the results should be viewed as an association rather than a direct cause.

This finding suggests that tracking nutrition could be a useful tool for doctors to monitor patients and stratify risk early on. While it is not a replacement for medical treatment, it offers a clearer picture of a patient's baseline health during a critical illness.

What this means for you:
Higher nutritional scores at the start of treatment are linked to better survival rates in sepsis and pneumonia.

Common questions

What is the Prognostic Nutritional Index (PNI)?

The Prognostic Nutritional Index (PNI) is a tool used to assess a patient's nutritional status at the start of treatment. In this study of 28,757 patients, a higher PNI score was linked to a lower risk of death for those with sepsis and pneumonia.

Does this finding apply to all types of infections?

The results were strongest for patients with sepsis and pneumonia, where a higher PNI showed a significant protective effect. However, for patients with tuberculosis, the link between the nutritional score and mortality was not statistically significant.

How can doctors use this information?

Doctors can use the PNI to help with early risk stratification and nutritional monitoring. This helps them identify which patients might need more intensive monitoring or specific nutritional support during their recovery from infectious diseases.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
ObjectiveTo evaluate the prognostic value of the Prognostic Nutritional Index (PNI) in patients with infectious diseases, focusing on tuberculosis, pneumonia, and sepsis. By synthesizing extant evidence, we examine the association between baseline PNI and clinical outcomes to inform early risk stratification and nutritional monitoring. Additionally, we probe underlying pathophysiological mechanisms, offering prognostic insights.MethodsA systematic literature search was conducted across five databases, including PubMed, Web of Science, Embase, the Cochrane Library, and China National Knowledge Infrastructure (CNKI), from inception to June 2026. Following methodological appraisal via the Newcastle-Ottawa Scale, we investigated associations between PNI and mortality or unfavorable outcomes. PNI was uniformly calculated at baseline using the formula: PNI = serum albumin (g/L) + 5 × lymphocyte count (×109/L). Meta-analysis, Egger's test, and sensitivity analysis were performed in R software (version 4.5.0).ResultsFrom an initial pool of 1,383 relevant studies, 10 studies comprising 28,757 patients were included in the final analysis. Disease-stratified meta-analysis underscores PNI's prognostic association in infectious diseases. Notably, among sepsis patients, elevated baseline PNI is associated with a significantly attenuated mortality risk (hazard ratio [HR]: 0.63; 95% confidence interval [CI]: 0.44, 0.90). Similarly, in the pneumonia subgroup, a high PNI demonstrated a significant inverse association with mortality (HR: 0.47; 95% CI: 0.30, 0.73). Conversely, in the tuberculosis subgroup, the association between PNI and mortality did not reach statistical significance (HR: 0.38; 95% CI: 0.04, 3.82). Overall, higher PNI remained a significant protective factor against mortality or unfavorable clinical outcomes (pooled HR: 0.52; 95% CI: 0.39, 0.71; P 
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