Prognostic value of prognostic nutritional index in patients with heart failure: a systematic review and meta-analysis

Background According 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. Methods A 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. Results A 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 0.00001), cardiovascular mortality (HR = 0.77, 95% CI: 0.67–0.89; p = 0.0003), and first hospitalization for HF (OR = 0.73, 95% CI: 0.65–0.82; p 0.00001). Conclusion The available evidence suggests that PNI can be used for prognostic assessment in patients with HF and has the potential to serve as a prognostic biomarker. PNI was significantly inversely associated with adverse outcomes in patients with HF; that is, lower PNI values were associated with poorer prognosis. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/home .