Prognostic nutritional index predicts one-year outcome in heart failure with preserved ejection fraction

Background: This study aimed to examine the value of prognostic nutritional index (PNI) as a predictor of outcomes in patients with heart failure and preserved ejection fraction (HFpEF).Methods: We prospectively followed consecutive adult patients admitted to the cardiology outpatient units with HFPEF. Echocardiographic and laboratory data was recorded at enrolment. PNI was calculated from the following formula: 10 × serum albumin (g/dL)+0.005 × total lymphocyte count (per mm³). The primary endpoint of the study was all-cause mortality or heart failure hospitalisation through one year.Results: A total of 285 patients (median age of 68 years, 54.4% women) were included, and 42 (14.7%) reached the primary endpoint at one year of follow-up. Compared to patients without mortality or heart failure hospitalisation, patients who reached the primary endpoint during follow-up were older, more likely be symptomatic, had higher prevalence of coronary artery disease, had higher natriuretic peptide but lower PNI levels at study entry. Multivariate analyses showed that older age, higher New York Heart Association class, higher N-terminal pro-B-type natriuretic peptide above the median of 396 pg/mL, and PNI < 37 at admission was independently associated with the primary outcome.Conclusions: This study is the first to demonstrate that the lower PNI is associated with all-cause mortality and heart failure hospitalisations in outpatients with HFPEF.