Prognostic value of objective nutritional indices (PNI, CONUT, and HALP) for in-hospital all-cause mortality in surgically treated infective endocarditis: a 14-year retrospective study in a Chinese cohort

Objective Malnutrition is closely associated with poor clinical outcomes; however, its prognostic value in patients with infective endocarditis (IE) undergoing surgical treatment remains unclear. This study aimed to investigate the association of three objective nutritional indices (PNI, CONUT, and HALP) with in-hospital all-cause mortality in surgically treated patients with IE. Methods In this retrospective study, clinical data were collected from 450 patients with IE who underwent surgical treatment at Jiangsu Provincial People’s Hospital over 14 years. Patients were categorized into a non-survivor group ( n = 42) and a survivor group ( n = 408). Nutritional status was assessed using the PNI, CONUT, and HALP scores. Stepwise-adjusted multivariate logistic regression models and receiver operating characteristic (ROC) curve analyses were used to evaluate the independent prognostic value and discriminatory performance of these nutritional indices for in-hospital all-cause mortality. Results The in-hospital all-cause mortality rate in this cohort was 9.33%. Preoperative malnutrition risk was common among patients with IE, with nutritional risk identified in 44.00 and 75.11% of patients according to the PNI and CONUT criteria, respectively. Compared with survivors, non-survivors had significantly poorer baseline nutritional status. After adjustment for confounding factors, each one-unit increase in the PNI was associated with a 7% lower risk of in-hospital all-cause mortality (OR = 0.93, 95% CI: 0.89–0.98, p = 0.009). Similarly, each one-unit increase in the HALP score was associated with a 4% lower risk of in-hospital all-cause mortality (OR = 0.96, 95% CI: 0.93–0.98, p = 0.001). In contrast, each one-unit increase in the CONUT score was associated with a 16% higher risk of in-hospital all-cause mortality (OR = 1.16, 95% CI: 1.03–1.32, p = 0.017). A prognostic model incorporating these nutritional indicators showed good discrimination (AUC = 0.839) and acceptable predictive accuracy (Brier score = 0.063). Conclusion Preoperative malnutrition risk is highly prevalent among patients with IE undergoing surgery and is an independent predictor of postoperative in-hospital all-cause mortality. Routine use of objective nutritional scoring tools, including the PNI, CONUT, and HALP, may improve preoperative risk stratification. Early nutritional assessment and targeted intervention for patients at moderate-to-severe nutritional risk may provide meaningful clinical benefits.