Baseline and changes in prognostic nutritional index associate with heart failure hospitalization and all-cause death in patients with cardiac pacemaker

OBJECT: The study evaluated prognostic nutritional index (PNI) levels and changes as predictors of heart failure hospitalization (HFH) and mortality in cardiac pacemaker patients. METHODS: PNI was calculated on admission and at the end of the 1-month follow-up, and their net changes (Δ) were calculated by PNI at follow-up minus the corresponding PNI on admission. The optimal cutoff value of baseline PNI was determined by the ROC curve. Based on this optimal cutoff value or the change in PNI during follow-up, patients were divided into high-PNI and low-PNI groups, or into improved PNI group (ΔPNI > 0) and deteriorated group (ΔPNI ≤ 0). The crude and adjusted cox proportional hazard models were used to analyze the associations between adverse events and PNI or ΔPNI. Restricted cubic splines were used to model the association of the PNI-endpoint events. RESULTS: A total of 927 patients were enrolled in the study. The risk of HFH and all-cause death remained significantly higher in patients with low PNI, even after adjusting for other risk factors (hazard ratio [HR]: 1.997, 95% confidence interval [CI]: 1.220 - 3.203, P = 0.006; HR: 2.501, 95% CI: 1.392 - 4.494, P = 0.002, respectively). Patients with ΔPNI ≤ 0 faced higher risks of HFH and mortality compared to those with ΔPNI > 0(HR: 3.146, 95% CI: 2.024 - 4.892, P < 0.001, HR: 2.082, 95% CI: 1.223 - 3.544; P = 0.007, respectively) CONCLUSION: Low baseline PNI and ΔPNI ≤ 0 during follow-up effectively predicted HFH and mortality in cardiac pacemaker patients. CLINICAL TRIAL NUMBER: Not applicable.