Table_2_Prognostic nutritional index and prognosis of patients with coronary artery disease: A systematic review and meta-analysis.DOCX

BackgroundThis review assessed if prognostic nutritional index (PNI) can predict mortality and major adverse cardiac events (MACE) in coronary artery disease (CAD) patients.
MethodsPubMed, Web of Science, Scopus, and Embase were searched up to 1st November 2022 for all types of studies reporting adjusted associations between PNI and mortality or MACE in CAD patients. A random-effect meta-analysis was conducted for PNI as categorical or continuous variable. Subgroup analysis were conducted for multiple confounders.
ResultsFifteen studies with 22,521 patients were included. Meta-analysis found that low PNI was a significant predictor of mortality in CAD patients as compared to those with high PNI (HR: 1.67 95% CI: 1.39, 2.00 I2 = 95% p < 0.00001). Increasing PNI scores were also associated with lower mortality (HR: 0.94 95% CI: 0.91, 0.97 I2 = 89% p = 0.0003). Meta-analysis demonstrated that patients with low PNI had significantly higher incidence of MACE (HR: 1.57 95% CI: 1.08, 2.28 I2 = 94% p = 0.02) and increasing PNI was associated with lower incidence of MACE (HR: 0.84 95% CI: 0.72, 0.92 I2 = 97% p = 0.0007). Subgroup analyses showed mixed results.
ConclusionMalnutrition assessed by PNI can independently predict mortality and MACE in CAD patients. Variable PNI cut-offs and high inter-study heterogeneity are major limitations while interpreting the results. Further research focusing on specific groups of CAD and taking into account different cut-offs of PNI are needed to provide better evidence.
Systematic Review RegistrationNo CRD42022365913 https://www.crd.york.ac.uk/prospero/.

背景 本系统综述旨在评估预后营养指数（prognostic nutritional index, PNI）能否预测冠状动脉疾病（coronary artery disease, CAD）患者的死亡率与主要不良心血管事件（major adverse cardiac events, MACE）。
方法 本研究检索了PubMed、Web of Science、Scopus及Embase数据库，检索时限截至2022年11月1日，纳入所有报道冠状动脉疾病患者中预后营养指数与死亡率或主要不良心血管事件间校正后关联的各类研究。针对以分类变量或连续变量形式呈现的预后营养指数，采用随机效应模型开展Meta分析；同时针对多种混杂因素进行亚组分析。
结果 本研究共纳入15项研究，涉及22521例患者。Meta分析结果显示，与预后营养指数较高的冠状动脉疾病患者相比，预后营养指数较低者的死亡率显著更高（风险比（Hazard Ratio, HR）=1.67，95%置信区间（Confidence Interval, CI）：1.39~2.00，I²=95%，p<0.00001）。预后营养指数评分升高与死亡率降低显著相关（HR=0.94，95%CI：0.91~0.97，I²=89%，p=0.0003）。Meta分析同时证实，预后营养指数较低的患者主要不良心血管事件发生率显著更高（HR=1.57，95%CI：1.08~2.28，I²=94%，p=0.02），而预后营养指数升高与主要不良心血管事件发生率降低相关（HR=0.84，95%CI：0.72~0.92，I²=97%，p=0.0007）。亚组分析结果存在异质性。
结论 由预后营养指数评估的营养状况不佳可独立预测冠状动脉疾病患者的死亡率与主要不良心血管事件。解读本研究结果时需注意两大核心局限性：不同研究采用的预后营养指数截断值存在差异，且各研究间异质性较高。未来需针对特定冠状动脉疾病亚组开展研究，并考量不同的预后营养指数截断值，以提供更严谨的循证证据。
系统综述注册信息 注册号：CRD42022365913，注册平台为国际前瞻性系统综述注册库（PROSPERO），网址：https://www.crd.york.ac.uk/prospero/。