The prognostic nutritional index improves risk stratification for acute pulmonary embolism

TL;DR

A new tool called the Prognostic Nutritional Index helps better predict the risk of death in patients with acute pulmonary embolism.

Contribution

The PNI improves the accuracy of existing risk models for acute pulmonary embolism by identifying high-risk intermediate patients.

Findings

A lower PNI is independently linked to higher 30-day and in-hospital mortality in APE patients.

Adding PNI to the 2019 ESC model enhances its ability to predict 30-day mortality.

A PNI ≤42.5 identifies intermediate-risk APE patients with significantly different mortality rates.

Abstract

Risk stratification guides management in acute pulmonary embolism (APE), yet current models have limitations. We investigated the Prognostic Nutritional Index (PNI) as a potential biomarker to refine risk assessment. Analyzing 1,163 discovery, 208 internal-validation, and 212 external-validation APE patients, we found that a higher PNI was independently associated with lower 30-day and in-hospital mortality after multivariable adjustment. Incorporating PNI into the European Society of Cardiology (ESC) risk model improved its predictive performance for 30-day mortality. Crucially, a PNI ≤42.5 effectively stratified intermediate-risk patients, identifying subgroups with 4.7- and 6-fold higher 30-day mortality in the intermediate-low- and intermediate-high-risk categories, respectively. These findings position PNI as a simple, valuable tool for enhancing precision in APE risk stratification.

•Low PNI predicts substantially higher mortality risk in APE•Adding PNI to the 2019 ESC model improves its 30-day mortality prediction accuracy•PNI stratifies intermediate-risk APE patients for intensified care

Low PNI predicts substantially higher mortality risk in APE

Adding PNI to the 2019 ESC model improves its 30-day mortality prediction accuracy

PNI stratifies intermediate-risk APE patients for intensified care

Health sciences

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