# 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.

## Key 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