# Association between prognostic nutritional index and prognosis of patients receiving coronary artery bypass grafting surgery: a systematic review and meta-analysis

## TL;DR

This study finds that a higher nutritional index is linked to better outcomes for patients undergoing heart bypass surgery.

## Contribution

This is the first systematic review and meta-analysis on the prognostic nutritional index in coronary artery bypass grafting patients.

## Key findings

- Higher PNI is associated with lower all-cause mortality (OR: 0.81) after CABG.
- Higher PNI is linked to reduced risk of acute kidney injury (OR: 0.82) after CABG.
- Sensitivity analyses confirmed the stability of the PNI-outcome associations.

## Abstract

To conduct the first systematic review and meta-analysis to assess the association between prognostic nutritional index (PNI) and prognosis of patients receiving coronary artery bypass grafting surgery (CABG).

We conducted a systematic literature search via PubMed, Embase, Web of Science, and Cochrane until March 2025, for studies that evaluated the association between PNI and prognosis of patients receiving CABG. All-cause mortality and acute kidney injury (AKI) were the primary outcomes. Odds ratios (OR) and 95% confidence intervals (CI) were used for data pooling. In addition, sensitivity analysis and subgroup analysis were performed to evaluate the stability of the results and potential sources of heterogeneity. All data analyses were conducted using Review Manager 5.4 and STATA 15.1 software.

A total of 11 studies including 11,444 patients were included in the meta-analysis. The results showed that, compared with the low PNI group, the high PNI group had a significantly lower all-cause mortality rate (OR: 0.81; 95% CI: 0.72, 0.90) and a significantly lower risk of acute kidney injury (OR: 0.82; 95% CI: 0.77, 0.86). Sensitivity analyses confirmed that the associations between PNI and all-cause mortality and AKI were stable.

PNI can effectively predict postoperative all-cause mortality and AKI in patients undergoing CABG. Considering the inevitable heterogeneity and potential publication bias in this article, more large-scale, multicenter, prospective cohort studies are needed in the future to assess the predictive value of PNI for prognosis after CABG and to identify its influencing factors.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251077959, PROSPERO CRD420251077959.