LVEF-defined septic cardiomyopathy modifies the association between the prognostic nutritional index and mortality in adults with sepsis: a 72-h landmark analysis.

Authors

Xianju Wang, Min Cheng, Fengqi Ruan, Chong Chen, Shuai Wang

Published in

Frontiers in nutrition. Volume 13. Pages 1903225. Epub Oct 06, 2026.

Abstract

The prognostic nutritional index (PNI) combines albumin and lymphocyte count and may capture nutrition-related immune-inflammatory status in sepsis. Whether its association with mortality differs by left ventricular ejection fraction (LVEF)-defined septic cardiomyopathy (SCM) is unclear.
We conducted a retrospective 72-h landmark study of MIMIC-IV adults with Sepsis-3 who survived to the landmark, had clinically indicated pre-landmark echocardiographic LVEF assessment, and had calculable early PNI. The prespecified primary analysis tested the lower-PNI-by-LVEF-defined-SCM interaction for 28-day mortality in an adjusted Cox model. Ninety-day and sensitivity analyses were supportive or exploratory. A single-center cohort was examined separately, not as formal validation.
Among 1,976 patients, 240 had LVEF-defined SCM; 506 and 633 died by 28 and 90 days, respectively. Each 5-point lower PNI was associated with higher 28-day mortality without SCM (adjusted hazard ratio [HR], 1.18; 95% CI, 1.11-1.24) but not with LVEF-defined SCM (HR, 0.96; 95% CI, 0.87-1.05); the ratio of HRs was 0.82 (95% CI, 0.73-0.91; p < 0.001). The secondary 90-day ratio was 0.84 (95% CI, 0.76-0.94; nominal p = 0.001). Absolute-risk and restricted-mean-survival-time analyses supported attenuation, whereas same-calendar-day PNI pairing and some alternative LVEF definitions attenuated the interaction estimates toward the null. The external estimate was imprecise and statistically inconclusive (ratio of odds ratios, 0.89; 95% CI, 0.51-1.55).
Among selected 72-h survivors with clinically indicated pre-landmark echocardiography, the association between lower PNI and 28-day mortality was attenuated with LVEF-defined SCM. PNI should not be used alone for nutritional or clinical decision-making.

PMID:
42903086
Bibliographic data and abstract were imported from PubMed on 22 Oct 2026.

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