SynthesisFrontiers in nutrition2026
Prognostic value of nutritional assessment tools in patients with sepsis: a systematic review with meta-analysis of PNI and GNRI.
Synthesis in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: Malnutrition is common in patients with sepsis and is associated with prolonged hospitalization and increased mortality. Early assessment of nutritional status using standardized nutritional assessment tools may be important for risk stratification and outcome prediction. Methods: We searched PubMed, Embase, Web of Science, and the Cochrane Library from database inception to November 2025. Two reviewers independently performed study selection, data extraction, and risk-of-bias assessment, with disagreements resolved through discussion. Cohort and case-control studies evaluating nutritional assessment tools in patients with sepsis and reporting mortality-related outcomes were included. Results: A total of 11 studies involving 34,810 patients were included. All included studies had a Newcastle-Ottawa Scale (NOS) score of ≥7. Seven nutritional assessment tools were evaluated: the Prognostic Nutritional Index (PNI), Nutrition Risk in the Critically Ill (NUTRIC) score, modified NUTRIC (mNUTRIC) score, Controlling Nutritional Status (CONUT) score, Geriatric Nutritional Risk Index (GNRI), Nutritional Risk Screening 2002 (NRS 2002), and blood urea nitrogen-to-albumin ratio (BAR). Quantitative synthesis was feasible only for PNI and GNRI because of the limited number and heterogeneity of studies evaluating the other tools. A random-effects meta-analysis of studies evaluating PNI showed a pooled hazard ratio (HR) of 0.57 (95% CI: 0.51-0.64), indicating that higher PNI scores were associated with lower short-term mortality in patients with sepsis. The remaining tools were therefore summarized narratively. Conclusions: Among the nutritional assessment tools included, the NUTRIC score appeared to have favorable predictive performance and may be one of the more promising tools based on currently available evidence. Early nutritional assessment may help identify patients at increased risk of poor outcomes and support clinical risk stratification. However, the evidence remains limited because most studies were retrospective and single-center, and direct quantitative comparisons among all nutritional assessment tools were not possible. The included observational studies do not demonstrate that use of these tools or subsequent nutritional interventions improves patient outcomes. Further prospective, multicenter studies are required to validate their prognostic utility in sepsis research.
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