SynthesisFrontiers in medicine2026
Prognostic value of the prognostic nutritional index in sepsis, pneumonia, and tuberculosis: a systematic review and meta-analysis.
Synthesis in Frontiers in medicine, 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
Objective: To evaluate the prognostic value of the Prognostic Nutritional Index (PNI) in patients with infectious diseases, focusing on tuberculosis, pneumonia, and sepsis. By synthesizing extant evidence, we examine the association between baseline PNI and clinical outcomes to inform early risk stratification and nutritional monitoring. Additionally, we probe underlying pathophysiological mechanisms, offering prognostic insights. Methods: A systematic literature search was conducted across five databases, including PubMed, Web of Science, Embase, the Cochrane Library, and China National Knowledge Infrastructure (CNKI), from inception to June 2026. Following methodological appraisal via the Newcastle-Ottawa Scale, we investigated associations between PNI and mortality or unfavorable outcomes. PNI was uniformly calculated at baseline using the formula: PNI = serum albumin (g/L) + 5 × lymphocyte count (×10 Results: From an initial pool of 1,383 relevant studies, 10 studies comprising 28,757 patients were included in the final analysis. Disease-stratified meta-analysis underscores PNI's prognostic association in infectious diseases. Notably, among sepsis patients, elevated baseline PNI is associated with a significantly attenuated mortality risk (hazard ratio [HR]: 0.63; 95% confidence interval [CI]: 0.44, 0.90). Similarly, in the pneumonia subgroup, a high PNI demonstrated a significant inverse association with mortality (HR: 0.47; 95% CI: 0.30, 0.73). Conversely, in the tuberculosis subgroup, the association between PNI and mortality did not reach statistical significance (HR: 0.38; 95% CI: 0.04, 3.82). Overall, higher PNI remained a significant protective factor against mortality or unfavorable clinical outcomes (pooled HR: 0.52; 95% CI: 0.39, 0.71; Conclusions: Reduced baseline PNI correlates with heightened mortality in sepsis and pneumonia, yet its prognostic value in tuberculosis remains uncertain. Although PNI is a cost-effective clinical adjunct, the current evidence is too heterogeneous to support its universal use in infectious diseases. Addressing these gaps requires large-scale prospective investigations across a wider spectrum of diseases.
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