ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1605032
Association between Prognostic Nutritional Index and all-cause mortality in critically ill patients with ventilator-associated pneumonia: a retrospective study based on MIMIC-IV database
Provisionally accepted
- 1Department of Respiratory and Critical Care Medicine, First Affiliated Hospital of Xi’an Jiaotong University, Xi'an, China
- 2Department of Respiratory Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
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Ventilator-associated pneumonia (VAP) remains a significant clinical challenge in ICU due to its high mortality rate.The Prognostic Nutritional Index (PNI), a composite biomarker based on serum albumin levels and total lymphocyte counts, reflects nutritional and immune status, but its prognostic significance in VAP patients remains unclear. This study evaluated the association between PNI and mortality in critically ill patients with VAP.We retrospectively analyzed data from 1,457 patients diagnosed with VAP from the Medical Information Mart for Intensive Care IV (MIMIC-IV) database. Patients were grouped according to PNI quartiles and an identified optimal threshold. Cox regression, restricted cubic spline (RCS) analysis, and subgroup analyses were conducted to evaluate associations between PNI and 30-day and 90-day all-cause mortality.Among 1,457 critically ill patients with VAP, the all-cause mortality rates were 23.68% at 30 days and 34.32% at 90 days. Patients in highest PNI quartile exhibited significantly reduced mortality risks compared with the lowest quartile, with adjusted HR of 0.60 (95% CI, 0.44-0.81) for 30-day mortality and 0.64 (95% CI, 0.50-0.82) for 90-day mortality. RCS analysis revealed a significant nonlinear "L"-shaped relationship between PNI and mortality (P < 0.001). Below the threshold, patients with higher PNI had significantly lower risk of 30-day mortality (HR= 0.93, 95% CI: 0.91-0.95) and 90day mortality (HR= 0.94, 95% CI: 0.92-0.96).A higher PNI at ICU admission was independently associated with lower short-term and long-term mortality in critically ill VAP patients. Routine assessment of PNI could enable early identification of high-risk patients and guide targeted nutritional and immunological interventions.
Keywords: Prognostic nutritional index, ventilator-associated pneumonia, Mortality, Cox regression model, Restricted cubic spline analysis
Received: 02 Apr 2025; Accepted: 29 Jul 2025.
Copyright: © 2025 Ji, Wang and Liu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Jia Liu, Department of Respiratory Medicine, Honghui Hospital, Xi'an Jiaotong University, Xi'an, China
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