SYSTEMATIC REVIEW article
Front. Nutr.
Sec. Clinical Nutrition
Volume 12 - 2025 | doi: 10.3389/fnut.2025.1631128
Predictive value of prognostic nutritional index (PNI) for the long-term prognosis of elderly patients with fracture: a systematic review and metaanalysis Runing title: Predictive value of PNI for the long-term prognosis of elderly patients with fracture
Provisionally accepted
- China-Japan Union Hospital of Jilin University, Changchun, China
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Objectives: To present the most recent and comprehensive systematic review and meta-analysis assessing the predictive value of prognostic nutritional index (PNI) for the long-term outcomes of elderly patients with fractures.We systematically searched PubMed, Cochrane, Embase and Web of Science up to July, 2025 for studies assessing the predictive value of PNI for the longterm prognosis of elderly patients with fractures. The primary outcome measured was mortality. Odds ratios (ORs) and 95% confidence intervals (CIs) were used for data pooling. Additionally, sensitivity and subgroup analyses were performed to assess the stability of the results and identify potential sources of heterogeneity. All analyses were performed using Review Manger 5.4 and STATA 15.1.Eight studies encompassing 11,576 elderly individuals were included for meta-analysis. The meta-analysis demonstrated that mortality was notably lower in individuals with high PNI compared to those with low PNI (OR: 0.75; 95% CI: 0.66, 0.85; P ＜0.0001). Subgroup analysis of mortality based on study design and PNI cutoff showed that the predictive value of PNI for mortality remained significant in prospective studies and those with a cut-off value ≥ 40. However, this association was not observed in retrospective studies or those with a cut-off below 40.Conclusions: PNI can effectively predict the long-term mortality in elderly individuals with fractures. Considering the limitations of this article, future largescale, multicenter prospective cohort studies are still required to evaluate the prognostic value of PNI in senior patients with fractures and its influencing factors.
Keywords: Prognostic nutritional index, Elderly, Fracture, Mortality, Meta-analysis
Received: 19 May 2025; Accepted: 31 Jul 2025.
Copyright: © 2025 Bai, Liu and Li. 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: Hong Li, China-Japan Union Hospital of Jilin University, Changchun, China
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