ORIGINAL RESEARCH article
Front. Nutr.
Sec. Clinical Nutrition
This article is part of the Research TopicThe Role of Nutrition in Enhancing Surgical Recovery and OutcomesView all 8 articles
Prognostic Nutritional Index as a Predictor of In-Hospital Mortality in Neonates and Infants Undergoing Cardiac Surgery
Provisionally accepted
- Guangdong Provincial People's Hospital, Guangzhou, China
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Objective:The Prognostic Nutritional Index (PNI), combining nutritional and systemic inflammation markers is suggested as a predictor of negative outcomes post-cardiac surgery.This study investigated the link between PNI and in-hospital mortality in neonates and infants undergoing cardiac surgery. Methods:This retrospective cohort study included 3082 neonates and infants (aged ≤365 days) who underwent primary cardiac surgery between January 2017 and October 2023. The PNI was utilized to evaluate nutritional status. Patients were stratified into two groups based on PNI values: low (PNI ≤51.65) and high (PNI >51.65).The association between PNI and in-hospital mortality was assessed using multivariable logistic regression models, adjusted for demographic, preoperative, and surgical variables.Subgroup analyses were performed to assess potential effect modification. The potential linear relationship between PNI and mortality was examined using generalized additive models and smooth curve fitting. Results:The overall in-hospital mortality rate was 1.72% (53/3, 082). Patients with a PNI ≤51.65 exhibited a significantly higher mortality rate of 6.03% compared to 0.92% for those with a PNI >51.65 (p < 0.001). Multivariable analysis identified PNI as an independent predictor of in-hospital mortality (adjusted odds ratio: 0.95; 95% CI: 0.91–0.98; p = 0.005). Subgroup analyses revealed significant effect modification by age, congenital heart disease (CHD) complexity, and cardiopulmonary bypass status (p for interaction < 0.05). The inverse relationship between PNI and mortality was stronger in neonates aged 30 days or younger, patients with non-complex CHD, and those undergoing off-pump surgery.Receiver operating characteristic analysis indicated that PNI effectively predicted in-hospital mortality, with an area under the curve of 0.745 (95% CI: 0.675-0.815; p < 0.001) and an optimal cutoff value of 51.65 determined by the Youden index. Conclusions:PNI independently predicts in-hospital mortality in neonates and infants undergoing cardiac surgery.The findings indicate that PNI could be an efficient tool for preoperative risk assessment in high-risk populations.
Keywords: Prognostic nutritional index, neonates, infants, congenital heart disease, cardiac surgery, Mortality
Received: 16 Aug 2025; Accepted: 24 Oct 2025.
Copyright: © 2025 Gu, Li, Huang, Bao, He, Li, Luo and Chongjian. 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: Zhang Chongjian, zhangchongjian@gdph.org.cn
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