Prognostic nutritional index as a predictor of in-hospital mortality in neonates and infants undergoing cardiac surgery.

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 3,082 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 ( 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.