Association between prognostic nutritional index and prognosis of patients receiving coronary artery bypass grafting surgery: a systematic review and meta-analysis

Objectives: To conduct the first systematic review and meta-analysis to assess the association between prognostic nutritional index (PNI) and prognosis of patients receiving coronary artery bypass grafting surgery (CABG). Methods: We conducted a systematic literature search via PubMed, Embase, Web of Science, and Cochrane until March 2025, for studies that evaluated the association between PNI and prognosis of patients receiving CABG. All-cause mortality and acute kidney injury (AKI) were the primary outcomes. Odds ratios (OR) and 95% confidence intervals (CI) were used for data pooling. In addition, sensitivity analysis and subgroup analysis were performed to evaluate the stability of the results and potential sources of heterogeneity. All data analyses were conducted using Review Manager 5.4 and STATA 15.1 software. Results: A total of 11 studies including 11,444 patients were included in the meta-analysis. The results showed that, compared with the low PNI group, the high PNI group had a significantly lower all-cause mortality rate (OR: 0.81; 95% CI: 0.72, 0.90) and a significantly lower risk of acute kidney injury (OR: 0.82; 95% CI: 0.77, 0.86). Sensitivity analyses confirmed that the associations between PNI and all-cause mortality and AKI were stable. Conclusions: PNI can effectively predict postoperative all-cause mortality and AKI in patients undergoing CABG. Considering the inevitable heterogeneity and potential publication bias in this article, more large-scale, multicenter, prospective cohort studies are needed in the future to assess the predictive value of PNI for prognosis after CABG and to identify its influencing factors. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251077959, PROSPERO CRD420251077959.