Relationship Between Prognostic Nutrition Index and New York Heart Association Classification in Patients with Coronary Heart Disease: A RCSCD-TCM Study

Figures & data

Figure 1 The flow chart of case screening.

Table 1 Baseline Demographics of Study Participants

Characteristic	Total (N=17413)	PNI			P-value
		Normal (N=16684)	Moderate (N=374)	Severe (N=355)
Sex					<0.001
Male, n (%)	9657(55.5)	9192(55.1)	235(62.8)	230(64.8)
Female, n (%)	7756(44.5)	7492(44.9)	139(37.2)	139(37.2)
Age, years, median (IQR)	64(59–69)	64(58–69)	67(61–71)	66(60–70)	<0.001
Occupation, n (%)					<0.001
Worker, n (%)	297(1.7)	281(1.7)	7(1.9)	9(2.5)
Farmer, n (%)	199(1.1)	186(1.1)	8(2.1)	5(1.4)
Cadre, n (%)	124(0.7)	119(0.7)	2(0.5)	3(0.8)
Clerk, n (%)	367(2.1)	362(2.2)	1(0.3)	4(1.1)
Retirement, n (%)	5512(31.7)	5190(31.1)	154(41.2)	168(43.7)
Others, n (%)	10,914(62.7)	10,546(63.2)	202(54.0)	166(46.8)
SBP, mmHg, median (IQR)	134(120–149)	134(120–149)	130(115–150)	130(115–150)	0.010
DBP, mmHg, median (IQR)	80(72–89)	80(72–89)	80(70–88)	80(70–89)	0.007
FBG, mmol/L, median (IQR)	5.71(4.92–7.40)	5.70(4.93–7.36)	6.00(4.70–8.51)	6.03(4.90–8.18)	0.035
HbA1c, %, median (IQR)	6.30(5.60–7.20)	6.28(5.60–7.20)	6.53(5.68–7.56)	6.60(5.76–7.60)	<0.001
TC, mmol/L, median (IQR)	4.36(3.64–5.16)	4.39(3.66–5.17)	3.84(3.16–4.51)	3.88(3.08–5.03)	<0.001
TG, mmol/L, median (IQR)	1.45(1.05–2.07)	1.47(1.06–2.09)	1.10(0.81–1.58)	1.21(0.82–1.59)	<0.001
HDL-C, mmol/L, median (IQR)	1.07(0.91–1.27)	1.08(0.92–1.28)	0.98(0.79–1.19)	0.93(0.73–1.19)	<0.001
LDL-C, mmol/L, median (IQR)	2.55(1.98–3.23)	2.56(1.99–3.23)	2.34(1.74–2.87)	2.37(1.74–3.32)	0.018
LDH, U/L, median (IQR)	189.50(163.00–229.00)	188.10(162.10–227.00)	217.00(177.00–303.00)	237.00(190.00–314.50)	<0.001
FIB, g/L, median (IQR)	3.15(2.67–3.68)	3.13(2.67–3.65)	3.73(2.99–4.79)	4.30(3.01–5.68)	<0.001
D-dimer, mg/L, median (IQR)	0.38(0.23–0.63)	0.36(0.23–0.60)	0.85(0.47–1.67)	1.16(0.62–2.13)	<0.001
Smoking, n (%)	7754(44.5)	7389(44.3)	187(50.0)	178(50.1)	0.009
Drinking, n (%)	5454(31.3)	5207(31.2)	125(33.4)	122(34.4)	0.302
Hypertension, n (%)	7071(40.6)	6806(40.8)	133(35.6)	233(37.2)	0.052
Hyperlipoidemia, n (%)	9200(52.8)	8734(52.3)	222(59.4)	244(68.7)	<0.001
Diabetes, n (%)	5739(33.0)	5444(32.6)	140(37.4)	155(43.7)	<0.001
Current antilipidemic medication, n (%)	5202(29.9)	4970(29.8)	119(31.8)	113(31.8)	0.501
Current antihypertensive medication, n (%)	6430(36.9)	6095(36.5)	165(44.1)	170(47.9)	<0.001
Hospitalization time, day, median (IQR)	7(4–12)	7(4–12)	10(6–14)	11(7–15)	<0.001
NYHA classification, n (%)					<0.001
NYHA class I	4494(25.8)	4380(26.2)	63(16.8)	51(14.4)
NYHA class II	9739(55.9)	9488(56.9)	139(37.2)	112(31.5)
NYHA class III	2756(15.8)	2467(14.8)	132(35.3)	157(44.2)
NYHA class IV	424(2.4)	349(2.1)	40(10.7)	35(9.9)

Abbreviations: IQR, interquartile range; PNI, prognostic nutrition index; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin A1c; TC, total cholesterol; TG, triglycerides; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; LDH, lactate dehydrogenase; FIB, fibrinogen; NYHA, New York Heart Association.

Table 2 Relationship Between Univariate and NYHA Classification

	NYHA Class II		NYHA Class III		NYHA Class IV
	β	OR (95% CI)	β	OR (95% CI)	β	OR (95% CI)
Sex
Male	Reference
Female	0.726	2.067(1.919–2.225)**	0.517	1.677(1.521–1.849)**	0.460	1.584(1.294–1.938)**
Age, years	0.035	1.035(1.031–1.046)**	0.055	1.056(1.050–1.063)**	0.076	1.079(1.064–1.095)**
SBP, mmHg	0.007	1.008(1.006–1.009)**	0.007	1.007(1.005–1.009)**	0.005	1.007(1.005–1.009)*
DBP, mmHg	0.000	1.000(0.997–1.003)	0.007	1.007(1.003–1.011)**	0.015	1.015(1.007–1.022)**
FBG, mmol/L	0.057	1.059(1.043–1.074)**	0.116	1.123(1.104–1.142)**	0.149	1.160(1.129–1.192)**
HbA1c, %, median (IQR)	−0.031	0.969(0.944–0.995)*	0.069	1.071(1.036–1.108)**	0.155	1.168(1.094–1.247)**
Smoking
No	Reference
Yes	0.417	1.158(1.414–1.630)**	0.126	1.134(1.032–1.247)**	−0.064	0.938(0.768–1.145)
Drinking
No	Reference
Yes	0.414	1.512(1.403–1.629)**	0.308	1.361(1.231–1.506)**	0.325	1.384(1.115–1.716)**
Hypertension
No	Reference
Yes	0.161	1.175(1.091–1.265)**	−0.044	0.957(0.868–1.055)	−0.422	0.655(0.537–0.801)**
Diabetes
No	Reference
Yes	0.067	1.069(0.991–1.153)	0.189	1.208(1.092–1.335)**	0.274	1.315(1.070–1.617)**
Current antilipidemic medication
No	Reference
Yes	−1.717	0.180(0.160–0.201)**	−2.258	0.105(0.092–0.119)**	−2.835	0.059(0.047–0.073)**
Current antihypertensive medication
No	Reference
Yes	−1.487	0.224(0.205–0.249)**	−2.207	0.110(0.098–0.123)**	−2.943	0.053(0.042–0.067)**
TC, mmol/L, median (IQR)	−0.042	0.959(0.931–0.988)**	−0.167	0.847(0.812–0.883)**	−0.328	0.720(0.655–0.791)**
TG, mmol/L, median (IQR)	−0.060	0.942(0.919–0.965)**	−0.179	0.836(0.800–0.874)**	−0.633	0.531(0.459–0.615)**
HDL-C, mmol/L, median (IQR)	0.274	1.315(1.167–1.483)**	−0.6021	0.548(0.462–0.50)**	−0.692	0.500(0.347–0.722)**
LDL-C, mmol/L, median (IQR)	−0.075	0.928(0894–0.962)**	−0.100	0.905(0.860–0.951)**	−0.122	0.885(0.795–0.985)*
FIB, g/L, median (IQR)	0.085	1.089(1.051–1.128)**	0.347	1.415(1.354–1.479)**	0.517	1.677(1.557–1.808)**
D-dimer, mg/L, median (IQR)	0.097	1.102(1.037–1.172)**	0.513	1.671(1.565–1.784)**	0.625	1.869(1.725–2.025)**
LDH, U/L, median (IQR)	−0.005	0.995(0.995–0.996)**	−0.002	0.998(0.998–0.998)**	0.001	0.999(0.999–1.000)*

Notes: Compared with NYHA class I: *P<0.05, **P<0.01.

Abbreviations: OR, odds ratio; CI, confidence interval; β, regression coefficient; IQR, interquartile range; SBP, systolic blood pressure; DBP, diastolic blood pressure; FBG, fasting blood glucose; HbA1c, glycosylated hemoglobin A1c; TC, total cholesterol; TG, triglycerides; HDL-C, high-density lipoprotein cholesterol; LDL-C, low-density lipoprotein cholesterol; LDH, lactate dehydrogenase; FIB, fibrinogen; NYHA, New York Heart Association.

Table 3 Relationship Between PNI and Classification of NYHA

Variables	NYHA Class II
	β	OR^a (95% CI)	β	OR^b (95% CI)	β	OR^c (95% CI)
PNI	−0.004	0.996(0.990–1.002)	0.001	1.001(0.995–1.007)	0.005	1.005(0.999–1.012)
Normal (PNI≥38)	Reference		Reference		Reference
Moderate (35<PNI<38)	0.018	1.019(0.755–1.375)	0.035	1.035(0.764–1.402)	−0.030	0.971(0.713–1.323)
Severe (PNI≤35)	0.014	1.014(0.727–1.414)	0.077	1.081(0.771–1.513)	0.073	1.076(0.762–1.519)
	NYHA class III
	β	OR^a (95% CI)	β	OR^b (95% CI)	β	OR^c (95% CI)
PNI	−0.084	0.920(0.912–0.927)**	−0.076	0.927(0.919–0.935)**	−0.067	0.935(0.927–0.944)**
Normal (PNI≥38)	Reference		Reference		Reference
Moderate (35<PNI<38)	1.314	3.720(2.744–5.042)**	1.257	3.514(2.576–4.794)**	1.098	2.997(2.165–4.148)**
Severe (PNI≤35)	1.698	5.466(3.970–7.525)**	2.005	5.577(4.024–7.730)**	1.586	4.883(3.455–6.901)**
	NYHA class IV
	β	OR^a (95% CI)	β	OR^b (95% CI)	β	OR^c (95% CI)
PNI	−0.147	0.863(0.850–0.877)**	−0.138	0.871(0.857–0.886)**	−0.124	0.883(0.868–0.899)**
Normal (PNI≥38)	Reference		Reference		Reference
Moderate (35<PNI<38)	2.075	7.968(5.283–12.018)**	1.955	7.067(4.639–10.767)**	1.691	5.422(3.469–8.578)**
Severe (PNI≤35)	2.153	8.613(5.526–13.424)**	2.145	8.545(5.431–13.444)**	1.882	6.564(4.043–10.658)**

Notes: Model a: unadjusted; Model b: adjusted for age, sex, SBP, DBP, FBG; HbA1c, Model c: adjusted for age, sex, SBP, DBP, FBG; HbA1c, TC, TG, HDL-C, LDL-C, smoking, drinking, hypertension, hyperlipidemia, use of antihypertensives, and use of antilipidemic, Compared with NYHA class I, **P<0.01.

Abbreviations: OR, odds ratio; CI, confidence interval; β, regression coefficient; IQR, interquartile range; NYHA, New York Heart Association; PNI, prognostic nutrition index.

Figure 2 Relationship between PNI and NYHA classification, **:P<0.01.

Abbreviations: PNI, prognostic nutrition index; NYHA, New York Heart Association classification.

Table 4 Relationship Between PNI Combined BMI and NYHA Classification

PNI Combined BMI (N=2,052)	NYHA Class III and IV
	β	OR^a (95% CI)	β	OR^b (95% CI)	β	OR^c (95% CI)
Well-nourished-normalweight (PNI≥38, 18.5<BMI<25)	Reference		Reference		Reference
Well-nourished-overweight (PNI≥38, BMI≥25.0)	0.101	1.106(0.891–1.373)	0.054	1.056(0.846–1.318)	0.016	1.016(0.811–1.274)
Well-nourished-underweight (PNI≥38, BMI≤18.5)	0.524	1.689(0.994–2.867)	0.542	1.719(1.001–2.952)*	0.560	1.751(1.010–3.033)*
Malnourished-normal weight (PNI<38, 18.5<BMI<25)	0.657	1.930(0.558–6.672)	0.306	1.358(0.386–4.771)	0.195	1.215(0.331–4.456)
Malnourished-overweight (PNI<38, BMI≥25.0)	1.574	4.825(1.809–12.870)**	1.369	3.930(1.425–10.834)**	1.275	3.580(1.286–9.966)*
Malnourished-underweight (PNI<38, BMI≤18.5)	2.316	10.132(2.712–37.852)**	2.282	9.797(2.555–37.567)**	2.084	8.038(2.091–30.892)**

Notes: Model a: unadjusted; Model b: adjusted for age, sex, SBP, DBP, FBG; HbA1c, Model c: adjusted for age, sex, SBP, DBP, FBG; HbA1c, TC, TG, HDL-C, LDL-C, smoking, drinking, hypertension, hyperlipidemia, use of antihypertensives, and use of antilipidemic, Compared with NYHA class I, *:P<0.05, **:P<0.01.

Abbreviations: OR, odds ratio; CI, confidence interval; β, regression coefficient; PNI, prognostic nutrition index; BMI, body mass index; NYHA, New York Heart Association.

Figure 3 Relationship between PNI combined BMI and NYHA classification, **:P<0.01.