Background: Malnutrition is common in patients with acute myocardial infarction (AMI) and is associated with a poor prognosis. The prognostic value of the prognostic nutritional index (PNI) in patients with AMI remains controversial. We aimed to explore the relationship between PNI and all-cause mortality in critically ill patients with AMI and evaluate the incremental prognostic value of PNI to commonly used prognostic assessment tools. Methods: The Medical Information Mart for Intensive Care-IV (MIMIC-IV) database was used to conduct a retrospective cohort analysis on 1180 critically ill patients with AMI. The primary endpoints were defined as 6-month and 1-year all-cause mortality. Cox regression analysis was used to investigate the relationship between admission PNI and all-cause mortality. The effect of adding PNI to sequential organ failure assessment (SOFA) score, or charlson comorbidity index (CCI) on its discriminative ability was assessed using C-statistic, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). Results: Multivariate cox regression analysis demonstrated that the low PNI was regarded as an independent predictor of 1-year all-cause mortality in AMI patients admitted to ICU (adjusted Hazard Ratio: 95% CI = 1.75 (1.22–2.49)). The ROC test showed that admission PNI had a moderate predictive ability to predict all-cause mortality of critically ill patients with AMI. Furthermore, the net reclassification and integrated discrimination of the CCI alone model improved significantly with PNI. [C-statistic increased from 0.669 to 0.752, p < 0.001; NRI = 0.698, p < 0.001; IDI = 0.073, p < 0.001]. When PNI was added to the SOFA score, the C-statistic significantly improved from 0.770 to 0.805 (p < 0.001), and the NRI and IDI were estimated at 0.573 (p < 0.001) and 0.041 (p < 0.001), respectively. Conclusion: PNI could be a novel predictor for identifying patients at high risk of 1-year all-cause mortality in critically ill patients with AMI. The addition of PNI to the SOFA score or CCI may be useful for very early risk stratification.

Background: The triglyceride-glucose index serves as a dependable biomarker for gauging insulin resistance linked to cardiovascular disease. Our study was designed to investigate how the trajectory of the triglyceride-glucose index relates to the risk of worsening heart failure and overall mortality in patients aged 60 years and older with chronic heart failure and type 2 diabetes. Methods: This study enrolled 466 patients who had ≥ 3 medical exams. The formula for calculating the triglyceride-glucose index was ln (fasting triglycerides [mg/dL] × fasting blood glucose [mg/dL]/2). The trajectory of the triglyceride-glucose index in longitudinal analysis was analyzed via linear mixed models. The relationships between the trajectory of the TyG index and the risk of worsening heart failure and overall mortality were analyzed via competing Cox regression analysis and mixed-effects Cox regression analysis. Results: After the variables adjustment, compared with the first quartile group, the adjusted hazard ratios for worsening heart failure in top quartile group were 2.40 (1.35–3.28) for 10-year follow-up, and 2.09 (1.22-3.58) for overall follow-up duration. The adjusted hazard ratios for overall mortality in top quartile group were 1.99 (1.56–3.14) for 10-year follow-up, and 1.87 (1.22–2.88) for overall follow-up duration. Compared with the low decreasing trajectory, adjusted hazard ratios for worsening heart failure of high decreasing trajectory were 1.37 (1.10–1.71) for the 5-year follow-up, 1.78 (1.10–2.88) for 10-year follow-up, and 1.67 (1.04–2.68) for overall follow-up duration. The adjusted hazard ratios for overall mortality were 2.16 (1.39–3.35) for 10-year follow-up, and 2.23 (1.46–3.40) for overall follow-up duration. Conclusion: During follow-up, a higher baseline level of TyG index and a high decreasing trajectory were independently associated with long-term worsening heart failure and an increased risk of overall mortality.