{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:54:16Z","timestamp":1791262456427,"version":"4.1.0"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T00:00:00Z","timestamp":1791244800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic nutritional index (PNI) combines albumin and lymphocyte count and may capture nutrition-related immune-inflammatory status in sepsis. Whether its association with mortality differs by left ventricular ejection fraction (LVEF)-defined septic cardiomyopathy (SCM) is unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective 72-h landmark study of MIMIC-IV adults with Sepsis-3 who survived to the landmark, had clinically indicated pre-landmark echocardiographic LVEF assessment, and had calculable early PNI. The prespecified primary analysis tested the lower-PNI-by-LVEF-defined-SCM interaction for 28-day mortality in an adjusted Cox model. Ninety-day and sensitivity analyses were supportive or exploratory. A single-center cohort was examined separately, not as formal validation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Among 1,976 patients, 240 had LVEF-defined SCM; 506 and 633 died by 28 and 90\u202fdays, respectively. Each 5-point lower PNI was associated with higher 28-day mortality without SCM (adjusted hazard ratio [HR], 1.18; 95% CI, 1.11\u20131.24) but not with LVEF-defined SCM (HR, 0.96; 95% CI, 0.87\u20131.05); the ratio of HRs was 0.82 (95% CI, 0.73\u20130.91;\n                      <jats:italic>p<\/jats:italic>\n                      \u202f&amp;lt;\u202f0.001). The secondary 90-day ratio was 0.84 (95% CI, 0.76\u20130.94; nominal\n                      <jats:italic>p<\/jats:italic>\n                      \u202f=\u202f0.001). Absolute-risk and restricted-mean-survival-time analyses supported attenuation, whereas same-calendar-day PNI pairing and some alternative LVEF definitions attenuated the interaction estimates toward the null. The external estimate was imprecise and statistically inconclusive (ratio of odds ratios, 0.89; 95% CI, 0.51\u20131.55).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Among selected 72-h survivors with clinically indicated pre-landmark echocardiography, the association between lower PNI and 28-day mortality was attenuated with LVEF-defined SCM. PNI should not be used alone for nutritional or clinical decision-making.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1903225","type":"journal-article","created":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T04:25:12Z","timestamp":1791260712000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["LVEF-defined septic cardiomyopathy modifies the association between the prognostic nutritional index and mortality in adults with sepsis: a 72-h landmark analysis"],"prefix":"10.3389","volume":"13","author":[{"given":"Xianju","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Emergency, Linyi People's Hospital","place":["Linyi, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Min","family":"Cheng","sequence":"additional","affiliation":[{"name":"Department of Emergency, Linyi People's Hospital","place":["Linyi, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fengqi","family":"Ruan","sequence":"additional","affiliation":[{"name":"Department of Emergency Surgery, Linyi People\u2019s Hospital","place":["Linyi, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chong","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Critical Care Medicine, Linyi People's Hospital","place":["Linyi, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuai","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Emergency, Linyi People's Hospital","place":["Linyi, Shandong, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,10,6]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1001\/jama.2016.0287","article-title":"The third international consensus definitions for Sepsis and 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