Prognostic value of controlling nutritional status score (CONUT) and prognostic nutritional index (PNI) in patients with peripheral artery disease: an evidence-based analysis

To evaluate the controlling nutritional status score (CONUT) and the prognostic nutritional index (PNI) prognostic value in peripheral artery disease (PAD) patients through a meta-analysis. We searched PubMed, Embase, Web of Science, and Cochrane databases up to November 2024. Mortality, major adverse cardiovascular events (MACE), amputation, and poor ulcer healing were extracted. Data were synthesized using odds ratios (OR) with 95% confidence intervals (CI). Sensitivity analysis assessed result stability and heterogeneity sources. All analyses were performed using Review Manager 5.4 and STATA 15.1. Fifteen cohort studies with 6,830 PAD patients were included. Higher CONUT scores were linked to increased mortality (12 studies, HR: 1.34; 95% CI: 1.21–1.49) and amputation risk (6 studies, OR: 1.20; 95% CI: 1.10–1.32), while higher PNI was associated with reduced mortality (3 studies, HR: 0.95; 95% CI: 0.92–0.97) and amputation risk (2 studies, OR: 0.91; 95% CI: 0.87–0.95). No significant link was found between CONUT and MACE or poor ulcer healing. Sensitivity analysis revealed instability in the association between CONUT and poor ulcer healing. CONUT and PNI could predict mortality and amputation risk in PAD patients, aiding early identification of high-risk individuals. Due to the study's retrospective design and potential instability, further large-scale, multicenter prospective studies are needed to confirm these findings.