摘要Background Valvular heart disease has become a concerning problem globally and has gradually been solved by valve replacement surgery.However,the prognostic significance of preoperative Prognostic Nutritional Index(PNI)in elderly patients receiving heart valve replacement remains unclear.Method Our study enrolled 3745 elderly patients receiving heart valve replacement from January 2010 to December 2017 in Guangdong Provincial People's Hospital.The PNI were calculated at admission and patients were divided into three groups according to the tertiles of PNI:＞49(n=1 181),44-49(n=1341)and＜44(n=1223).Univariate and multivariable analysis were conducted to explore the relationship between PNI and in-hospital death.Results Patients with lower PNI may be indicated with worse nutritional status and with higher rate of in-hospital death.Age(OR:1.052,P=0.004),NYHA classification(OR:2.547,P＜0.001),anemia(OR:1.508,P=0.033),platelet count(OR:0.994,P＜0.001),LVEF(OR:0.983,P＜0.05),tricuspid regurgitation(OR:1.898,P=0.002),CABG(OR:2.119,P＜0.001),PNI(OR:1.57,P=0.012)were all independent predictor for in-hospital mortality of patients receiving heart valve replacement after accounting for confounding factors.Kaplan-Meier analysis proved that patients with lower PNI would have higher risk to suffer from one-year mortality compared with the group with higher PNI(Log-rank:55.682,P＜0.001).Conclusions In general,PNI was an independent factor for evaluating nutritional status and could predict in-hospital death in elderly patients receiving heart valve replacement.