Prognostic nutrition index is associated with the all‐cause mortality in sepsis patients: A retrospective cohort study

The ability of the prognostic nutritional index to predict short-term mortality in geriatric acute heart failure

BACKGROUND

Heart failure is a critical cardiovascular condition, necessitating comprehensive treatment approaches and contributing to elevated mortality rates. This study aimed to evaluate the effect of the prognostic nutritional index (PNI) on the prognosis of geriatric patients diagnosed with acute heart failure.

RESULTS

A total of 104 patients were included and evaluated retrospectively in this study; 57.7% of them were females, and 19.24% of the patients died. A statistically significant difference was identified between high (≥ 35.6) and low PNI (< 35.6) groups in terms of lymphocyte count, neutrophil-lymphocyte ratio, C-reactive protein, and albumin (p values: < 0.001, < 0.001, 0.011, and < 0.001, respectively). The area under the curve (AUC) value for albumin was 0.53 (95% CI: 0.30-0.83) with a cutoff value of 3.1 g/dL; for lymphocyte count, it was 0.61 (95% CI: 0.57-0.84) with a cutoff value of 0.34 × 103/µL; and for PNI, it was 0.58 (95% CI: 41.18-85.06) with a cutoff value of 34.6.

CONCLUSION

The low PNI group exhibited a significantly higher mortality rate; nonetheless, PNI alone does not hold clinical significance as a prognostic marker. However, when combined with other clinical parameters, it can contribute to a more comprehensive assessment of patients.

Impact of the prognostic nutritional index on renal replacement therapy-free survival and mortality in patients on continuous renal replacement therapy

BACKGROUND

The survival of critically ill patients with acute kidney injury (AKI) undergoing continuous renal replacement therapy (CRRT) is highly dependent on their nutritional status.

OBJECTIVES

The prognostic nutritional index (PNI) is an indicator used to assess nutritional status and is calculated as: PNI = (serum albumin in g/dL) × 10 + (total lymphocyte count in/mm3) × 0.005. In this retrospective study, we investigated the correlation between this index and clinical outcomes in critically ill patients with AKI receiving CRRT.

METHODS

We analyzed data from 2076 critically ill patients admitted to the intensive care unit at Changhua Christian Hospital, a tertiary hospital in central Taiwan, between January 1, 2010, and April 30, 2021. All these patients met the inclusion criteria of the study. The relationship between PNI and renal replacement therapy-free survival (RRTFS) and mortality was examined using logistic regression models, Cox proportional hazard models, and propensity score matching. High utilization rate of parenteral nutrition (PN) was observed in our study. Subgroup analysis was performed to explore the interaction effect between PNI and PN on mortality.

RESULTS

Patients with higher PNI levels exhibited a greater likelihood of achieving RRTFS, with an adjusted odds ratio of 2.43 (95% confidence interval [CI]: 1.98-2.97, p-value < 0.001). Additionally, these patients demonstrated higher survival rates, with an adjusted hazard ratio of 0.84 (95% CI: 0.72-0.98) for 28-day mortality and 0.80 (95% CI: 0.69-0.92) for 90-day mortality (all p-values < 0.05), compared to those in the low PNI group. While a high utilization rate of parenteral nutrition (PN) was observed, with 78.86% of CRRT patients receiving PN, subgroup analysis showed that high PNI had an independent protective effect on mortality outcomes in AKI patients receiving CRRT, regardless of their PN status.

CONCLUSIONS

PNI can serve as an easy, simple, and efficient measure of lymphocytes and albumin levels to predict RRTFS and mortality in AKI patients with require CRRT.

Influence of lymphopenia on long-term mortality in septic shock, a retrospective observational study

BACKGROUND AND OBJECTIVE

The diagnosis of infection, to diagnose septic shock, has been qualified by leukocyte counts and protein biomarkers. Septic shock mortality is persistently high (20%-50%), and rising in the long term. The definition of sepsis does not include leukocyte count, and lymphopenia has been associated with its mortality in the short term. Immunosuppression and increased mortality in the long term due to sepsis have not been demonstrated. The aim is to relate the occurrence of lymphopenia and its lack of recovery during septic shock with mortality at 2 years.

PATIENTS AND METHODS

Cohort of 332 elderly patients diagnosed with septic shock. Mortality at 28 days and 2 years was analysed according to leukocyte, neutrophil, and lymphocyte counts, and the ability to recover from lymphopenia (LRec).

RESULTS

A total of 74.1% of patients showed lymphopenia, and 73.5% did not improve during ICU stay. Mortality was 31.0% and 50.3% at 28 days and 2 years, respectively. Lymphopenia was a predictor of early mortality (OR 2.96) and LRec of late mortality (OR 3.98). Long-term mortality was associated with LRec (HR 1.69).

CONCLUSIONS

In elderly patients with septic shock, 28-day mortality is associated with lymphopenia and neutrophilia, and LRec with 2-year mortality; this may represent 2 distinct phenotypes of behaviour after septic shock.

Determining if the prognostic nutritional index can predict outcomes in community acquired bacterial pneumonia

BACKGROUND

The Prognostic Nutritional Index (PNI) uses albumin levels and total lymphocyte count to predict the relationship between immune-nutritional state and prognosis in a variety of diseases, however it has not been studied in community acquired bacterial pneumonia (CABP). We conducted a historical cohort study to determine if there was an association between PNI and clinical outcomes in patients with CABP.

METHODS

We reviewed 204 adult patients with confirmed CABP, and calculated admission PNI and Neutrophil-to-Lymphocyte Ratio (NLR). A comparative analysis was performed to determine the association of these values, as well as other risk factors, with the primary outcomes of 30-day readmissions and death.

RESULTS

Of the 204 patients, 56.9% (116) were male, 48% (98) were black/African American and the mean age was 63.2 ± 16.1 years. The NLR was neither associated with death nor 30-day readmission. The mean PNI in those who survived was 34.7 ± 4.5, compared to 30.1 ± 6.5, in those who died, p < 0.001. From multivariable analysis after controlling for the Charlson score and age, every one-unit increase in the PNI decreased the risk of death by 13.6%. The PNI was not associated with readmissions.

CONCLUSIONS

These findings suggest that poor immune and nutritional states, as reflected by PNI, both contribute to mortality, with a significant negative correlation between PNI and death in CABP. PNI was predictive of mortality in this patient cohort; NLR was not. Monitoring of albumin and lymphocyte count in CABP can provide a means for prevention and early intervention.

Prognostic Nutritional Index Enhances the Discriminatory Ability of Procalcitonin for Predicting Pediatric Sepsis

Objective. Improving diagnostic ability of pediatric sepsis is of great significance for reducing the mortality of sepsis. This study explored the discriminatory capacity of nutritional index (PNI) in pediatric sepsis. Methods. We retrospectively enrolled 134 children with suspected sepsis and collected their clinical and laboratory data. Receiver operating characteristic curves (ROC), decision curve analysis (DCA) and net reclassification improvement (NRI) were performed to compare the predictive significance of the PNI, procalcitonin (PCT) and their combination. Results. Among 134 patients, 65 children were diagnosed with sepsis and 69 children with non-sepsis. PCT and PNI were independently associated with pediatric sepsis. PCT was superior to PNI to predict pediatric sepsis. The model based on PCT + PNI improved the predictive capacity than them alone, as demonstrated by ROC, DCA and NRI, respectively. Conclusion. PNI was independently associated with pediatric sepsis, and addition of PNI could improve the capacity of PCT to predict pediatric sepsis.

Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study in South Korea

BACKGROUND

The Controlling Nutritional Status (CONUT) score and the prognostic nutritional index (PNI) have emerged as important nutritional indices because they provide an objective assessment based on data. We aimed to investigate how these nutritional indices relate to outcomes in patients with sepsis.

METHODS

Data were collected retrospectively at five hospitals for patients aged ≥18 years receiving treatment for sepsis between January 1, 2017, and December 31, 2021. Serum albumin and total cholesterol concentrations, and peripheral lymphocytes were used to calculate the CONUT score and PNI. To identify predictors correlated with 30-day mortality, analyses were conducted using univariate and multivariate Cox proportional hazards models.

RESULTS

The 30-day mortality rate among 9,763 patients was 15.8% (n=1,546). The median CONUT score was 5 (interquartile range [IQR], 3-7) and the median PNI score was 39.6 (IQR, 33.846.4). Higher 30-day mortality rates were associated with individuals with moderate (CONUT score: 5-8; PNI: 35-38) or severe (CONUT: 9-12; PNI: <35) malnutrition compared with those with no malnutrition (CONUT: 0-1; PNI: >38). With CONUT scores, the hazard ratio (HR) associated with moderate malnutrition was 1.52 (95% confidence interval [CI], 1.24-1.87; P<0.001); for severe, HR=2.42 (95% CI, 1.95-3.02; P<0.001). With PNI scores, the HR for moderate malnutrition was 1.29 (95% CI, 1.09-1.53; P=0.003); for severe, HR=1.88 (95% CI, 1.67-2.12; P<0.001).

CONCLUSIONS

The nutritional indices CONUT score and PNI showed significant associations with mortality of sepsis patients within 30 days.

Association between ferritin to albumin ratio and 28-day mortality in patients with sepsis: a retrospective cohort study

OBJECTIVES

The ratio of ferritin to albumin (FAR) has been proposed as a novel prognostic indicator for COVID-19. However, the role of FAR in predicting the all-cause mortality rate in patients with sepsis has not been evaluated. Therefore, the aim of this study is to elucidate the correlation between FAR and the 28-day all-cause mortality rate in patients with sepsis.

METHODS

This study used data from the Medical Information Mart for Intensive Care IV database (v2.0) for a retrospective cohort analysis. The study focused on adult patients with sepsis who were admitted to the intensive care unit. The primary objective was to assess the predictive capability of FAR in determining the 28-day all-cause mortality rate among patients with sepsis.

RESULTS

The study involved 1553 sepsis patients in total. Based on the survival status of sepsis patients within 28 days, they were divided into two groups: a survival group consisting of 973 patients, and a death group consisting of 580 patients. The results revealed a 28-day mortality rate of 37.35% among sepsis patients. The multivariable Cox regression analysis revealed that FAR was an independent predictor of the 28-day all-cause mortality rate in patients with sepsis (hazard ratio [HR]: 1.17-1.19; 95% confidence interval 1.11-1.26; P < 0.001). The FAR demonstrated a higher area under the curve (AUC) of 61.01% (95% confidence interval 58.07-63.96%), compared to serum ferritin (60.48%), serum albumin (55.56%), and SOFA score (56.97%). Receiver operating characteristic curve (ROC) analysis determined the optimal cutoff value for FAR as 364.2215. Kaplan-Meier analysis revealed a significant difference in the 28-day all-cause mortality rate between patients with FAR ≥ 364.2215 and those with FAR < 364.2215 (P < 0.001). Furthermore, subgroup analysis showed no significant interaction between FAR and each subgroup.

CONCLUSIONS

This study revealed a significant correlation between FAR and the 28-day mortality rate in patients with sepsis. Higher FAR values were strongly associated with increased mortality rates within 28 days.

Interpretations of the Role of Plasma Albumin in Prognostic Indices: A Literature Review

This review assesses how publications interpret factors that influence the serum or plasma albumin (PA) level in prognostic indices, focusing on inflammation and nutrition. On PubMed, a search for "albumin AND prognosis" yielded 23,919 results. From these records, prognostic indices were retrieved, and their names were used as search strings on PubMed. Indices found in 10 or more original research articles were included. The same search strings, restricted to "Review" or "Systematic review", retrieved yielded on the indices. The data comprised the 10 latest original research articles and up to 10 of the latest reviews. Thirty indices had 294 original research articles (6 covering two indices) and 131 reviews, most of which were from recent years. A total of 106 articles related the PA level to inflammation, and 136 related the PA level to nutrition. For the reviews, the equivalent numbers were 54 and 65. In conclusion, more publications mention the PA level as a marker of nutrition rather than inflammation. This is in contrast to several general reviews on albumin and nutritional guidelines, which state that the PA level is a marker of inflammation but not nutrition. Hypoalbuminemia should prompt clinicians to focus on the inflammatory aspects in their patients.

Progress in the study of biomarkers for early prediction of systemic inflammatory response syndrome after percutaneous nephrolithotomy

Urolithiasis is a common and frequent disease in urology. Percutaneous nephrolithotomy (PCNL) is preferred for the treatment of upper urinary tract stones and complicated renal stones &gt;2 cm in diameter, but it has a higher rate of postoperative complications, especially infection, compared with other minimally invasive treatments for urinary stones. Complications associated with infection after percutaneous nephrolithotomy include transient fever, systemic inflammatory response syndrome (SIRS), and sepsis, which is considered one of the most common causes of perioperative death after percutaneous nephrolithotomy. In contrast, SIRS serves as a sentinel for sepsis, so early intervention of SIRS by biomarker identification can reduce the incidence of postoperative sepsis, which in turn reduces the length of stay and hospital costs for patients. In this paper, we summarize traditional inflammatory indicators, novel inflammatory indicators, composite inflammatory indicators and other biomarkers for early identification of systemic inflammatory response syndrome after percutaneous nephrolithotomy.

Comparison of Nutrition Indices for Prognostic Utility in Patients with Sepsis: A Real-World Observational Study

Background: Nutritional status of critically ill patients is an important factor affecting complications and mortality. This study aimed to investigate the impact of three nutritional indices, the Geriatric Nutritional Risk Index (GNRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CONUT), on mortality in patients with sepsis in Japan. Methods: This retrospective observational study used the Medical Data Vision database containing data from 42 acute-care hospitals in Japan. We extracted data on baseline characteristics on admission. GNRI, PNI, and CONUT scores on admission were also calculated. To evaluate the significance of these three nutritional indices on mortality, we used logistic regression to fit restricted cubic spline models and constructed Kaplan–Meier survival curves. Results: We identified 32,159 patients with sepsis according to the inclusion criteria. Of them, 1804 patients were treated in intensive care units, and 3461 patients were non-survivors. When the GNRI dropped below 100, the risk of mortality rose sharply, as did that when the PNI dropped below about 40. An increased CONUT score was associated with increased mortality in an apparent linear manner. Conclusion: In sepsis management, GNRI and PNI values may potentially be helpful in identifying patients with a high risk of death.

Prognostic nutritional index: A potential biomarker for predicting the prognosis of decompensated liver cirrhosis

Background

Prognostic nutritional index (PNI) is an independent predictor of the prognosis of various diseases. However, the prognosis value of PNI in patients with decompensated liver cirrhosis (DLC) remains unknown. The study aimed to investigate the prognostic significance of PNI in patients with DLC.

Methods

A total of 214 eligible patients were enrolled in the study's development cohort between January 2018 and March 2021. The clinical primary study endpoints were mortality at 3 and 6 months. Receiver operating characteristic (ROC) curve analysis was used to assess the PNI's prediction accuracy, and Youden's index was utilized to determine the PNI's optimal cut-off value. Moreover, based on the optimal cut-off value, patients were categorized into high and low PNI groups. Multivariate logistic regression analysis was used to determine independent risk factors for mortality, while the relationship between PNI and the risk of death was identified and demonstrated using restricted cubic splines (RCS). A validation cohort of 139 patients was to verify the predictive power of the PNI.

Results

In the development cohort, the mortality rate at 3 and 6 months were 10.3% (22) and 14.0% (30), respectively. The PNI had comparable predictive power with the MELD score at all follow-up endpoints. Decreased PNI was an independent predictor of adverse prognosis at all follow-up endpoints. The RCS revealed a linear correlation between PNI and the risk of death. We confirmed that lower PNI was an independent predictor of poor prognosis in the validation cohort.

Conclusion

The findings showed that lower PNI is an independent factor of poor outcomes and might be utilized as a potentially promising prognostic predictor in patients with DLC.

Association between blood urea nitrogen to serum albumin ratio and in-hospital mortality of patients with sepsis in intensive care: A retrospective analysis of the fourth-generation Medical Information Mart for Intensive Care database

BACKGROUND

This study aimed to investigate the relationship between the blood urea nitrogen to serum albumin ratio (BAR) and in-hospital mortality in patients with sepsis.

MATERIALS AND METHODS

This is a retrospective cohort study. All septic patient data for the study were obtained from the intensive care unit of Beth Israel Deaconess Medical Center. Adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using multivariable Cox regression analyses. Survival curves were plotted and subgroup analyses were stratified by relevant covariates.

RESULTS

Among 23,901 patients, 13,464 with sepsis were included. The overall in-hospital mortality rate was 18.9% (2550/13464). After adjustment for confounding factors, patients in the highest BAR quartile had an increased risk of sepsis death than those in the lowest BAR quartile (HR: 1.42, 95% CI: 1.3-1.55), using BAR as a categorical variable. When BAR was presented as a continuous variable, the prevalence of in-hospital sepsis-related death increased by 8% (adjusted HR: 1.08, 95% CI: 1.07-1.1, P < 0.001) for each 5-unit increase in BAR, irrespective of confounders. Stratified analyses indicated age interactions (P < 0.001), and the correlation between BAR and the probability of dying due to sepsis was stable.

CONCLUSION

BAR was significantly associated with in-hospital mortality in intensive care patients with sepsis. A higher BAR in patients with sepsis is associated with a worse prognosis in the ICU in the USA. However, further research is required to confirm this finding.

Red cell distribution width and in-hospital mortality in septic shock: A public database research

OBJECTIVE

This study aimed to explore the relationship between red cell distribution width (RDW) and in-hospital mortality in septic shock based on a large-scale public database.

METHODS

All patients with septic shock in MIMIC-IV were enrolled. Based on RDW values, the general characteristics of different groups were compared. Different models were constructed for exploring the association of RDW and in-hospital mortality. To assess the predictive value of RDW, receiver operator characteristic (ROC) curve analysis was applied.

RESULTS

A total of 3006 patients with septic shock were included and in-hospital mortality was 32.27% (n = 970). The results of the fully adjusted model demonstrated that RDW was positively associated with in-hospital mortality in septic shock patients after adjusting all confounders (OR = 1.12, 95% CI:1.08-1.17, p < .001). A linear relationship between RDW and in-hospital mortality was found. For predicting in-hospital mortality, the area under the ROC curve (AUC) of RDW was .602 and the best threshold of RDW was 17.25%.

CONCLUSION

RDW was associated with in-hospital mortality in septic shock. It could be a useful marker for predicting clinical outcomes in septic shock.

Clinical Value of Prognostic Nutritional Index and Neutrophil-to-Lymphocyte Ratio in Prediction of the Development of Sepsis-Induced Kidney Injury

Background

Sepsis-related acute kidney injury (S-AKI) is a frequent complication of hospitalized patients and is linked to increased morbidity and mortality. Early prediction and detection remain conducive to optimizing treatment strategies and limiting further insults. This study was aimed at evaluating the potential predictive value of the combined prognostic nutrition index (PNI) and neutrophil-to-lymphocyte ratio (NLR) to predict the risk of AKI in septic patients.

Methods

In this retrospective study, 1238 adult patients with sepsis who were admitted to the First Affiliated Hospital of Xi'an Jiaotong University from January 2015 to June 2021 were enrolled. Patients were divided into two groups: the non-AKI group (n = 731) and the S-AKI group (n = 507). Univariate and multivariate logistic regression analyses were performed to screen the independent predictive factors of S-AKI. A receiver operating characteristic (ROC) curve was used to evaluate the predictive value of PNI and NLR.

Results

Multivariate logistic regression analysis indicated that age, chronic liver disease, cardiovascular disease, respiratory rate (RR), white blood cells (WBC), blood urea nitrogen (BUN), creatinine (CRE), international normalized ratio (INR), neutrophil-to-lymphocyte ratio (NLR), and prognostic nutrition index (PNI) were independent prognostic factors of S-AKI. In the three models, the adjusted OR of PNI for S-AKI was 0.802 (0.776-0.829), 0.801 (0.775-0.829), and 0.717 (0.666-0.772), while that of NLR was 1.094 (1.078-1.111), 1.097 (1.080-1.114), and 1.044 (1.016-1.072), respectively. In addition, the area under the ROC curve of the PNI plus NLR group was significantly greater than that of the CRE plus BUN group (0.801, 95% CI: 0.775-0.827 vs. 0.750, 95% CI: 0.722-0.778, respectively; P < 0.001).

Conclusions

PNI and NLR have been identified as readily available and independent predictors in septic patients with S-AKI. PNI, in combination with NLR, is of vital significance for early warning and efficient intervention of S-AKI and is superior to combined BUN and CRE.

Clinical Value of the Prognostic Nutrition Index in the Assessment of Prognosis in Critically Ill Patients with Stroke: A Retrospective Analysis

Purpose

The purpose of study was to evaluate the association between prognostic nutritional index (PNI) and all-cause mortality of critically ill patients with stroke.

Methods

Clinical data derived from Multiparameter Intelligent Monitoring in Intensive Care were analyzed. The primary endpoint was 30-day all-cause mortality; secondary endpoints were 90-day mortality and one-year cause mortality. The potential prognostic roles of PNI were analyzed by Cox proportional hazard models. The independent prognostic roles of PNI in the cases were analyzed by smooth curve fitting.

Results

Concerning 30-day mortality, the HR (95% CI) for a high PNI (≥39.7) was 0.700 (0.544, 0.900; P = 0.00539), compared to a low PNI (<39.7). After adjusting for multiple confounders, the HR (95% CI) for a high PNI (≥39.7) was 0.732 (0.547, 0.978; P = 0.03514), compared to a low PNI (<39.7). Regarding 90-day and one-year mortality, a similar trend was observed. In addition, a nonlinear association between PNI and 30-day mortality was found. Using recursive algorithm and two-piecewise linear regression model, inflection point (IP) was calculated, which was 49.4. On the right side of the IP, there was a positive relationship between PNI and 30-day mortality, and the effect size, 95% CI, and P value were 1.04 (1.01, 1.07), P = 0.0429, respectively. On the left of the IP, the effect size, 95% CI, and P value were 0.97 (0.96, 0.99) and 0.0011, respectively.

Conclusions

The PNI was an independent predicting factor of 30-day, 90-day, and 1-year mortality of the critically ill patients with stroke. In addition, there was a U-shaped relationship between PNI and all-cause mortality of stroke patients. PNI was a risk factor for the outcome of stroke when PNI was >49.4, while PNI was a protective factor for outcome of stroke when PNI was <49.4.