IDDF2019-ABS-0164 The modified prognostic nutritional index (mPNI): a new risk index for predicting clinical outcomes after percutaneous endoscopic gastrostomy

Abstract

Background Onodera’s Prognostic Nutritional Index (O-PNI) is a screening tool derived from serum albumin levels (Alb) and total lymphocyte count (TLC). C-reactive protein (CRP) and blood urea nitrogen (BUN) levels were added to create the modified Prognostic Nutritional Index (mPNI). In this study, the utility of mPNI in predicting clinical outcomes after percutaneous endoscopic gastrostomy (PEG) was investigated. Methods Based on multiple logistic regression analysis, mPNI was calculated using the equation 10 + 2xAlb(g/dL) + TLC(/μL)/1000 - CRP(mg/dL)/2 - BUN(mg/dL)/20. ROC analysis was used to evaluate mPNI as a predictor for postoperative aspiration pneumonia, in-hospital mortality, 30-day mortality and 90-day mortality. Results Derivation group 306 patients, mean age 82.6±10.0 years old, Alb 3.2±0.5 g/dL, TLC 1357±586/μL, CRP 2.5±2.9 g/dL, BUN 26.9±22.0 mg/dL, O-PNI 38.5±6.3 and mPNI 15.1±2.6. Postoperatively, 69 patients developed aspiration pneumonia and 49 died before discharge, 22 within 30 days. AUC (area under the curve) for clinical outcomes summarized in table 1. Validation group: 190 patients, mean age 81.4±8.6 years old, Alb 2.8±0.5 g/dL, TLC 1498±744/μL, CRP 2.1±2.7 mg/dL, BUN 22.8±16.7 mg/dL, O-PNI 35.7±6.8 and mPNI 15.0±2.5. Postoperatively, 26 patients developed aspiration pneumonia, 19 died before discharge and 25 within 90 days. AUC for clinical outcomes summarized in table 2. Conclusions The results of this study show that mPNI, an easy to calculate prognostic index using four biomarkers frequently measured during routine laboratory testing, is a strong predictor of both postoperative aspiration pneumonia and mortality after PEG.