Prognostic nutritional index and risk of incident hyperuricemia: A retrospective cohort study

Background: Recently, the preoperative immune-nutritional status has been reported to correlate with the long-term survival in colorectal cancer (CRC) patients. Markers of the immune-nutritional status, such as the serum albumin concentration and prognostic nutritional index (PNI) were reported to have prognostic value. However, there have been no reports on the relationship between the controlling nutritional status (CONUT) score and the clinical outcome after curative surgery for CRC. We herein evaluated the prognostic significance of the CONUT score in patients with CRC, and compared the accuracy of the CONUT score and the PNI as a predictor of survival. Materials and methods: We retrospectively reviewed a database of 204 patients who underwent curative surgery for Stage II/III CRC between 2004 and 2009. Patients were divided into two groups according to the CONUT score and the PNI. Result: The low-CONUT group (N = 150) had two or fewer points, while the high-CONUT group (N = 54) had a score of three points or more. The low-PNI group (N = 27) had a PNI < 40, while the high-PNI group (N = 177) had a PNI of 40 or more. The five-year relapse-free survival (RFS) rate was 73.0% in the low-CONUT group and 53.6% in the high-CONUT group, which was significantly different (p = 0.0018). The five-year RFS was 51.5% in the low-PNI group and 70.4% in the high-PNI group, there was a significant difference between the low PNI group and the high PNI group (p = 0.0162). In a univariate analysis of the postoperative survival based on the clinicopathological factors, the sex, age, lymphatic vessel invasion, venous invasion, lymph node metastasis, preoperative CA19-9 level, the CONUT score and the PNI were associated with the RFS. A multivariate analysis showed that sex (Odds ratio (OR) = 2.012, 95%CI; 1.135-3.685, p = 0.0164) and the preoperative CA19-9 (OR = 2.194,95%CI; 1.054-4.271, p = 0.0364) were independently associated with the RFS. The five-year cancer-specific survival (CSS) rate was significantly higher at 92.7% in the low-CONUT group than that of 81.0% in the high-CONUT group (p = 0.0016). The five-year CSS was 71.2% in the low PNI group and 92.3% in the high PNI group, which was also significantly different (p = 0.0155). In a univariate analysis for the CSS, lymph node metastasis, the preoperative CA19-9 level, the CONUT score and the PNI were significantly associated with the CSS. A multivariate analysis showed that lymph node metastasis (OR = 4.080, 95%CI; 1.476-13.089, p = 0.0097) and the CONUT score (OR = 3.661, 95%CI;1.084-11.234, p = 0.0376) were independently associated with the CSS. Conclusion: This study suggested that the CONUT score is a strong independent predictor of the survival among CRC patients. The CONUT score is a more sensitive prognostic factor than the PNI. Citation Format: Yasuhito Iseki, Masatsune Shibutani, Kiyoshi Maeda, Hisashi Nagahara, Hiroshi Ohtani, Tetsuro Ikeya, Kenji Sugano, Sadaaki Yamazoe, Katsinobu Sakurai, Kenjiro Kimura, Takahiro Toyokawa, Ryosuke Amano, Naoshi Kubo, Hiroaki Tanaka, Kazuya Muguruma, Masaichi Ohira, Kosei Hirakawa. Impact of the preoperative Controlling Nutritional Status (CONUT) score on the clinical outcome after curative surgery for colorectal cancer. [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 3418. doi:10.1158/1538-7445.AM2015-3418

Hip fractures in super-elderly patients are associated with high short-term mortality. The Prognostic Nutritional Index (PNI) is a simple marker reflecting both nutritional and immune status, but its prognostic value in super-elderly hip fracture patients remains unclear. We retrospectively included 614 patients aged ≥80 years with traumatic hip fractures from a tertiary hospital (n = 457) and the MIMIC-IV database (n = 157). PNI was calculated from serum albumin and absolute lymphocyte count measured within 24 h of admission. The optimal PNI cut-off for predicting 90-day all-cause mortality was determined using X-tile and used to define low- and high-PNI groups. Least absolute shrinkage and selection operator (LASSO) regression, Cox proportional hazards models, and propensity score matching (PSM) were applied to evaluate the association between admission PNI and 90-day mortality. The optimal PNI cut-off was 37.2, yielding 231 patients (37.6%) in the low-PNI group (PNI ≤ 37.2) and 383 (62.4%) in the high-PNI group (PNI > 37.2). Before PSM, patients with low PNI were older and had worse laboratory profiles, including lower hemoglobin, albumin, and lymphocyte counts. The 90-day mortality rate was significantly higher in the low-PNI than in the high-PNI group (21.65% vs. 9.40%, p < 0.001). LASSO identified sex, race, chronic pulmonary disease, hemoglobin, creatinine, and PNI as variables associated with 90-day mortality. After 1:2 PSM, 398 patients were retained with most baseline imbalances effectively reduced. In robust Cox proportional hazards analyses for the matched cohort, high PNI was associated with lower 90-day mortality in univariate models (HR 0.34, 95% CI 0.18-0.63; p < 0.001); Race violated the proportional hazards assumption; this association remained robust in the fully adjusted robust Cox model with race treated as a stratified variable (HR 0.34, 95% CI 0.19-0.63; p < 0.001). A low admission PNI (≤37.2) is strongly and independently associated with higher 90-day mortality in super-elderly patients with hip fractures. PNI, derived from routine laboratory tests within 24 h of admission, provides a simple and inexpensive tool for early risk stratification in this vulnerable population.

ObjectiveTo assess the prognostic nutritional index (PNI) and quality of life (QOL) of patients with cervical cancer (CC) who underwent radiotherapy and chemotherapy and to reveal the effect of PNI on QOL and its prognostic value.MethodsA total of 138 CC patients who underwent radiotherapy and chemotherapy in the Second Affiliated Hospital of Fujian Medical University from January 2020 to October 2022 were selected as the study subjects via convenient sampling. According to the PNI cut-off value of 48.8, they were divided into a high-PNI group and a low-PNI group, and the quality of life of the two groups was compared. The Kaplan-Meier method was used to draw the survival curve, and the Log-Rank test was employed to compare the survival rates of the two groups.ResultsThe scores of physical functioning and overall QOL in the high-PNI group were significantly higher than those in the low-PNI group (P < 0.05). The scores of fatigue, nausea and vomiting, pain and diarrhea were higher than those in the low-PNI group, and the difference was statistically significant (P < 0.05). The objective response rates were 96.77% and 81.25% in the high-PNI group and the low-PNI group, respectively, and the difference was statistically significant (P = 0.045). The 1-year survival rates of patients with high PNI and low PNI were 92.55% and 72.56% in the high-PNI group and the low-PNI group, respectively; the difference in survival rates was statistically significant (P = 0.006).ConclusionThe overall quality of life of CC patients with low PNI receiving radiotherapy and chemotherapy is lower than that of patients with high PNI. Low PNI reduces the tolerance to radiotherapy and chemotherapy and the objective response rate, which can be used as a prognostic indicator for cervical cancer patients.

Effects of prognostic nutritional index and obesity on 1-year mortality in patients with acute heart failure

Background The prognostic nutrition index (PNI) has been shown to have prognostic value for several common cancers. The study aim was to explore the clinical application value of the PNI for prognosis of patients with esophageal squamous cell carcinoma (ESCC) treated with radical chemoradiotherapy (CRT) or radiotherapy (RT). Methods Overall, 193 patients with ESCC who received radiotherapy with or without chemotherapy at Sichuan Cancer Hospital from March 20, 2012 to December 25, 2017 were retrospectively analyzed. Based on serum measurements before treatment, the PNI at ESCC recurrence was calculated as albumin (g/L) + 5 × total lymphocyte count. The Kaplan–Meier method and Cox proportional regression model were used to analyze the relationship between PNI and overall survival (OS). Results The average PNI of 193 ESCC patients was 49.01 ± 4.68. The optimal cutoff value of PNI was 47.975, and the patients were divided into a low-PNI group (<47.975) and a high-PNI group (≥47.975). PNI was related to tumor length, T-stage and synchronous chemotherapy in ESCC patients (P < 0.05). The median OS for the entire group was 22.37 mo,. The median OS of patients in the high-PNI group and low-PNI group were 32.63 mo, and 15.4 mo, respectively, the 3-year survival rates were 47.5% and 32.2% and the 5-year survival rates were 37.7% and 16.8%, respectively, (all P = 0.001). Univariate analysis showed that PNI, tumor length, T-stage and synchronous chemotherapy were related to the prognosis of ESCC patients (P < 0.05). Multivariate analysis showed that tumor length (P = 0.019), synchronous chemotherapy (P = 0.009) and PNI (P = 0.003) were independent prognostic factors affecting the prognosis of patients in ESCC treated with RT or CRT. Conclusions The calculation of PNI value is simple, reliable and repeatable and can improve the accuracy of a patient’s prognosis. Confirmation of these results by a large-sample prospective study is desirable.

Prognostic nutritional index (PNI) and age are effective prognostic factors for patients with non-metastatic nasopharyngeal carcinoma (NPC), and an interaction between them may exist. However, the age cutoff value is generally set at 45years in current studies. The clinical implications of PNI in middle-aged and elderly patients are unclear. Therefore, we aimed to uncover this issue. We retrospectively collected data from 132 middle-aged and elderly (≥ 45years old) patients with non-metastatic NPC. The association between covariates and the PNI was analyzed using 2 or t-test. The effect of PNI on the prognosis was evaluated using univariate and multivariate Cox regression analyses. Unadjusted and multivariate-adjusted models were applied. Stratified and interactive analyses were performed to investigate the potential source of heterogeneity. Median age (61.0years versus 59.5years) and the proportion of patients aged ≥ 60years (57.6% versus 50.0%) in the low-PNI group were higher than those in the high-PNI group (P > 0.05). The patients with a low PNI had shorter overall survival (OS) (hazard ratio (HR) = 0.86, 95% confidence interval (CI) = 0.80-0.93; P < 0.001) and progression-free survival (PFS) (HR = 0.93, 95% CI = 0.87-0.99; P = 0.034). The results remained stable after three adjusted models of covariates, including age (P < 0.05). No significant interactions were observed in middle-aged (45-59years) and elderly (≥ 60years) subgroups for OS and PFS (P for interaction > 0.05). Although there is an interaction between PNI and age, PNI is an independent prognostic factor in middle-aged and elderly patients with non-metastatic NPC.

We hypothesised that the prognostic nutrition index (PNI) is useful for evaluating host immunity and response to immune checkpoint inhibitors. We investigated the effect of PNI on nivolumab monotherapy efficacy in advanced or recurrent gastric cancer (GC) or gastro-oesophageal junction cancer (GOC) patients. We retrospectively examined 110 patients, divided them into a high-PNI group and a low-PNI group, and compared treatment efficacy, adverse events (AEs), and survival between the groups. Median overall survival (OS) was significantly longer in the high-PNI group than in the low-PNI group (205 vs. 109 days; p<0.001). Multivariate analysis revealed that low PNI was an independent risk factor for OS (hazard ratio=2.398; 95% confidence interval=1.384-4.154; p=0.002). The overall response rate and frequency of AEs were not significantly different between the groups. PNI could be a useful prognostic factor in GC or GOC patients undergoing nivolumab monotherapy.

The preoperative nutritional and immunological statuses have an important impact in predicting the survival outcome of patients with various types of malignant tumors. Our study aimed to explore the clinical significance and predictive prognostic potential of Onodera’s prognostic nutritional index (PNI) in patients with colorectal carcinoma. This retrospective study included a total of 1321 patients who were diagnosed with colorectal cancer and who had been surgically treated between January 1994 and December 2007. The PNI level was determined according the following formula: 10 × serum albumin (g/dL) + 0.005 × total lymphocyte count (per mm3). The impact of PNI on clinicopathological features and overall survival (OS) was determined. The optimal cutoff value of PNI was set at 45. Patients in the low-PNI group had a greater potential to have aggressive histological features, advanced tumors (T), nodal involvement (N), metastasis (M), and TNM stage than those in the high-PNI group. The low-PNI group had a worse OS than the high-PNI group (5-year survival rate 56.1 vs 64.8 %, respectively; P < 0.05). Furthermore, the PNI value was an independent prognostic factor for colorectal cancer in this study. The OS was significantly lower in the low-PNI group than in the high-PNI group in patients with TNM stage II and III diseases. Preoperative PNI is a simple and useful marker to predict clinicopathological features and long-term survival outcome in patients with colorectal carcinoma. PNI analysis should be included in the routine assessment of patients with locally advanced colorectal cancer.

The prognostic nutritional index (PNI) is an indicator of systemic immune-nutritional condition and is a well-known prognostic biomarker in lung cancer patients. Tumour-infiltrating lymphocytes (TILs) is a specific histological feature of cancers, influencing an individual's immunological tumour responses. However, whether PNI can reflect lung cancer patients' prognosis through local immunity such as TIL is unclear. We selected 64 lung squamous cell carcinoma patients who underwent curative operations. We investigated the significance of preoperative PNI level and evaluated the relationship between PNI and immune cells surrounding the lung cancer tissue using immunohistochemical analysis of a cluster of differentiation (CD)3, CD4, CD8 and CD68. A low-PNI level was significantly associated with a worse postoperative prognosis (P = 0.042). The PNI (hazard ratio 2.768, 95% confidence interval 1.320-5.957; P = 0.007) was an independent prognostic factor. The low-PNI group had a significantly shorter recurrence-free survival and overall survival (P = 0.013 and P = 0.002, log-rank test) compared with the high-PNI group. A significant positive correlation between PNI components including preoperative peripheral blood lymphocyte count and serum albumin concentration, and TILs, was observed. Absolute numbers of TILs in the preoperative high-PNI group were significantly increased compared with those in the preoperative low-PNI group (CD3+ cells; P = 0.002, CD4+ cells; P = 0.049 and CD8+ cells; P = 0.024). The preoperative PNI level was strongly associated with the postoperative outcome in lung cancer patients. Considering the positive relationship between preoperative PNI level and TIL status, preoperative immune-nutritional condition may influence lung cancer patients' postoperative prognosis through local immunity as well as systemic immune response.

T4 esophageal cancer that has invaded adjacent organs is often symptomatic and unresectable, and radiotherapy represents an important treatment option. Treatment strategies range from definitive to palliative approaches, making accurate prognostic assessment essential in clinical practice. Immunonutritional indices, such as the Glasgow Prognostic Score (GPS) and the Prognostic Nutritional Index (PNI), can be easily calculated from routine blood tests and have been reported as prognostic factors in various malignancies. However, their clinical significance in patients with T4 esophageal cancer treated with radiotherapy remains unclear. We retrospectively analyzed 79 patients with T4 esophageal cancer who were treated with radiotherapy. GPS was calculated based on serum C-reactive protein and albumin levels, and PNI was calculated using serum albumin levels and total lymphocyte counts. Overall survival (OS) was compared according to pretreatment GPS and PNI. Pretreatment GPS scores were zero in 26 patients, one in 23 patients, and two in 30 patients, and the median pretreatment PNI was 40.7. The median OS for all 79 patients was 12 months. When patients were dichotomized into GPS 0/1 (N=49) and GPS 2 (N=30) groups, OS was significantly longer in the GPS 0/1 group than in the GPS 2 group (p=0.00224). Patients were also stratified according to a PNI cut-off value of 41 into a high-PNI group (PNI ≥41, N=38) and a low-PNI group (PNI <41, N=41); OS was significantly longer in the high-PNI group than in the low-PNI group (p=0.021). GPS and PNI, which are readily available from routine blood tests, are simple and useful prognostic indicators in patients with T4 esophageal cancer undergoing radiotherapy.

Objective The purpose of this multicenter retrospective study was to investigate the impact of the prognostic nutritional index (PNI) on the survival of Japanese patients with hepatocellular carcinoma (HCC) treated with sorafenib. Methods A total of 178 HCC patients from May 2009 to December 2015 at our affiliated hospitals was included in this study. The PNI was calculated as follows: 10×serum albumin (g/dL)+0.005×total lymphocyte count (per mm3). The patients were divided into two groups according to the cut-off value of the PNI and as calculated by a receiver operating characteristic curve analysis. Results The optimum cut-off value of the PNI was set at 46.8. We defined the 33 patients with a PNI≥46.8 as the PNI-high group and the 145 patients with a PNI<46.8 as the PNI-low group. The response rate was 20.0% in the PNI-high group and 8.1% in the PNI-low group, without any statistically significance (p=0.09). The duration of sorafenib therapy and the overall survival in the PNI-high group were significantly better than those in the PNI-low group. The PNI-high group was thus found to be a predictive factor associated with the duration of sorafenib therapy [hazard ratio (HR) 0.58; 95% confidence interval (CI) 0.39-0.87, p=0.008] and overall survival (HR 0.62; 95% CI 0.39-0.99, p=0.046) in a multivariate analysis. Conclusion The PNI is a simple and useful marker for predicting the survival of patients with HCC treated with sorafenib.

Background Adjuvant durvalumab after chemoradiation has become the standard of care for patients with stage III NSCLC, according to the PACIFIC trial. Whether biomarkers before durvalumab for patients with stage III NSCLC showed predictive and prognostic effects remains unknown. Methods This is a retrospective study in the Fujieda Municipal General Hospital between October 2018 and March 2022. We assessed the predictive value of the Prognostic Nutritional Index (PNI) in stage III non-small cell lung cancer (NSCLC) patients treated with durvalumab after chemoradiation. Results After applying the inclusion and exclusion criteria, the study included 56 patients for further analysis. The median follow-up period was 17.6 months (range, 3.0–45.4 months). According to receiver operating characteristic curve results, the PNI cutoff value to predict overall survival (OS) was 37.9, with sensitivity and specificity at 67.9% and 67.9%. Accordingly, the patients were divided into low- and high-PNI groups. Patients with the low-PNI group had a significantly shorter progression-free survival compared to the high-PNI group (median, 9.1 vs. 21.3 months, p = 0.032). OS was also shorter in the low-PNI group (median, 19.0 months vs. not reached, p < 0.001). In the multivariate Cox hazards regression analyses, the high-PNI was an independent prognostic factor for OS (hazard ratio, 0.187; 95% confidence interval, 0.046–0.760; p = 0.019). Conclusions It seems that PNI could be used as a predictor for OS in patients with stage III NSCLC treated with durvalumab after chemoradiation. KEY MESSAGES Inadequate immunocompetence and nutritional status after chemoradiation therapy may result in poor antitumor efficacy of ICIs. Pretreatment immune and nutritional assessment using PNI could be considered an independent predictor for the survival of stage III NSCLC patients treated with durvalumab after chemoradiation therapy.

Background: The prognostic nutritional index (PNI) is a useful parameter that indicates the immunonutritional status of patients with malignant tumors. In this retrospective study, we aimed to investigate the value of PNI to predict the outcome of gastrointestinal stromal tumors (GISTs).Material and methods: This study enrolled 431 GIST patients who underwent curative resection from January 2000 to December 2012. A receiver operating characteristic (ROC) curve analysis was used to identify the cutoff value of PNI, neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR). Survival curves were produced using the Kaplan-Meier method and were compared using a log-rank test. The Cox proportional hazards model was used to identify independent prognostic factors.Results: Of the 431 patients, 209 (48.5%) were male and 222 (51.5%) were female. The median age was 56 (range 20-80 years old). The PNI cutoff value was 47.45, with a sensitivity of 61.1 % and a specificity of 69.9 %. Compared to the PNI-low group (PNI < 47.45), the PNI-high group (PNI ≥47.45) had a significantly longer recurrence-free survival (RFS) (5-year RFS rate 89.9% versus 70.8%, p<0.001). Patients with higher PNI (p<0.001), lower NLR (p<0.001) and lower PLR (p=0.002) had significant better prognosis. PNI was found to be an independent prognostic factor of RFS (hazard ratio [HR] =1.967, 95% confidence interval [95% CI]: 1.243-3.114, p=0.004).Conclusions: PNI is a simple and useful marker that can predict the prognosis of GIST.

To investigate the impact of prognostic nutritional index (PNI) on the postoperative complications and long-term outcomes in gastric cancer patients undergoing total gastrectomy. The data for 386 patients with gastric cancer were extracted and analyzed between January 2003 and December 2008 in our center. The patients were divided into two groups according to the cutoff value of the PNI: those with a PNI ≥ 46 and those with a PNI < 46. Clinicopathological features were compared between the two groups and potential prognostic factors were analyzed. The relationship between postoperative complications and PNI was analyzed by logistic regression. The univariate and multivariate hazard ratios were calculated using the Cox proportional hazard model. The optimal cutoff value of the PNI was set at 46, and patients with a PNI ≥ 46 and those with a PNI < 46 were classified into PNI-high and PNI-low groups, respectively. Patients in the PNI-low group were more likely to have advanced tumor (T), node (N), and TNM stages than patients in the PNI-high group. The low PNI is an independent risk factor for the incidence of postoperative complications (OR = 2.223). The 5-year overall survival (OS) rates were 54.1% and 21.1% for patients with a PNI ≥ 46 and those with a PNI < 46, respectively. The OS rates were significantly lower in the PNI-low group than in the PNI-high group among patients with stages II (P = 0.001) and III (P < 0.001) disease. The PNI is a simple and useful marker not only to identify patients at increased risk for postoperative complications, but also to predict long-term survival after total gastrectomy. The PNI should be included in the routine assessment of advanced gastric cancer patients.

The prognostic nutritional index (PNI) has been shown to be prognostic value for many types of cancer of the gastrointestinal system. However, there are limited data on its value for metastatic colorectal cancer (mCRC). This study aimed to evaluate the prognostic value of PNI in newly diagnosed mCRC patients. The data of 468 patients who had been admitted to our center upon being diagnosed with mCRC between January 2010 and December 2017 were reviewed retrospectively, whereby satisfying the inclusion criteria were included in the study. Receiver operating characteristic (ROC) analysis was used for PNI's optimum cut-off value for overall survival (OS). The Cox regression model was used in the single-variable analysis in order to test whether or not variables with prognostic properties were independent prognostic factors. A total of 308 patients were included in the study. Sixty-two percent (n=192) of the patients were males, and the median age was 57.5 years (range: 25-83). Forty-five percent (n=137) of the patients had KRAS mutation. Tumors localized in the colon accounted for 63% (n=193) of the patients. The liver was the most common region of metastasis at 69%. According to the ROC curve, the optimal cut-off value for PNI was 46 (sensitivity 74%, specificity 47%, AUC 0.615, 95% confidence interval [CI]: 0.54-0.68, P=.002). One hundred and eighty-two patients (59%) fell into the PNI-High (>46) group, while 126 patients (41%) fell into the PNI-Low (≤ 46) group. The rectum localization was higher, whereas the neutrophil-lymphocyte ratio and platelet-lymphocyte ratio were lower in the PNI-High group. There was no difference in terms of other patient characteristics. The median OS was significantly longer in the PNI-High group compared to the PNI-Low group (28.4 vs 19.1 months, P<.001). The Cox regression analysis showed that a high PNI was an independent positive prognostic factor (hazard ratio: 0.61, 95% CI: 0.42-0.87, P=.007). We found PNI to be an independent prognostic factor in mCRC. We think that PNI, which can be calculated by a simple formula, may provide clinicians important clues in order to make desicion for individual treatment.