Abstract
The prognostic nutritional index (PNI), controlling nutritional status (CONUT) score and nutritional risk index (NRI) have been described as useful screening tools for patient prognosis in several diseases. The aim of this study was to examine the relationship between PNI, CONUT and NRI with clinical disease activity and damage in 173 patients with systemic lupus erythematous (SLE). Disease activity was assessed with the SLE disease activity index (SLEDAI-2K), and disease-related organ damage was assessed using the SLICC/ACR damage index (SDI) damage index. PNI and NRI were significantly lower in active SLE patients than in inactive SLE patients (p < 0.001 and p = 0.012, respectively). PNI was inversely correlated with the SLEDAI score (p < 0.001) and NRI positively correlated with SLEDAI and SDI scores (p = 0.027 and p < 0.001). Linear regression analysis adjusting for age, sex and medications showed that PNI was inversely correlated with SLEDAI (β (95% CI) = −0.176 (−0.254, −0.098), p < 0.001) and NRI positively correlated with SLEDAI (β (95% CI) = 0.056 (0.019, 0.093), p = 0.003) and SDI (β (95% CI) = 0.047 (0.031, 0.063), p < 0.001). PNI (odds ratio (OR) 0.884, 95% confidence interval (CI) 0.809–0.967, p = 0.007) and NRI ((OR) 1.067, 95% CI 1.028–1.108, p = 0.001) were independent predictors of active SLE. These findings suggest that PNI and NRI may be useful markers to identify active SLE in clinical practice.
Highlights
Systemic lupus erythematosus (SLE) is a heterogeneous, chronic, inflammatory autoimmune disease that involves multiple organ systems and displays a variable clinical score [1]
We identified a relationship between nutritional risk index (NRI) and damage accrual measured by SLICC/American College of Rheumatology (ACR) damage index (SDI), and both prognostic nutritional index (PNI) and NRI correlated with disease activity measured by SLEDAI in SLE
Idborg et al proposed the use of plasma albumin as a potential biomarker of disease activity in SLE [8], while Yip et al showed that higher SLEDAI scores correlated with lower serum albumin levels in a large population of patients [9]
Summary
Systemic lupus erythematosus (SLE) is a heterogeneous, chronic, inflammatory autoimmune disease that involves multiple organ systems and displays a variable clinical score [1]. SLE patients are undergoing multiple medical treatments, and can go through chronic fatigue, depression and the presence of comorbidities which lead to changes in appetite and an increased risk of malnutrition [4]. Serum albumin is a well-known negative acute-phase protein whose levels decrease during inflammation and malnutrition [5,6]. Subnormal levels have commonly been reported in SLE patients [7,8] and serum albumin has previously been established as a potential surrogate marker of SLE disease activity [8,9,10]
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