High Prognostic Nutritional Index Group Research Articles

Preoperative prognostic nutritional index predicts long-term outcomes of patients with ampullary adenocarcinoma after curative pancreatoduodenectomy

BACKGROUND The prognostic nutritional index (PNI), a marker of immune-nutrition balance, has predictive value for the survival and prognosis of patients with various cancers. AIM To explore the clinical significance of the preoperative PNI on the prognosis of ampullary adenocarcinoma (AC) patients who underwent curative pancreaticoduodenectomy. METHODS The data concerning 233 patients diagnosed with ACs were extracted and analyzed at our institution from January 1998 to December 2020. All patients were categorized into low and high PNI groups based on the cutoff value determined by receiver operating characteristic curve analysis. We compared disease-free survival (DFS) and overall survival (OS) between these groups and assessed prognostic factors through univariate and multivariate analyses. RESULTS The optimal cutoff value for the PNI was established at 45.3. Patients with a PNI ≥ 45.3 were categorized into the PNI-high group, while those with a PNI < 45.3 were assigned to the PNI-low group. Patients within the PNI-low group tended to be of advanced age and exhibited higher levels of aspartate transaminase and total bilirubin and a lower creatinine level than were those in the PNI-high group. The 5-year OS rates for patients with a PNI ≥ 45.3 and a PNI < 45.3 were 61.8% and 43.4%, respectively, while the 5-year DFS rates were 53.5% and 38.3%, respectively. Patients in the PNI- low group had shorter OS (P = 0.006) and DFS (P = 0.012). In addition, multivariate analysis revealed that the PNI, pathological T stage and pathological N stage were found to be independent prognostic factors for both OS and DFS. CONCLUSION The PNI is a straightforward and valuable marker for predicting long-term survival after pancreatoduodenectomy. The PNI should be incorporated into the standard assessment of patients with AC.

Prognostic importance of prognostic nutritional index and modified Glasgow prognostic score in advanced lung cancer with targetable mutation

BackgroundInflammation and nutrition are important parameters that significantly affect survival in various malignancies. Prognostic nutritional index (PNI) and modified Glasgow prognostic score (mGPS) can reflect both inflammatory and nutritional conditions. Therefore, we aimed to evaluate the prognostic value of PNI and mGPS in patients who had the targetable mutation and also received targeted therapy.Materials and MethodsAdvanced lung cancer patients with EGFR mutation (mut) and ALK rearrangement were enrolled to study, retrospectively. PNI has with the following formula: 10 × serum albumin (g/dl) + 0.005 × peripheral lymphocyte count (per mm3) and threshold value was accepted as 50. Modified GPS was also calculated using albumin and CRP level and patients were scored as range 0 to 2.ResultsA total of 182 patients enrolled in the study. 132 and 50 of 182 patients had EGFR mut and ALK rearrangement, respectively. PFS was significantly longer in high PNI group in both the EGFR and ALK rearrangement-positive subgroups (P = 0.004 for EGFR mut-positive group; P = 0.017 for ALK rearrangement-positive group). Additionally, PFS was significantly shortened from mGPS 0 to 2 (P = < 0.001 for EGFR mut-positive group; P = 0.016 for ALK rearrangement-positive group).ConclusionBoth PNI and mGPS can be used as a reliable, inexpensive, and easily applicable prognostic index in the advanced lung cancer patients who had the targetable mutation and also received targeted therapy.

Effectiveness of prognostic nutritional index in predicting overall survival and evaluating immunotherapy response in anaplastic thyroid carcinoma.

The prognostic value of nutritional status in anaplastic thyroid carcinoma (ATC) remains unclear. The Prognostic Nutritional Index (PNI) is a reliable indicator of overall nutritional and immune status, and it has emerged as a significant prognostic factor in various malignancies. This study aimed to explore the utility of PNI in ATC. We systematically reviewed ATC patients in our institute from January 2000 to June 2023 and categorized them into high and low PNI groups based on the median PNI value. Kaplan-Meier analysis and Cox regression were employed to assess the impact of PNI on overall survival, while ROC curve analysis evaluated the predictive value of PNI. Mimics software was used for three-dimensional reconstruction of pre- and post-immunotherapy tumor volumes, enabling the assessment of treatment response. A total of 77 ATC patients were included in this study. Low baseline PNI was associated with significantly shorter overall survival (1-year survival rate: 5.26% vs 30.77%; median survival time: 5.30 months vs 8.87 months). The 1-year, 2-year, and 3-year AUC values for PNI were 0.82, 0.79, and 0.77, respectively. In the multivariate analysis, both PNI and tumor size emerged as independent prognostic factors for patient overall survival. Among ATC patients receiving 2-3 cycles of immunotherapy, an increase in post-treatment PNI levels was positively correlated with a reduction in tumor volume. PNI is an independent predictor of overall survival and holds the potential to serve as a valuable indicator for assessing and predicting immunotherapy efficacy in ATC patients.

Predictive role of the prognostic nutritional index in patients with pancreatic ductal adenocarcinoma who underwent neoadjuvant chemoradiotherapy followed by curative pancreatic resection: A retrospective study using prospectively collected data.

Despite a strong association between nutritional indices and disease prognosis, evidence regarding the evaluation of nutritional indices after preoperative treatment for pancreatic ductal adenocarcinoma (PDAC) is insufficient. We evaluated the clinical significance of the prognostic nutritional index (PNI) in patients with resectable (R-) and borderline resectable (BR-) PDAC who received neoadjuvant chemoradiotherapy (NACRT) followed by pancreatic resection. We assessed 153 patients with R- and BR-PDAC who underwent NACRT followed by curative resection between 2009 and 2022. We evaluated the association between preoperative PNI after NACRT and short- and long-term outcomes. The median preoperative PNI value after NACRT was 42.1, and the optimal cutoff value from the time-dependent receiver operating characteristic curve was 38.6. The low PNI group (PNI < 38.6, n = 44) exhibited significantly worse inflammatory parameters, surgical outcomes, and prognoses than the high PNI group (PNI ≥ 38.6, n = 109). Multivariate analysis identified preoperative PNI ≤ 38.6 (hazard ratio [HR]: 2.32, 95% confidence interval [CI]: 1.00-5.38, p = .049), blood loss ≥1642 mL (HR: 3.05, 95% CI: 1.65-5.64, p < .001), node positive pathology (HR: 2.10, 95% CI: 1.32-3.34, p = .002), and lack of postoperative adjuvant chemotherapy (HR: 3.55, 95% CI: 2.05-6.15, p < .001) as significant predictors of overall survival. For patients with R- and BR-PDAC receiving preoperative treatment, it is imperative to closely monitor their nutritional status when determining the optimal surgical procedure timing.

Association of Nutritional Indices With Adverse Effects and Time-to-Treatment-Failure in Triple Therapy for Lung Cancer.

Recent lung cancer treatments include an immune checkpoint inhibitor (ICI) pembrolizumab, platinum-based agents, plus an additional cytotoxic anticancer agent. Nutritional indices, such as the geriatric nutritional risk index (GNRI) and the prognostic nutritional index (PNI), are known to correlate with the prognosis of cancer chemotherapy. Several previous studies have investigated the relationship between PNI and treatment response in non-small cell lung cancer patients, reporting significantly increased OS and PFS in the high PNI group before treatment. However, the relationship between the three-drug combination and GNRI/PNI is unclear. The current study aimed to investigate the association of nutritional indices with duration of treatment success and occurrence of side effects in triple therapy. Seventy-two patients with non-small cell lung cancer, treated with combination of carboplatin, pemetrexed, and pembrolizumab from November 2019 to September 30, 2022, were classified into two groups (High and Low) for GNRI and PNI, and a retrospective study was performed. In terms of time-to-treatment-failure (TTF), univariate and multivariate Cox proportional hazards regression analysis showed the Low-PNI group to have significantly shorter TTF than the High-PNI group (p=0.006); multivariate analysis results also showed PNI as a factor affecting TTF (HR=2.791, 95%CI=1.362-5.721, p=0.005). On the other hand, GNRI was not shown to be a factor affecting TTF. PNI at the start of treatment was an independent prognostic factor affecting treatment success time (TTF) in non-small cell lung cancer patients receiving triple therapy. However, PNI was not shown to be a prognostic predictor of irAE development.

Nutritional index in relation to prognosis of endometrial cancer.

Objective: Evaluate the prognostic value of the prognostic nutritional index (PNI) in patients with endometrial cancer (EC). Method: Laboratory and clinicopathological data from 370 patients who were diagnosed with EC between January 2010 and December 2021 were reviewed. The PNI was analyzed for correlations with recurrence and survival. The receiver operating characteristic curves were generated for the PNI. Optimal cut-off values were determined as the points at which the Youden index (sensitivity + specificity - 1) was maximal. Based on the results of the ROC curve analysis, the patients were grouped into high and low PNI groups. Differences in the clinicopathological characteristics between patients with high and low PNI were compared between the two groups. The effects of the prognostic factors were analyzed using univariate and multivariate Cox proportional hazards model. Results: The optimal cutoff value of the PNI was 52.74 for DFS (area under the curve: 0.817; 95% CI: 0.738-0.858, p <0.001). Significantly more patients in the low PNI group experienced recurrence (30.6% vs. 5.2%, p <0.001) and cancer-related death (17.8% vs. 2.8%, p <0.001). In multivariate analysis, PNI were independent prognostic factors for both DFS and overall survival OS. Conclusion: Low PNI was significantly associated with worse clinical outcomes in patients with EC. Our findings demonstrate that the PNI may be clinically reliable and useful as a prognostic marker for patients with EC. Further large-scale prospective studies are needed to confirm our findings.

The Prognostic Value of Prognostic Nutritional Index Combined with D-dimer in Patients with Diffuse Large B-Cell Lymphoma

To explore the effects of prognostic nutritional index (PNI) combined with D-dimer on the prognosis of patients with newly diagnosed diffuse large B-cell lymphoma (DLBCL). The clinical data of 73 DLBCL patients at initial diagnosis were retrospectively evaluated, and the optimal cut-off point of PNI and D-dimer were determined by ROC curve. The overall survival (OS) rate and progression-free survival (PFS) rate in different subgroups were compared using Kaplan-Meier survival curves. Univariate and multivariate Cox regression analysis was performed to identify the factors associated with OS. Compared with the low PNI group (PNI<44.775), the high PNI group (PNI≥44.775) had better OS (P =0.022) and PFS (P =0.029), the 2-year OS rates of the two groups were 55.6% and 78.3% respectively (P =0.041). Compared with the high D-dimer group (D-dimer≥0.835), the low D-dimer group (D-dimer<0.835) had better OS (P <0.001) and PFS (P <0.001), the 2-year OS rates of the two groups were 51.4% and 86.8% respectively (P =0.001). Meanwhile, patients in the high PNI+ low D-dimer group had better OS (P =0.003) and PFS (P <0.001) than the other three groups, the 2-year OS rate was statistically different from the other three groups (P <0.05). The multivariate analysis revealed that NCCN-IPI (HR =2.083, 95%CI : 1.034-4.196, P =0.040), PNI (HR =0.267, 95%CI : 0.076-0.940, P =0.040) and PNI+D-dimer (HR =9.082, 95%CI : 1.329-62.079, P =0.024) were the independent risk factors affecting OS in patients with DLBCL. Subgroup analysis showed that PNI, D-dimer, and PNI combined with D-dimer could improve the prognostic stratification in low and low-intermediate risk DLBCL patients. High PNI, low D-dimer and combination of high PNI and low D-dimer at initial diagnosis suggest a better prognosis in DLBCL patients.

High prognostic nutritional index could be associated with improved survival in patients with brain metastases: a retrospective observational study

ABSTRACT Background Prognostic nutritional index (PNI) is an indicator of immunonutritional status. The present study aimed to evaluate the association between PNI and overall survival in patients with brain metastases. Methods A total of 257 patients with histologically confirmed brain metastasis who underwent surgery at our center between April 2011 and April 2021 were investigated retrospectively. Demographic, clinical, and radiologic data of all cases were extracted. Patients were divided into the low PNI group(PNI <45) (malnutrition status) and the high PNI group (PNI ≥45)(normal nutritional status). Survival analyses were performed using the Kaplan-Meier method and compared using the log-rank test. Univariate and multivariate analyses were performed using the Cox proportional hazards method. Results From the 257 cases of brain metastases, there were 148 (57.6%) males and 109 (42.4%) females. The mean age was 57.02 ± 8.7. The median overall survival was 13 months. The results of the multivariate Cox regression analyses showed primary cancer site (HR 2.196, 95% CI 1.988–6.52605, P = 0.000), the number of metastases (HR 1.829, 95% CI 1.380–2.872, P = 0.037), extracranial involvement (HR 2.186, 95% CI 1.213–4.171, P = 0.026), adjuvant radiotherapy (HR 2.823, 95% CI 1.187–5.415, P = 0.017) and PNI (HR 1.961, 95% CI 1.168–3.515, P = 0.021) as the independent predictors of overall survival in patients with brain metastases. Conclusion Our results suggest that PNI could be associated with survival in patients with brain metastases. Patients with a lower PNI had a significantly worse outcome in comparison with those with a higher PNI. Evaluation of PNI may provide additional prognostic information in patients with brain metastases.

Preoperative prognostic nutritional index is an independent indicator for perioperative prognosis in coronary artery bypass grafting patients

ObjectivesThe prognostic nutritional index is widely used for surgery prognosis, but the association between preoperative prognostic nutritional index and short-term prognosis for coronary artery bypass grafting surgery and the profiles of perioperative prognostic nutritional index remain unclear. MethodsThis study retrospectively enrolled a total of 879 adult patients undergoing coronary artery bypass grafting surgery in the Shanghai Chest Hospital from 2006 to 2022. The prognostic nutritional index was calculated based on serum albumin and peripheral lymphocyte count. In-hospital mortality, demographic characteristics, blood biochemistry parameters, cardiovascular medical history, and physical examination results were collected from the hospital information system. The propensity score matching method and multivariate logistic regression were used to detect the association between preoperative prognostic nutritional index and in-hospital mortality. ResultsPatients were divided into a high–prognostic nutritional index group (n = 500) and a low–prognostic nutritional index group (n = 379), using a cutoff value of 48.1 according to receiver operating characteristic curve analysis. The propensity score matching–adjusted mean prognostic nutritional index levels decreased from 48.35 before the operation to 34.04 an in ≤24 h after the operation and rebounded to 43.36 before discharge. High preoperative prognostic nutritional index was inversely associated with in-hospital mortality for coronary artery bypass grafting surgery (odds ratio = 0.86; 95% CI, 0.77–0.97) in propensity score matching–adjusted multivariate logistic regression. ConclusionsPreoperative prognostic nutritional index is an independent indicator for in-hospital mortality of for coronary artery bypass grafting surgery, and the variation trend of prognostic nutritional index during perioperation tends to be U-shaped.

The Prognostic Nutritional Index in prediction of two-year mortality in patients undergoing Transcatheter Aortic Valve Replacement

Objective: Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure employed to treat aortic valve disease in patients who are ineligible for open-heart surgery. Undergoing TAVR patients generally include the elderly and frail. Malnutrition is associated with high morbidity and mortality in patients with undergoing TAVR. The aim of this study was to investigate the prognostic value of the prognostic nutritional index (PNI) for two-year survival after TAVR. Material and Methods: A cohort of 213 consecutive patients with severe aortic stenosis who underwent transcatheter aortic valve replacement between March 2019 and July 2021. The study population was divided into two groups according to the cut-off PNI level in a receiver operator characteristic (ROC) curve analysis. The two-year follow-up results of the patients were recorded retrospectively. PNI was defined according to the following formula: PNI = (10 x serum albumin [g/dl]) + (0.005 x total lymphocyte counts [1000/mcL]). Results: Mean age of the patients was 76.15, and 93 (43.7%) of them were males. Patients with low PNI (group 1) were significantly older. The mean PNI of group 1 was 43.17 ± 4.04 and the mean PNI of group 2 was 54.23 ± 4.30. Mortality at two-year was 32.6% in low PNI group and 10.7% in high PNI group. Hypertension and PNI were independent predictors of mortality after TAVR. In ROC curve analysis, PNI at a cut off value of 48.325 predicted the mortality after TAVR with 63.5% sensitivity and 70.1% specificity. Kaplan-Meier curves for two-year mortality between low and high PNI groups showed worse outcomes in patients with low PNI. Conclusion: PNI is a practical and useful nutritional index that predicts two-year mortality after TAVR.

Is the Prognostic Nutritional Index a Prognostic Marker for the Survival of Patients with Lymph-Node Positive Stage II-III Gastric Cancer Who Receive Adjuvant Chemotherapy?

The prognostic nutritional index (PNI), like other systemic inflammatory markers, has been shown to be a prognostic factor in various cancer patients. In this study, we aimed to show whether PNI calculated before adjuvant chemotherapy is a prognostic factor for overall survival (OS) and disease-free survival (DFS) in patients with lymph node-positive stage II-III gastric cancer. The PNI was calculated using the albumin and lymphocyte count. The PNI cut-off value was found to be 39.5. They were divided into two groups as being ≤ 39.5 (PNI low group) and > 39.5 (PNI high group). Our study included 168 patients with lymph node-positive stage II-III gastric cancer who received adjuvant chemotherapy. Of the patients, 116 (69.0%) were 65 years or younger, and 52 (31.0%) were over 65 years old. Of the patients, 117 (69.6%) were pT3, 51 (30.4%) were pT4. Seventy-three (43.4%) patients had pN1-2 disease and 95 (56.6%) patients had pN3 disease. The number of stage II patients was 73 (43.5%) and the number of stage III patients was 95 (56.5%). There were 73 patients with PNI ≤ 39.5 and 95 patients with PNI > 39.5. The mOS of the patients with low PNI group was 39.5 months, while the OS of the patients with high PNI group was 96.8 months (p = 0.002). In the group of patients with PNI low group, mDFS 24.4 months was significantly higher than those with PNI high group was 50.7 months (p = 0.021). The PNI score was statistically significant in univariate and multivariate analyzes for both DFS and OS. PNI can be used as an independent prognostic factor for both OS and DFS in patients lymph node-positive, stage II-III gastric cancer who will receive adjuvant chemotherapy.

227. RELATIONSHIP BETWEEN 90-DAY PROGNOSIS NUTRITIONAL INDEX AND INFLAMMATORY RESPONSE MARKERS AND LONG-TERM SURVIVAL IN ESOPHAGEAL CANCER

Abstract Background The incidence rate of esophageal cancer in Asia is mainly squamous cell carcinoma, which is characterized by high mortality and poor prognosis. The prognosis of tumors is not only related to the biological characteristics of tumor cells, but also closely related to the nutritional status and inflammatory response of patients. The aim of this study is to investigate the relationship between nutritional index (PNI) and inflammatory response markers (NLR, LMR) at 90 days after surgery and long-term survival in patients with esophageal squamous cell carcinoma. To provide reference for accurately assessing the condition, identifying survival risks, and improving long-term prognosis. Methods The data of ESCC patients who underwent radical resection for esophageal cancer from April 2018 to November 2018 were extracted (n = 66). Calculate the prognostic nutritional index (PNI), neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR) and other indicators of patients at 90 days after operation. ROC was used to calculate the cut-off values of PNI, NLR, and LMR. KaplanMeier survival curve was used to analyze the relationship between different PNI, NLR, LMR levels and long-term survival of patients. All patients were followed up regularly after surgery, and the last follow-up time was April 2023. Results The best cut-off values of PNI, NLR, and LMR were 42.8, 3.27, and 4.76, respectively. Kaplan Meier survival analysis showed a correlation between postoperative PNI, NLR, LMR at 90 days and overall survival and disease-free survival. At 90 days after surgery, the OS (P = 0.007) and DFS (P = 0.038) of patients in the high PNI group (PNI ≥ 42.8) were better than those in the low PNI group; The OS (P = 0.002) and DFS (P = 0.048) of patients in the low NLR group (NLR &amp;lt; 3.27) were better than those in the high NLR group; The OS (P = 0.001) and DFS (P = 0.039) of patients in the high LMR group (LMR ≥ 4.76) were better than those in the low LMR group. Conclusions PNI, NLR, and LMR are important predictors of OS and DFS in patients with esophageal squamous cell carcinoma after radical resection of esophagus. Patients with PNI ≥ 42.8, NLR&amp;lt;3.27, and LMR ≥ 4.76 at 90 days after surgery have better OS and DFS.

Impact of the Prognostic Nutritional Index on Postoperative Outcomes in Patients Undergoing Heart Surgery.

Background Malnutrition is associated with adverse outcomes in patients undergoing cardiac surgery. The prognostic nutritional index (PNI) is a validated tool for assessing nutritional status in cardiovascular diseases. This study aims to evaluate the prognostic value of PNI in heart surgery patients, including mortality rate, length of hospital and ICU stays, and infection rate, while investigating correlations with demographic and clinical characteristics. Methods A retrospective cross-sectional study was conducted in King Fahad Armed Forces Hospital in Jeddah, Saudi Arabia. Data from electronic medical records of patients undergoing heart surgery between 2019 and 2021 were retrospectively reviewed. The study involved patients with valvular heart disease, including those requiring concomitant procedures. Statistical analysis was conducted using t-tests, logistic regression, and Kaplan-Meier survival curve analysis. Results This study included 264 individuals with a mean age of 56.48±12.11 years. The prevalence of low PNI was 50.80% and high PNI was 49.20%. No significant differences in PNI levels were found between individuals with various clinical conditions, except for target vessel revascularization. The mortality rate was slightly higher in the low PNI group, but not statistically significant. Significant differences in laboratory findings were observed between high and low PNI groups. Individuals with low PNI had longer hospital stays. Conclusion Lower PNI levels consistently correlate with longer hospital stays and higher morbidity and mortality rates, suggesting the potential importance of PNI and other nutritional markers in assessing risk and predicting outcomes in cardiac surgery patients.

Peripheral blood nutrient indices as biomarkers for anti‑PD‑1 therapy efficacy and prognosis in patients with advanced gastric cancer.

Immunotherapy offers survival benefits for patients with advanced gastric cancer, but not all populations can benefit from immunotherapy. Good nutritional status is fundamental to a patient's immune function and may have an impact on the efficacy of immunotherapy. The present study aimed to investigate changes in prognostic nutritional index (PNI), advanced lung cancer inflammation index (ALI) and albumin-globulin ratio (AGR) values before and after immunotherapy in patients with advanced gastric cancer. The study also aimed to determine the potential association of the aforementioned values with patient outcomes and prognosis. Body mass index (BMI), serum albumin, total protein, peripheral blood lymphocyte, neutrophil, carcinoembryonic antigen (CEA), carbohydrate antigen19-9 (CA19-9) and a-fetoprotein (AFP) data were collected from 195 patients with advanced gastric cancer who underwent immunotherapy from January 2020 to October 2021. In addition, PNI, ALI and AGR values were calculated based on variables in blood collected from the patients within 3 days prior to immunotherapy and 3 weeks after immunotherapy. The results demonstrated that low PNI was associated with elevated CEA levels. Moreover, low ALI levels were associated with reduced BMI levels, elevated AFP levels, PD-L1 negative and first-line treatment. Comparison of responding and non-responding groups revealed that patients who responded to immunotherapy had higher PNI and AGR values than patients who did not respond, both before and after treatment, but had lower CEA and CA19-9 levels after treatment. Furthermore, in the non-responding group, PNI and AGR values were decreased and CEA values were increased following treatment compared with those prior to treatment. The objective response and disease control rates were higher in the high PNI and AGR groups compared with the low PNI and AGR groups, respectively. Moreover, PNI and AGR were found to be independent predictors of the short-term efficacy of immunotherapy for advanced gastric cancer, with cut-off values of 47.18 and 1.29, respectively. Univariate analysis revealed that ALI was associated with the progression-free survival (PFS) of patients, while multivariate analysis demonstrated that baseline PNI and AGR were independent predictors of PFS. In conclusion, tumor progression leads to a decline in the nutritional level of patients, and the present study indicated that effective immunotherapy may alleviate this deterioration to a certain extent. Furthermore, PNI and AGR exhibit potential in predicting the efficacy of immunotherapy and the prognosis of patients with advanced gastric cancer, and may exhibit potential as biomarkers in clinical practice.

Predictive Value of the Prognostic Nutritional Index for Long-Term Mortality in Patients with Advanced Heart Failure.

Malnutrition is common in patients with advanced heart failure (HF), and both conditions have a poor prognosis. We sought to determine the predictive value of nutritional status using the prognostic nutritional index (PNI) for long-term mortality in patients with advanced HF. This is a retrospective observational study. The optimal PNI cut-off value for predicting all-cause mortality was determined to be 50.5 using receiver operating characteristic curve analysis. Patients were divided into two groups: the low PNI (≤ 50.5) and high PNI (> 50.5) group. A total of 217 patients (age 48.9 ± 9.9 years, 82.5% male) with advanced HF were included in this study. The mean follow-up duration was 28.6 ± 19.4 months. The high PNI group had higher 5-year all-cause and cardiovascular death-free survival rates compared to the low PNI group (86.7% vs. 24.6%, log-rank p < 0.001) and (89.6% vs. 36.1%, log-rank p < 0.001), respectively. In multivariable Cox regression analyses, low PNI [hazard ratio (HR): 4.70; 95% confidence interval (CI): 2.19-10.11, p < 0.001] and high sensitivity C-reactive protein (hsCRP) (HR: 1.02; 95% CI: 1.01-1.03, p = 0.04) were found to be independent predictors of long-term all-cause mortality. Low PNI (HR: 4.52; 95% CI: 1.99-10.24, p < 0.001), hsCRP (HR: 1.01; 95% CI: 1.00-1.03, p = 0.04), and New York Heart Association class IV vs. III (HR: 2.56; 95% CI: 1.36-4.82, p = 0.03) were also found to be independent predictors of long-term cardiovascular mortality. PNI was found to be an independent predictor of long-term all-cause and cardiovascular mortality in patients with advanced HF, and it can be used as an objective and simple tool for risk stratification.

Clinical influence of neoadjuvant chemoradiotherapy on immunonutritional status in locally advanced rectal cancer.

Cancer patients receiving various anti-cancer treatments commonly experience malnutrition, and many studies have reported that nutritional status is associated with survival and prognosis. Although standard neoadjuvant chemoradiotherapy (CRT) is commonly used in patients with locally advanced rectal cancer owing to its tumor-downsizing and downstaging effects, there is a lack of research on the impact of patients' nutritional status on the efficacy of neoadjuvant CRT. We investigated the immunonutritional markers before and after long-course neoadjuvant CRT in 131 patients diagnosed with locally advanced rectal cancer from March 2013 to March 2022. We divided the patients into two groups: a low prognostic nutritional index (PNI) with a cutoff value of 50.92, and a high PNI. In both groups, significant decreases in lymphocyte count and PNI and an increase in neutrophil-to-lymphocyte ratio (NLR) were observed before and after CRT (P<0.001). Furthermore, a higher proportion of patients experienced adverse effects in the low PNI group than in the high PNI group (76.6% in low PNI vs. 54.8% in high PNI, P=0.013). The most commonly reported CRT-induced adverse effect was lower gastrointestinal tract toxicity. By measuring the PNI and NLR without additional tests prior to starting neoadjuvant CRT in patients with locally advanced rectal cancer, it is possible to predict the risk of acute adverse effects caused by CRT. Additionally, providing external nutritional support to reduce the immunonutritional changes that occur during CRT can decrease side effects and potentially increase treatment compliance.

Use of the prognostic nutrition index as a predictive biomarker in small-cell lung cancer patients undergoing immune checkpoint inhibitor treatment in the Chinese alpine region.

Whether the prognostic nutritional index (PNI), which is suggested to reflect systemic inflammation and nutritional status of patients, could be used as an effective prognostic factor for small-cell lung cancer (SCLC) has not yet been clarified. The purpose of this study was to verify the prognostic value of the PNI in SCLC patients treated with programmed cell death ligand-1/programmed cell death 1 (PD-L1/PD-1) inhibitors in the alpine region of China. SCLC patients treated with PD-L1/PD-1 inhibitors monotherapy or combined with chemotherapy between March 2017 and May 2020 were included. Based on the values of serum albumin and total lymphocyte count, the study population was divided into two groups: high and low PNI. The Kaplan-Meier method was used to compute the median survival time and the log-rank test was used to compare the two groups. To evaluate the prognostic value of the PNI, univariable and multivariable analyses of progression-free survival (PFS) and overall survival (OS) were performed. The correlations between PNI and DCR or ORR were calculated by Point biserial correlation analysis. One hundred and forty patients were included in this study, of which, 60.0% were high PNI (PNI > 49.43) and 40.0% were low PNI (PNI ≤ 49.43). Results indicated that the high PNI group had better PFS and OS than the low PNI group in the patients who received PD-L1/PD-1 inhibitors monotherapy (median PFS: 11.0 vs. 4.8 months, p < 0.001 and median OS: 18.5 vs. 11.0 months, p = 0.004). Similarly, better PFS and OS were associated with an increase in PNI level in the patients who accepted PD-L1/PD-1 inhibitors combined with chemotherapy (median PFS: 11.0 vs. 5.3 months, p < 0.001 and median OS: 17.9 vs. 12.6 months, p = 0.005). Multivariate Cox-regression model showed that high PNI was significantly related to better PFS and OS in patients who accepted PD-L1/PD-1 inhibitors monotherapy or combined with chemotherapy (PD-L1/PD-1 inhibitors monotherapy: PFS: HR = 0.23, 95% CI: 0.10-0.52, p < 0.001 and OS: HR = 0.13, 95% CI: 0.03-0.55, p = 0.006; PD-L1/PD-1 inhibitors combined with chemotherapy: PFS: HR = 0.34, 95% CI: 0.19-0.61, p < 0.001 and OS: HR = 0.53, 95% CI: 0.29-0.97, p = 0.040, respectively). Additionally, Point biserial correlation analysis between PNI and disease control rate (DCR) showed that PNI status was positively correlated with DCR in SCLC patients receiving PD-L1/PD-1 inhibitors or combined with chemotherapy (r = 0.351, p < 0.001; r = 0.285, p < 0.001, respectively). PNI may be a promising biomarker of treatment efficacy and prognosis in SCLC patients treated with PD-L1/PD-1 inhibitors in the alpine region of China.

Assessment of Peripheral Platelet to Lymphocyte Ratio and Prognostic Nutritional Index in the Efficacy and Prognosis of Radiotherapy for Cervical Cancer.

This study aimed to evaluate the correlation between the pre-treatment peripheral platelet-to-lymphocyte ratio (PLR) and the prognostic nutritional index (PNI) with the efficacy and prognosis of radiotherapy for cervical cancer. A total of 110 patients with cervical cancer who received radiotherapy at our hospital from November 2017 to November 2020 were retrospectively analysed. The cut-off values of PLR and PNI were obtained using the receive operating characteristic curve (ROC) and the Youden index. The patients were divided into high PLR and low PLR and high PNI and low PNI groups. We compared the clinical characteristics, 3-year overall survival (OS), and progression-free survival (PFS) between the high and low PLR groups, as well as the high and low PNI groups of patients. Cox regression was used to analyse the factors influencing OS and PFS. The median follow-up duration was 26 months. The optimal cut-off value for PLR was 186.88 and that for PNI was 47.35. The 3-year OS values were 81.00% and 97.10% for the high PLR (PLR > 186.88) and low PLR (PLR ≤ 186.88) groups, respectively, and the 3-year PFS values were 59.50% and 88.20% for the high PLR and low PLR groups, respectively, with statistically significant differences (p < 0.05). The 3-year OS values were 97.50% and 74.20% for the high PNI (PNI > 47.35) and the low PNI (PNI ≤ 47.35) groups, respectively, and the 3-year PFS values were 87.30% and 51.60% for the high PNI and low PNI groups, respectively, with statistically significant differences (p < 0.05). Multifactorial Cox regression analyses revealed that high PLR value (PLR > 187.88), low PNI value (PNI ≤ 47.35), histological type, and FIGO stage were independent risk factors for the OS of cervical cancer. Pretreatment PNI values and PLR values can be used as simple and feasible predictors of clinical efficacy and prognosis for patients treated with radiotherapy for cervical cancer.

Prognostic value of the preoperative prognostic nutritional index and systemic immuno-inflammatory index in Chinese breast cancer patients: A clinical retrospective cohort study.

It has been shown that peripheral blood inflammatory factor ratios correlate with the prognosis of various malignancies. Although indicative of prognosis in some tumors, its value for prognosis in breast cancer patients is unclear. The clinical data of breast cancer patients diagnosed with breast cancer in the Second Hospital of Jilin University from January 1, 2013, to December 31, 2017, were retrospectively analyzed. Theprognostic nutritional index(PNI) optimal cutoff values of the subjects' operating characteristic curves divided the patients into a low PNI group (≤51.05) and a high PNI group (>51.05). Correlations between breast cancer and PNI clinicopathological variables were determined by the χ2 test or Fisher exact test. Kaplan-Meier plots and log-rank tests were used to assess clinical outcomes in terms of disease-free survival (DFS). The prognostic value of PNI was analyzed by univariate and multivariate Cox proportional risk regression models. The best cutoff value for predicting DFS by pretreatment PNI was 51.05 and the Youden index when was 0.416, with a sensitivity of 71.4% and specificity of 70.2%. Univariate analysis showed that PNI ≤ 51.05, human epidermal growth factor receptor-2 (HER-2) positivity, and the number of lymph node metastases >4 were risk factors affecting DFS in invasive breast cancer (p < 0.05). Cox multifactor analysis showed that PNI and lymph node status were the most important factors affecting the prognosis of invasive breast cancer. Neutrophils-to-lymphocytes ratio and platelets-to-lymphocytes ratio were not significantly correlated with patient prognosis (p > 0.05). Preoperative peripheral blood PNI in patients with invasive breast cancer are independent risk factors affecting patients' prognosis, they are positively correlated with prognosis and can be used as indicators to assess prognosis. PNI, HER-2, and lymph node status had the best predictive efficacy with the area under the curve = 0.816 (95% confidence interval: 0.680-0.951, p < 0.001).

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

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. 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. 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. 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.