Impact Of Prognostic Nutritional Index Research Articles

Impact of prognostic nutritional index on the occurrence of post-operative delirium after total knee arthroplasty

PurposeDelirium has been reported to cause delayed functional recovery, prolonged hospitalization, future institutionalization, increased mortality, and increased healthcare costs. However, there are no reports on how prognostic nutritional index (PNI), Controlling Nutritional Status (CONUT) score, and geriatric nutritional risk index (GNRI) are related to delirium after total knee arthroplasty (TKA). This study aimed to identify risk factors for post-operative delirium after TKA using various pre-operative nutritional assessments (PNI, CONUT score, and GNRI). MethodsIn total, 289 patients who underwent primary TKA between September 2011 and April 2022 in our institute (Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan) were enrolled. Patients were divided into two groups: those who developed post-operative delirium (Group D), and those who did not (Group ND). Pre-operative risk factors, including nutritional indices, for post-operative delirium were evaluated. ResultsGroup D comprised 16 participants, while Group ND comprised 273 participants. Comparisons between the two groups revealed significant differences in age, PNI, CONUT score, GNRI, and history of cerebrovascular disease. Multiple logistic regression analysis revealed that significant risk factors for delirium after TKA were age, PNI, and history of cerebrovascular disease. A receiver operating characteristic curve indicated that the cutoff values for delirium were 47.4 for PNI (sensitivity, 0.810; specificity, 0.875) and 78.5 years for age (sensitivity, 0.813; specificity, 0.722). ConclusionsRisk factors for post-operative delirium after TKA were PNI <47.4, age >78.5 years, and history of cerebrovascular disease. Patients exceeding these pre-operative cutoff values or with a history of cerebrovascular disease should receive counseling about delirium before surgery.

Impact of Prognostic Nutritional Index (PNI) and Inflammatory Index among Critically Ill Patients with Acute Kidney Injury

Impact of Prognostic Nutritional Index (PNI) and Inflammatory Index among Critically Ill Patients with Acute Kidney Injury

Impact of Prognostic Nutritional Index and Systemic Immune-Inflammation Index on the Clinical Outcome of Diffuse Large B Cell Lymphoma Patients Treated with RCHOP

Impact of Prognostic Nutritional Index and Systemic Immune-Inflammation Index on the Clinical Outcome of Diffuse Large B Cell Lymphoma Patients Treated with RCHOP

Low Prognostic Nutritional Index Is Common and Associated with Poor Outcomes following Curative-Intent Resection for Gastro-Entero-Pancreatic Neuroendocrine Tumors

Introduction: To investigate the impact of prognostic nutritional index (PNI) on short- and long-term outcomes of patients who underwent curative-intent resection for gastro-entero-pancreatic neuroendocrine tumors (GEP-NETs). Methods: Patients with GET-NETs who underwent curative-intent resection were identified from a multi-center database. The prognostic impact of clinicopathological factors including PNI on post-operative outcomes were evaluated. A novel nomogram was developed and externally validated. Results: A total of 2,099 patients with GEP-NETs were included in the training cohort; 255 patients were in the external validation cohort. Median PNI (n = 973) was 47.4 (IQR 43.1–52.4). At the time of presentation, 1,299 (61.9%) patients presented with some type of clinical symptom. Low-PNI (≤42.2) was associated with gastrointestinal symptoms, as well as nodal metastasis and distant metastasis (all p < 0.05). Patients with a low PNI had a higher incidence of severe (≥Clavien-Dindo grade IIIa: low PNI 24.9% vs. high PNI 15.4%, p = 0.001) and multiple (≥3 types of complications: low PNI 14.5% vs. high PNI 9.2%, p = 0.024) complications, as well as a worse overall survival (OS)(5-year OS, low PNI 73.7% vs. high PNI 88.5%, p < 0.001), and RFS (5-year RFS, low PNI 68.5% vs. high PNI 79.8%, p = 0.008) versus patients with high PNI (>42.2). A nomogram based on PNI, tumor grade and metastatic disease demonstrated excellent discrimination and calibration to predict OS in both the training (C-index 0.748) and two external validation (C-index 0.827, 0.745) cohorts. Conclusions: Low PNI was common and associated with worse short- and long-term outcomes among patients with GEP-NETs.

The impact of Prognostic Nutritional Index on mortality in patients with COVID-19

Purpose Malnutrition has a significant effect on the onset and progression of infective pathology. The malnutrition status in COVID-19 cases are not understood well. Prognostic Nutritional Index (PNI) is a new and detailed assessment of nutrition and inflammation cases. This study aims to investigate the effect of PNI on mortality in COVID-19 patients. Design/methodology/approach In total, 334 patients (males, 142; females, 192; 64.5 ± 12.3 years of age) with COVID-19 bronchopneumonia were enrolled in this investigation. Cases were divided into two groups with respect to survival (Group 1: survivor patients, Group 2: non-survivor patients). Demographic and laboratory variables of COVID-19 cases were recorded. Laboratory parameters were calculated from blood samples taken following hospital admission. PNI was calculated according to this formula: PNI = 5 * Lymphocyte count (109/L) + Albumin value (g/L). Findings When the patients were assessed with respect to laboratory values, leukocytes, neutrophils, CRP, ferritin, creatinine and D-Dimer parameters were significantly lower in Group 1 patients than Group 2 patients. Nevertheless, serum potassium value, lymphocyte count, calcium and albumin values were significantly higher in Group 1 cases than in Group 2 cases. PNI value was significantly lower in Group 2 cases than in Group 1 cases (39.4 ± 3.7 vs 53.1 ± 4.6). Originality/value In this retrospective study of COVID-19 cases, it can be suggested that PNI may be a significant risk factor for mortality. In conclusion of this research, high-risk patients with COVID-19 can be determined early, and suitable medical therapy can be begun in the early duration.

Impact of prognostic nutritional index as a predictor of immunotherapy response in patients with gynecologic cancers: Development of a clinical calculator (106)

Objectives: Malnutrition is known to impair the immune system. The purpose of this study was to determine if nutritional status (NS) was associated with response to immunotherapy (IT) in patients with gynecologic cancers. Methods: Women with gynecologic cancers treated with IT between 2015 and 2021 in a single institution were eligible for this retrospective observational study. Patients could be eligible more than once if they had multiple ITs. NS was determined by the prognostic nutritional index (PNI), which was calculated by 10 × albumin (g/dL) + 0.005×total lymphocyte count per microliter. The relationship of PNI to disease control response (DCR), defined as complete and partial response (CR, PR), or stable disease (SD), was assessed by t-test and Chi-square test. Survival analyses were performed by Cox proportional hazards. The cut-off value for the PNI was determined by the point of maximum sensitivity and specificity on the receiver operator curve. The clinical calculator was constructed by regression modeling. Conclusions: PNI alone and in combination with prior lines of treatment were shown to impact the DCR to ITs in gynecologic cancer patients. Our clinical calculator may help to predict IT response and personalize decision-making. Prospective trials are needed to validate this. Objectives: Malnutrition is known to impair the immune system. The purpose of this study was to determine if nutritional status (NS) was associated with response to immunotherapy (IT) in patients with gynecologic cancers. Methods: Women with gynecologic cancers treated with IT between 2015 and 2021 in a single institution were eligible for this retrospective observational study. Patients could be eligible more than once if they had multiple ITs. NS was determined by the prognostic nutritional index (PNI), which was calculated by 10 × albumin (g/dL) + 0.005×total lymphocyte count per microliter. The relationship of PNI to disease control response (DCR), defined as complete and partial response (CR, PR), or stable disease (SD), was assessed by t-test and Chi-square test. Survival analyses were performed by Cox proportional hazards. The cut-off value for the PNI was determined by the point of maximum sensitivity and specificity on the receiver operator curve. The clinical calculator was constructed by regression modeling. Conclusions: PNI alone and in combination with prior lines of treatment were shown to impact the DCR to ITs in gynecologic cancer patients. Our clinical calculator may help to predict IT response and personalize decision-making. Prospective trials are needed to validate this.

Impact of Prognostic Nutritional Index and Systemic Immune-Inflammation Index on the Clinical Outcome of Patients with Advanced Hepatocellular Carcinoma Treated with Sorafenib

Impact of Prognostic Nutritional Index and Systemic Immune-Inflammation Index on the Clinical Outcome of Patients with Advanced Hepatocellular Carcinoma Treated with Sorafenib

P-286 Prognostic factors for pancreatic adenocarcinoma: Prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio

Pancreatic cancer is the seventh most deadly cancer worldwide with 495,773 new diagnosis and 466,003 deaths according to Globocan 2020. Despite increase on diagnosis and new therapeutic options available during last decade, 5-year survival rate for all stages remains poor both for early and metastatic disease. Nutritional and inflammatory status play an important role during pancreatic carcinogenesis, leading to an increasing interest on novel cost-effective biomarkers that access this status and predict prognosis. Prognostic Nutritional Index (PNI), Neutrophile to Lymphocyte Ratio (NLR) and Platelet to Lymphocyte Ratio (PLR) have been used as surrogates for nutritional and inflammatory status. Retrospective unicentric observational study of the prognostic impact of Prognostic Nutritional Index (PNI), Neutrophile/Lymphocyte Ratio (NLR) and Platelet/Lymphocyte Ratio (PLR) on all stage pancreatic adenocarcinomas diagnosed between January/15 and December/21. PNI calculated as “10xserum albumin(g/dL) + 0,005xtotal lymphocyte count(mm3)”, NRL as “total neutrophile count/total lymphocyte count” and PLR as “total platelet count/ total lymphocyte count”. Cut-off points calculated by receiver-operating curves (ROC analysis), correlations accessed using univariate Cox regression and Kaplan-Meier survival curves. 123 patients were diagnosed with pancreatic adenocarcinoma, 48%(n=60) women and 52% (n=64) men with a median age of 71 (37-98) years and ECOG of 1 (0-4). At diagnosis, 31% (n=39) presented with resectable disease, 2% (n=2) with borderline resectable, 15% (n=18) unresectable and 52% (n=64) with metastatic disease. For PNI, non-metastatic disease was stratified by a cut-off point of 35.0 with an overall survival (OS) of 11 (4-17) months for PNI>35 and 7 (1-14) months for PNI≤ 35 (p=0,032). Median time to progression of 10 (8-13) months for PNI>35 and 6 (1-10) months for PNI≤ 35 (p=0,04). No significant cut-off value for PNI was found for metastatic disease or general population. Regarding NLR, general population was stratified by a cut off point of 0.25, with OS of 4 (1-7) months for NLR≤0.25 and 11 (7-14) months for NLR>0.25 (p=0.05). Metastatic disease at diagnosis with NLR≤0.25 presented an OS of 3(1-6) months and for NLR>0.25 of 8(6-10) months (p=0,05). For PLR, general population with a PLR≤200.5 had an OS of 8(5-11) months and PLR>200.5 of 3(1-5) months (p=0,01). Time to progression for PLR≤179.5 of 9(5-11) months and 5 (3-7) months for PLR>179.5 (p=0,04). Metastatic disease with PLR≤179.5 had an OS of 8 (1-15) months and PLR>179.5 of 4(2-6) months (p=0,03). non-metastatic disease with PLR≤200.5 had an OS of 11(7-11) months and 2 (1-4) months for PLR>200.5 (p=0,03). Real-world data assessed demonstrates an association of higher levels of PNI with better overall survival and progression free survival. Inflammatory status assessed by NLR and PLR also showed a significant impact on both overall survival and progression free survival. Therefore, this real-world series adds evidence to the value of PNI, NLR and PLR as surrogates of nutritional and inflammatory status and its clinical relevance for pancreatic adenocarcinoma.

P25 Impact of prognostic nutritional index as a predictor of immunotherapy response in patients with gynecologic cancers: development of a clinical calculator

P25 Impact of prognostic nutritional index as a predictor of immunotherapy response in patients with gynecologic cancers: development of a clinical calculator

The value of prognostic nutritional index in nasal-type, extranodal natural killer/T-cell lymphoma.

Extranodal natural killer/T-cell lymphoma (ENKTL) is an aggressive disorder with heterogeneous clinical characteristics and poor prognosis. The combined value of baseline serum albumin level and absolute peripheral lymphocyte count showed prognostic information in a variety of malignancies, but its evidence is limited in ENKTL. The purpose of this study is to evaluate the impact of prognostic nutritional index (PNI) in ENKTL, and to provide some nutritionally and immunologically relevant information for better risk stratification. We conducted a retrospective study in 533 patients newly diagnosed with ENKTL. The PNI was calculated as albumin (g/L) + 5 × lymphocyte count (109/L). The optimal cutoff values for serum albumin and lymphocyte count were 40.6g/L and 1.18 × 109/L, respectively, and 47.3 for PNI. After a median follow-up of 70months, the 5-year overall survival (OS) and progression-free survival (PFS) were 56.2% and 49.5%, respectively. Patients in low PNI group had more unfavorable clinical features, and tended to have worse 5-year OS and PFS compared with those in high PNI group. According PNI-associated prognostic score, patients were classified into different risk groups. Significant difference has been found in 5-year OS and PFS in different risk groups. When PNI and PNI-associated prognostic score were superimposed on the International Prognostic Index (IPI), prognostic index of natural killer lymphoma (PINK), or nomogram-revised risk index (NRI) categories, the PNI and PNI-associated prognostic score provided additional prognostic information. Therefore, PNI and PNI-associated prognostic score could be independent prognostic factors for ENKTL and may be useful for risk stratification and clinical decision-making.

Impact of prognostic nutritional index on survival in recurrent glioblastoma.

Primary brain tumors are relatively rare malignancy, with high-grade gliomas (glioblastoma multiforme and anaplastic gliomas) are the most common types. We aimed to evaluate the prognostic value of Prognostic Nutritional Index (PNI), which is calculated by lymphocyte count and albumin, in recurrent glioblastoma patients treated with systemic treatment. Data of 64 patients with recurrent glioblastoma who received systemic treatment and followed in our clinic between 2012 and 2018 was retrospectively collected and analyzed. PNI was calculated as: [(10×serum albumin (g/dL))+(0.005×total lymphocyte count)]. Patients were categorized according to the median PNI value. We investigated the prognostic role of PNI groups, and survival outcomes. Median value of PNI was 45.7, and median follow-up duration was 9 months (1-68 months). Median overall survival (OS) was 7.9 months (95%CI: 5.5-10.4). Median OS was significantly longer in patients with PNI>45.7 compared to patients with PNI≤45.7 (13.9 months (95%CI: 10.5-17.4), and 4.6 months (95%CI: 2.5-6.8), p<0.001, respectively). In multivariate analysis, PNI was found to be an independent prognostic factor for OS [HR:0.41 (95%CI:0.22-0.74), p=0.03)]. In our study, the PNI was found to be an independent prognostic biomarker in patients with recurrent glioblastoma, but further prospective trials are necessary to validate its prognostic role.

Impact of Prognostic Nutritional Index on Long-Term Outcomes in Patients with Gastric Cancer: Izmir Oncology Group (IZOG) Study

Impact of Prognostic Nutritional Index on Long-Term Outcomes in Patients with Gastric Cancer: Izmir Oncology Group (IZOG) Study

Impact of prognostic nutritional index on survival in recurrent glioblastoma

BackgroundPrimary brain tumors are relatively rare malignancy, with high-grade gliomas (glioblastoma multiforme and anaplastic gliomas) are the most common types. We aimed to evaluate the prognostic value of Prognostic Nutritional Index (PNI), which is calculated by lymphocyte count and albumin, in recurrent glioblastoma patients treated with systemic treatment. MethodsData of 64 patients with recurrent glioblastoma who received systemic treatment and followed in our clinic between 2012 and 2018 was retrospectively collected and analyzed. PNI was calculated as: [(10×serum albumin (g/dL))+(0.005×total lymphocyte count)]. Patients were categorized according to the median PNI value. We investigated the prognostic role of PNI groups, and survival outcomes. ResultsMedian value of PNI was 45.7, and median follow-up duration was 9 months (1–68 months). Median overall survival (OS) was 7.9 months (95%CI: 5.5–10.4). Median OS was significantly longer in patients with PNI>45.7 compared to patients with PNI≤45.7 (13.9 months (95%CI: 10.5–17.4), and 4.6 months (95%CI: 2.5–6.8), p<0.001, respectively). In multivariate analysis, PNI was found to be an independent prognostic factor for OS [HR:0.41 (95%CI:0.22–0.74), p=0.03)]. ConclusionIn our study, the PNI was found to be an independent prognostic biomarker in patients with recurrent glioblastoma, but further prospective trials are necessary to validate its prognostic role.

Impact of prognostic nutritional index on the recurrence of hepatocellular carcinoma after a curative resection.

Backgrounds/AimsThe purpose of this retrospective study was to determine the association between prognostic nutritional index (PNI) and recurrence of hepatocellular carcinoma after a curative resection.MethodsBetween 2007 to 2019, 130 patients who underwent curative hepatectomy for hepatocellular carcinoma were enrolled. PNI was calculated. Its cutoff value was identified through receiver operating characteristic curve analysis. According to PNI, patients were divided into two groups. Univariate and multivariate analyses were performed to identify independent risk factors for recurrence.ResultsThe cutoff value of PNI was 52. In univariate analysis, alcoholic liver cirrhosis (p = 0.041), protein induced by vitamin K antagonist- II ≥ 200 (p = 0.012), indocyanine green retention test (ICG R15) >10% (p = 0.001), estimated blood loss ≥ 800 mL (p = 0.037), tumor size (p = 0.001), microvascular invasion (p = 0.023), T-stage (p = 0.001), and PNI < 52 (p = 0.001) were significant factors affecting the recurrence. In multivariate analysis, alcoholic liver cirrhosis (p = 0.046), ICG R15 >10% (p = 0.025), T-stage (p = 0.003), and PNI < 52 (p = 0.046) were independent prognostic factors for disease-free survival.ConclusionsPNI, a nutritional and immunologic factor, is an independent prognostic factor that can predict the recurrence of hepatocellular carcinoma in patients undergoing a curative resection.

Prognostic nutritional index as a prognostic factor in lung cancer patients receiving chemotherapy: a systematic review and meta-analysis.

Lung cancer is one of the leading causes of morbidity and mortality in the world. In the past decade, numerous studies focus on the prognostic nutritional index (i.e., a measure of serum albumin and lymphocyte in peripheral circulation) as a possible biomarker to predict the survival outcomes in cancer patients undergoing chemotherapy. Prognostic nutritional index can reliably predict the survivability outcomes by effectively quantifying the nutritional and immunological status of cancer patients. To date, only one review has attempted to evaluate the impact of the prognostic nutritional index on the survival outcomes in lung cancer patients with certain limitations. The goal of the present systematic review and meta-analysis is to bridge the gap in the literature and evaluate the capacity of the prognostic nutritional index for predicting the survivability outcomes in lung cancer patients undergoing chemotherapy. The aim of the study is to evaluate the impact of prognostic nutritional index scoring on survival outcomes in lung cancer patients undergoing chemotherapy. A systematic academic literature search was performed based on the PRISMA guidelines across Web of Science, EMBASE, CENTRAL, Scopus, and MEDLINE databases. A random-effect meta-analysis was performed to evaluate the impact of prognostic nutritional index scoring (i.e., high/low) on survival outcomes (i.e., progression-free survival, overall survival) in lung cancer patients undergoing chemotherapy. From 963 studies, 16 eligible studies with 4250 lung cancer patients (62.32 ± 5.08 years) undergoing chemotherapy were included. Our meta-analysis revealed worse mortality outcomes in terms of progression-free survival (HR: 1.31) and overall survival (1.21) for the group with a low prognostic nutritional index score as compared to the group with a high prognostic nutritional index score in lung cancer patients undergoing chemotherapy. Subsequent subgroup analyses further demonstrated markedly worse outcomes for progression-free survival (1.32) and overall survival (1.52) in non-small lung cancer patients with lower prognostic nutritional index scores. We provide preliminary evidence suggesting that lower prognostic nutrition index scores are associated with worse survivability outcomes (progression-free survival and overall survival) in lung cancer patients undergoing chemotherapy. We also show that lower prognostic nutrition index scores correlate with even worse survival outcomes in patients with non-small lung cancer histological subtype of lung cancer. These findings should help clinicians to stratify the risks associated with the chemotherapeutic management of lung cancer patients.

Predictive impact of the prognostic nutritional index in early-staged hepatocellular carcinoma after operative microwave ablation

BackgroundThe prognostic nutritional index (PNI) is used to assess immune and nutritional status, and is a prognostic factor for several malignant tumors. However, little evidence exists regarding the predictive impact of prognostic nutritional index (PNI) after local ablation therapy for hepatocellular carcinoma (HCC). The aim of this study was to evaluate the value of PNI to predict recurrence and survival after operative microwave ablation in patients with early-stage HCC. MethodsThis retrospective study included 341 patients who underwent operative microwave ablation for HCC in Barcelona Clinic Liver Cancer (BCLC) stage 0-A at our institute between 2007 and 2015. We analyzed overall survival (OS) and recurrence-free survival (RFS), and evaluated factors related to prognosis in multivariate Cox regression analyses. ResultsThe OS rates at 1, 3, 5, and 10 years after microwave ablation were 100%, 92.7%, 85.1%, and 57.5% in patients with high-PNI levels, and 96.5%, 78.2%, 59.7%, and 20.7% in patients with low-PNI levels, respectively (P < 0.001). The RFS rates at 1, 3, 5, and 10 years after microwave ablation were 96.3%, 75.2%, 55.4%, and 30.4% in patients with high-PNI levels, and 94.4%, 48.8%, 36.4%, and 13.1% in patients with low-PNI levels, respectively (P < 0.001). In multivariate analyses, preoperative PNI level was an independent prognostic factor for both OS and RFS. ConclusionOur results revealed the preoperative PNI level was a simple and novel predictive marker of survival and recurrence after microwave ablation in patients with early-stage HCC.

Predictive Impact of Prognostic Nutritional Index on Pembrolizumab for Metastatic Urothelial Carcinoma Resistant to Platinum-based Chemotherapy.

We investigated the prognostic nutritional index (PNI), comprised of lymphocytes and albumin, as a potential prognosticator of metastatic urothelial carcinoma (mUC) patients receiving pembrolizumab. Sixty-five patients were retrospectively enrolled and classified as low (<40) and high (≥40) based on pretreatment PNI. Progression-free survival (PFS), overall survival (OS) and response rates were evaluated. In the low PNI group, significantly shorter PFS and OS were observed. PNI was shown to be an independent predictor of PFS and OS in the multivariate analysis. C-index for both PFS and OS improved with the addition of PNI to the model described in the KEYNOTE-045 study. Significantly more patients experienced initial disease progression in the low PNI group. PNI is a useful predictor of prognosis and disease progression in mUC patients receiving pembrolizumab.

Prognostic Impact of Prognostic Nutritional Index and Neutrophil/Lymphocyte Ratio in Patients with Small-Cell Lung Cancer

Prognostic Impact of Prognostic Nutritional Index and Neutrophil/Lymphocyte Ratio in Patients with Small-Cell Lung Cancer

Impact of Prognostic Nutritional Index on Postoperative Pulmonary Complications in Radical Cystectomy: A Propensity Score-Matched Analysis.

BackgroundRadical cystectomy is a standard treatment for muscle-invasive bladder cancer but frequently entails postoperative pulmonary complications (PPCs). Nutrition is closely associated with postoperative outcomes. Therefore, we evaluated the impact of preoperative prognostic nutritional index (PNI) on PPCs in radical cystectomy.MethodsPNI was calculated as 10 × (serum albumin) + 0.005 × (total lymphocyte count). The risk factors for PPCs were evaluated using multivariate logistic regression analysis. A receiver operating characteristic curve analysis of PNI was performed, and an optimal cut-off value was identified. Propensity score-matched analysis was used to determine the impact of PNI on PPCs. Postoperative outcomes were also evaluated.ResultsPPCs occurred in 112 (13.6%) of 822 patients. Multivariate logistic regression analysis identified PNI, age, and serum creatinine level as risk factors. The area under the receiver operating characteristic curve of PNI for predicting PPCs was 0.714 (optimal cut-off value: 45). After propensity score matching, the incidence of PPCs in the PNI ≤ 45 group was significantly higher compared with the PNI > 45 group (20.8% vs. 6.8%; p < 0.001), and PNI ≤ 45 was associated with a higher incidence of PPCs (odds ratio 3.308, 95% confidence interval 1.779–6.151; p < 0.001). The rates of intensive care unit admission and prolonged (> 2 days) stay thereof were higher in patients who developed PPCs.ConclusionsPreoperative PNI ≤ 45 was associated with a higher incidence of PPCs in radical cystectomy, suggesting that PNI provides useful information regarding pulmonary complications after radical cystectomy.

Impact of prognostic nutritional index on outcomes in patients with Mycobacterium avium complex pulmonary disease.

Onodera's prognostic nutritional index (PNI) is useful in predicting prognosis of various diseases. But the usefulness of PNI in non-surgical patients has not been sufficiently proven yet. In patients with mycobacterium avium complex pulmonary disease (MAC-PD), malnutrition is an important factor that affects the quality of life and morbidity. Here, we aimed to evaluate whether PNI is related with clinical outcomes in MAC-PD patients. We examined 663 patients diagnosed with MAC-PD between May 2005 and November 2017. PNI score was calculated at the time of diagnosis and treatment initiation, and patients were divided into malnutrition and non-malnutrition groups according to a cut-off PNI score of 45. As the recommended duration of treatment for MAC-PD is 12 months following sputum conversion, treatment duration less than 12 months was defined as treatment intolerance. Survivals were compared with the log-rank test. Multivariate logistic regression and multivariate Cox proportional hazards models were used to estimate the odds ratio (OR) and hazards ratio (HR) for treatment intolerance and mortality, respectively. Of the 306 patients that received treatment, 193 received treatment longer than 12 months. In the multivariable logistic regression model, malnutrition at the time of treatment initiation was related with treatment intolerance (OR: 2.559, 95% confidence interval [CI]: 1.414-4.634, P = 0.002). Patients in the malnutrition group at the time of diagnosis exhibited lower survival (P<0.001) and malnutrition at the time of diagnosis was a significant risk for all-cause mortality (HR: 2.755, 95% CI: 1.610-4.475, P<0.001). Malnutrition, as defined by PNI, is an independent predictor for treatment intolerance and all-cause mortality in patients with MAC-PD.