Optimal Cut-off Value Of Prognostic Nutritional Index Research Articles

Malnutrition is associated with severe outcome in elderly patients hospitalised with COVID-19

Some studies have identified influencing factors of COVID-19 illness in elderly, such as underlying diseases, but research on the effect of nutritional status is still lacking. This study retrospectively examined the influence of nutritional status on the outcome of elderly COVID-19 inpatients. A retrospective analysis of the clinical data of 4241 COVID-19 patients who were admitted to a third-class hospital of Nanchang between November 1, 2022 and January 31, 2023 was conducted. Nutritional status was assessed using the prognostic nutritional index (PNI) and controlling nutritional status score (CONUT). The influence of nutritional status on the outcome of COVID-19 patients was determined through multivariate adjustment analysis, restrictive cubic spline, and receiver operating characteristic curve (ROC). Compared with mild/no malnutrition, severe malnutrition substantially increased the critical outcome of COVID-19. A linear relationship was observed between the odds ratio (OR) and PNI and CONUT (P > 0.05). The area under the ROC curve indicated that PNI was the better predictor. The optimal cutoff value of PNI was 38.04 (95%CI: 0.797 ~ 0.836, AUC = 0.817), with a sensitivity of 70.7% and a specificity of 79.6%. The critical illness of elderly COVID-19 patients shows a linear relationship with malnutrition at admission. The use of PNI to assess the prognosis of COVID-19 eldeely patients is reliable, highlighting the importance for doctors to closely pay attention to the nutritional status of COVID-19 patients. Focusing on nutritional status in clinical practice can effectively reduce the critical illness of elderly COVID-19 patients.

The effect of immunonutrition support on the prognostic nutritional index in the postoperative period in brain tumors

Objective: The prognostic nutritional index (PNI) reflects the immunological response and nutritional status. We evaluated the effect of immunonutrition on PNI in patients with brain tumors receiving chemoradiotherapy and immunonutritional support. Methods: Demographic, laboratory and clinical data were collected retrospectively from 30 consecutive brain tumor patients who received brain chemoradiotherapy between 2019 and 2022 in our clinic and who were given immunonutrition support during their treatment. The cut-off PNI value before adjuvant therapy was calculated in patients who received immunonutrition support in the postoperative period and compared with the PNI values after adjuvant therapy. Results: While glioblastoma patients constitute the majority (60%) of all patients diagnosed as pathological, different histopathological brain tumors were also included in the study (meningioma, oligodendroglioma). The mean albümin value before adjuvant treatment was 4.04 g/dL, while the mean albümin value after adjuvant treatment increased to 4.16 g/dL (p=0,057). The optimal cut-off value for PNI was found to be 45.5 by ROC analysis. PNI was calculated as 49.38 ± 6.03 SD before adjuvant treatment and 49.40 ± 6.12 SD after adjuvant treatment (p>0.05). Retrospective analysis was conducted on over 30 HGG patients who did not receive immunonutritional supplementation containing Arg/gln/HMB (Arginine/glutamine/Beta-Hydroxy Beta-Methylbutyrate). Interestingly, the analysis revealed that the average PNI was 45.15 before adjuvant therapy and decreased to 42.26 after adjuvant therapy, indicating a statistically significant decline in PNI among those without immunonutritional supplementation. This finding suggests a potential beneficial impact of immunonutritional supplementation on PNI. Conclusions: Immunonutrition support has positive effects on PNI and albumin levels in brain tumor patients who will undergo postoperative radiotherapy/chemoradiotherapy. It can be thought that low PNI, which may be an indicator of hematological and nutritional toxicity predicted by brain chemoradiotherapy, can be prevented by immunonutrition support.

Evaluation of the prognostic nutritional index (PNI) as a tool for assessing disease activity in rheumatoid arthritis patients.

Rheumatoid arthritis (RA) is an autoimmune disease of unknown exact cause, characterized by chronic inflammation. The prognostic nutritional index (PNI), reflecting albumin concentration and lymphocyte count, is a newly established inflammation-based nutritional score. This study aimed to determine the relationship between PNI and disease activity in RA patients. This cross-sectional study included 138 RA patients who met the 2010 revised criteria of the American College of Rheumatology (ACR) for RA. PNI was calculated using the following formula: 10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count in the peripheral blood (per mm3). The study population was divided into two groups: DAS28-ESR ≤ 3.2 (group 1 with remission and low disease activity) and DAS28-ESR > 3.2 (group 2 with moderate and high disease activity). A total of 138 patients with a mean age of 52.1years were recruited. While the female gender was more prevalent in both groups, it was significantly higher in group 2 (p < 0.05). Group 2 exhibited a lower PNI compared to those in group 1 (42.17 ± 3.46 vs. 44.02 ± 2.92; p = 0.001). Multivariate logistic regression analyses revealed that PNI was an independent predictor of disease activity (OR, 0.850; 95% CI, 0.735-0.983; p = 0.029). ROC curve analysis determined that the optimal cutoff value of PNI for disease activity was 43.01, with a sensitivity of 69.1% and specificity of 57.7% (AUC, 0.66; 95% CI, 0.57-0.75, p = 0.001). This study demonstrates that the simple and readily available PNI could serve as an independent predictor of disease activity in rheumatoid arthritis patients. Key Points •The relationship between disease activity and the prognostic nutritional index, which is a nutritional indicator, in rheumatoid arthritis patients was investigated. •It has been shown that there is a connection between low PNI and high disease activity. •It has been shown that PNI can be used to evaluate disease severity with a simple calculation.

Low prognostic nutrition index as a prognostic biomarker in elderly patients with early gastric cancer after gastrectomy.

Purpose Non-invasive biomarkers including systemic inflammatory or nutrition-based index including neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR) lymphocyte to monocyte ratio (LMR), and prognostic nutritional index (PNI) can be useful in determining treatment strategies for elderly patients with early gastric cancer (EGC). The aim of this study was to investigate the significance of these index for predicting the long-term survival of EGC patients aged 80 years over. Methods This study included 80 elderly EGC patients with pStageIA after gastrectomy. Optimal cutoff value for PNI, NLR, PLR and LMR were set by using receiver operating curve analysis. The long-term outcomes after gastrectomy were analyzed by univariate and multivariate Cox regression analyses. Results Cut-off value for PNI, NLR, PLR and LMR was set at 46.5, 2.8, 210 and 4.6, respectively. By univariate analyses, low PNI, high NLR, high PLR and low LMR were significantly associated with worse prognosis. By multivariate analysis, low PNI was confirmed as an independent prognostic factor after gastrectomy (HR 0.17 ; 95% CI 0.03-0.91 ; P = 0.04). 5-year overall survival rate of patients with low PNI (≤ 46.5) were 52.4%. Conclusion Low PNI might be useful biomarker to predict worse prognosis of elderly EGC patients after gastrectomy. J. Med. Invest. 71 : 113-120, February, 2024.

Prognostic Nutritional Index (PNI): A More Promising Nutritional Predictor for Patients Undergoing Surgery for Retroperitoneal Liposarcoma.

Extended surgery with multi-visceral resection is the standard treatment for retroperitoneal liposarcoma (RLPS). Malnutrition tends to result in increased surgical complications and reduced survival. The aim of this study was to identify the prognostic role of nutritional status in patients with RLPS. Data from 189 consecutive patients with RLPS who underwent surgical treatment at the Peking University Cancer Hospital Sarcoma Center between April 2011 and August 2022 were retrospectively reviewed. The following nutritional parameters were calculated: nutritional risk index, prognostic nutritional index (PNI) and Nutrition Risk Screening 2002. Time-dependent receiver operating characteristic (time-ROC) curve analysis was conducted to compare the prognostic utility of nutritional indicators. The associations between nutritional indicators and major complications, local recurrence-free survival (LRFS) and overall survival (OS) were investigated. Based on the time-ROC curve analysis, the PNI was superior to other nutritional indices at predicting OS. The optimal cut-off value of PNI was 41.2. The PNI was significantly inversely associated with tumor size, tumor grade, and histological subtype. Patients in the low PNI group (< 41.2) had significantly shorter LRFS and OS than those in the high PNI (≥ 41.2) group, with higher major morbidity and mortality rates. The PNI was found to be a unique nutritional predictor that independently predicted LRFS and OS in the multivariate analysis. The PNI is an effective tool for nutritional assessment in patients with RLPS. A low PNI value in patients with RLPS predicts worse survival outcomes.

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.

Preoperative low muscle mass and malnutrition affect the clinical prognosis of locally advanced gastric cancer patients undergoing radical surgery.

Gastric cancer is a common and highly aggressive malignant tumor of the gastrointestinal tract that poses a serious threat to human life and health. As the clinical symptoms of early gastric carcinoma are not obvious, many patients are diagnosed in the middle or late stages. With the advancement of medical technology, gastrectomy has become a safer surgical procedure, but it still has a high recurrence and mortality rate after surgery. The prognosis of gastric cancer patients after surgery is not only related to tumor-related factors (i.e., tumor stage) but the patient's nutritional status. This study aimed to investigate the effect of preoperative muscle mass combined with the prognostic nutritional index (PNI) on clinical prognosis in locally advanced gastric carcinoma. The clinical data of 136 patients with locally advanced gastric carcinoma diagnosed by pathology and undergoing radical gastrectomy were retrospectively reviewed. To analyze the influencing factors of preoperative low muscle mass and its correlation with the prognostic nutritional index. Patients with both low muscle mass and low PNI (≤46.55) were assigned a score of 2, and those with only one or neither of these abnormalities were assigned a score of 1 or 0, respectively, according to the new prognostic score (PNIS). The relationship between PNIS and clinicopathological characteristics was analyzed. Univariate and multivariate analyses were performed to identify risk factors for overall survival (OS). Low muscle mass was associated with a lower PNI (P < 0.01). The optimal cut-off value of PNI was 46.55, the sensitivity was 48%, and the specificity was 97.1%. There were 53 (38.97%), 59 (43.38%), and 24 patients (17.65%) in the PNIS 0, 1, and 2 groups, respectively. A higher PNIS and advanced age were independent risk factors for postoperative complications (P < 0.01). The overall survival rate in patients with PNIS 2 score was significantly poorer than in patients with scores of 1 or 0 (3-year OS: 45.8% vs 67.8% vs 92.4%, P < 0.001). A Multivariate Cox hazards analysis showed that PNIS 2, depth of tumor invasion, vascular invasion, and postoperative complications were independent predictors of the poor 3-year survival in patients with locally advanced gastric cancer. The combination of muscle mass and the PNI score system can be used to predict the survival outcome of patients with locally advanced gastric cancer.

Predictive Value of Prognostic Nutritional Index for Early Postoperative Mobility in Elderly Patients with Pertrochanteric Fracture Treated with Intramedullary Nail Osteosynthesis

Early postoperative mobilization is essential for orthogeriatric patients. The prognostic nutritional index (PNI) is widely used to evaluate nutritional status. This study sought to investigate the predictive value of PNI for early postoperative mobility in patients with pertrochanteric femur fractures. This study included 156 geriatric patients with pertrochanteric femur fractures treated with TFN-Advance™ (DePuy Synthes, Raynham, MA, USA). Mobility was evaluated on the third postoperative day and by discharge. Stepwise logistic regression analyses were performed to evaluate the association significance of PNI with postoperative mobility together with comorbidities. The optimal PNI cut-off value for mobility was analyzed using the receiver operating characteristic (ROC) curve. Three days postoperatively, PNI was an independent predictor of mobility (OR: 1.14, 95% CI: 1.07-1.23, p < 0.01). By discharge, it was found that PNI (OR: 1.18, 95% CI: 1.08-1.30, p < 0.01) and dementia (OR: 0.17, 95% CI: 0.07-0.40, p < 0.001) were significant predictors. PNI correlated weakly with age (r = -0.27, p < 0.001). The PNI cut-off value for mobility on the third postoperative day was 38.1 (specificity = 78.5%, sensitivity = 63.6%). Our findings indicate that PNI is an independent predictor of early postoperative mobility in geriatric patients with pertrochanteric femur fractures treated with TFNA™.

The prognostic nutritional index, an independent predictor of overall survival for newly diagnosed follicular lymphoma in China.

ObjectiveThe prognostic nutritional index (PNI) is an important prognostic factor for survival outcomes in various hematological malignancies. The current study focused on exploring the predictive value of the PNI in newly diagnosed follicular lymphoma (FL) in China.Materials and methodsThe clinical indicators and follow-up data of 176 patients who received chemotherapy or immunotherapy combined with chemotherapy with FL in our hospital from January 2016 to March 2022 were retrospectively analyzed. Cox proportional hazard model was used for univariate and multivariate analyses. Kaplan–Meier curves were used to calculate survival rates and draw survival curves. The log-rank test was applied to compare differences between groups.ResultsThe optimal cut-off value of PNI was 44.3. All patients were divided into a high PNI group (>44.3) and a low PNI group (≤44.3). The low PNI group had a low CR rate and a high risk of death, with a tendency toward POD24, and Both OS and PFS were worse than those in the high PNI group. PNI was able to predict OS and PFS in FL patients and was the only independent predictor of OS (P = 0.014 HR 5.024; 95%CI 1.388∼18.178) in multivariate analysis. PNI could re-stratify patients into groups of high FLIPI score, high FLIPI2 score, no POD24, and rituximab combined with chemotherapy. Moreover, integrating PNI into the FLIPI and FLIPI2 models improved the area under the curve (AUC) for more accurate survival prediction and prognosis.ConclusionPNI is a significant prognostic indicator for newly diagnosed FL in China that can early identify patients with poor prognosis and guide clinical treatment decisions.

Prognostic Value of the Pre-Treatment Prognostic Nutritional Index for Patients with Unresectable Locally-Advanced and Advanced Stage Upper Gastrointestinal Tract Cancer

PurposeThe prognostic nutritional index (PNI) is used to distinguish immune-nutritional status. Previous studies have shown that it is significantly associated with patient outcomes for various malignancies. This study aimed to evaluate the prognostic impact of PNI in patients with unresectable locally-advanced and advanced stage upper gastrointestinal tract cancer, including esophageal cancer and gastric cancer.MethodsA retrospective study of 170 unresectable stage III–IV esophageal cancer and gastric cancer patients was conducted from January 2018 to December 2020. In our retrospective analysis, the pretreatment PNI of patients was calculated and analyzed. The Youden index was estimated to select the optimal cut-off value for PNI. Univariate and multivariate flexible parametric proportional hazards models with restricted cubic splines (RCS) were used to identify independent prognostic factors, and the Kaplan–Meier method was used to estimate survival curves.ResultsThe median follow-up period was 5 months (ranging from 0.06 to 36.92 months). We determined 52.9 as the cut-off value by using the maximum Youden index. Subsequently, patients in the testing group were classified into high PNI and low PNI groups. Kaplan–Meier curves showed the low PNI group had significantly poorer overall survival (OS) than the high PNI group. Median OS in the low PNI group was 4.43 months compared with 8.23 months in the high PNI group (HR 2.42, 95% CI 1.33–4.40, p = 0.004). In the univariate analysis, low PNI, ECOG PS 2, and ECOG PS 3–4 were associated with OS. According to multivariate analysis, low PNI was an independent prognostic factor for OS (HR 2.31, 95% CI 1.24–4.29, p = 0.008).ConclusionPretreatment PNI is useful for independent prognosis of unresectable stage III–IV esophageal cancer and gastric cancer in patients.

Relationship between the prognostic nutritional index and resistant hypertension in patients with essential hypertension

ABSTRACT Objectives Immune system activation plays a role in resistant hypertension (RHTN) pathogenesis. The clinical effect of the prognostic nutritional index (PNI) on patients with RHTN remains unclear. The aim of this study investigated the possible correlation between PNI and RHTN. Methods In this cross-sectional study, we enrolled 180 adult subjects. In patients were classified into three groups according to their office and ambulatory blood pressure measurements (ABPM): RHTN (n = 60), controlled hypertension (CHTN, n = 60), and normotension-control (NT-C, n = 60). RHTN was defined as BP ≥140/90 mm Hg while taking ≥3 antihypertensive medications or BP <140/90 mm Hg while taking ≥4 medications. The PNI was calculated from the 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (/μL) formula. Results Office and ABPM were significantly higher in patients with RHTN. Patients in the RHTN (46.1 ± 5.3) had significantly lower PNI than that in the CHTN (54.9 ± 6.7) (P = .032), and PNIs of both hypertensive groups were significantly lower than the NT-C group (P = .019, for both). The ROC curve analysis performed to assess the predictive value of PNI for RHTN and using 50.9 optimal cutoff value of PNI for RHTN gave a sensitivity of 77% and a specificity of 68.5% (AUC = 0.73, 95% CI 0.69–0.96). Multivariate analysis indicated diabetes, 24-h ABPM SBP, CRP, pill burden, and PNI (<51.6) as independent predictors of RHTN. Conclusion This study showed that the level of PNI was significantly lower in patients with RHTN compared to patients with CHTN. PNI is independently related to RHTN.

The prognostic nutritional index predicts the biochemical recurrence of patients treated with robot-assisted laparoscopic radical prostatectomy.

To evaluate the prognostic nutritional index (PNI) in predicting the biochemical recurrence (BCR) of patients treated with robot-assisted laparoscopic radical prostatectomy (RALP). The clinical data of 136 patients treated with RALP in the Department of Urology, The Third Xiangya Hospital of Central South University were retrospectively analyzed. The endpoint of observation was BCR. The area under the receiver operating characteristic (ROC) curve was evaluated to determine the optimal cutoff value of PNI. The correlation of the PNI with BCR was estimated using Kaplan-Meier analysis and Cox proportional hazards model. The optimal cutoff value of the PNI was 46.03 according to the ROC curve. (95% confidence interval: 0.604-0.805, Youden index = 0.401, sensitivity = 82.5%, specificity = 57.6%, p < 0.01). Multivariate Cox analysis showed that clinical staging, prostate-specific antigen, and PNI were independent prognostic factors for predicting BCR in patients treated with RALP. PNI is an independent prognostic factor for predicting BCR in patients treated with RALP. The incorporation of the PNI into risk assessments may provide additional prognostic information.

Prognostic Nutritional Index (PNI) in Patients With Breast Cancer Treated With Neoadjuvant Chemotherapy as a Useful Prognostic Indicator.

ObjectivePrognostic nutritional index (PNI), calculated as serum albumin (ALB) (g/L) + 5 × total lymphocyte count (109/L), is initially used to evaluate nutritional status in patients undergoing surgery and may evaluate the therapeutic effects and predict the survival of various solid tumors. The present study aimed to evaluate the potential prognostic significance of PNI in breast cancer patients receiving neoadjuvant chemotherapy (NACT).MethodsA total of 785 breast cancer patients treated with neoadjuvant chemotherapy were enrolled in this retrospective study. The optimal cutoff value of PNI by receiver operating characteristic curve stratified patients into a low-PNI group (<51) and a high PNI group (≥51). The associations between breast cancer and clinicopathological variables by PNI were determined by chi-square test or Fisher’s exact test. Kaplan–Meier plots and log-rank test were used to evaluate the clinical outcomes of disease-free survival (DFS) and overall survival (OS). The prognostic value of PNI was analyzed by univariate and multivariate Cox proportional hazards regression models. The toxicity of NACT was accessed by the National Cancer Institute Common Toxicity Criteria (NCI-CTC).ResultsThe results indicated that PNI had prognostic significance by an optimal cutoff value of 51 on DFS and OS in univariate and multivariate Cox regression survival analyses. Breast cancer patients with a high PNI value had longer DFS and OS than those with a low PNI value [47.64 vs. 36.60 months, P < 0.0001, hazard ratio (HR) = 0.264, 95%CI = 0.160–0.435; 73.61 vs. 64.97 months, P < 0.0001, HR = 0.319, 95%CI = 0.207–0.491, respectively]. Furthermore, the results indicated that patients with high PNI had longer DFS and OS than those with low PNI in early stage and advanced breast cancer, especially in advanced breast cancer. The mean DFS and OS times for breast cancer patients with high PNI by the log-rank test were longer than in those with low PNI in different molecular subtypes. Moreover, the mean DFS and OS times in patients with high PNI by the log-rank test were longer than in those patients with low PNI without or with lymph vessel invasion. The common toxicities after neoadjuvant chemotherapy were hematologic and gastrointestinal reaction, and the PNI had no significance on the toxicities of all enrolled patients, except in anemia, leukopenia, and myelosuppression.ConclusionPretreatment PNI with the advantages of being convenient, noninvasive, and reproducible was a useful prognostic indicator for breast cancer patients receiving neoadjuvant chemotherapy and is a promising biomarker for breast cancer on treatment strategy decisions.

Abstract PS6-57: Association of the prognostic nutritional index and survival of patients with breast cancer in a third-level care hospital in Mexico

Abstract Introduction. The prognostic nutritional index (PNI) is a convenient and accessible tool that reflects the nutritional and immunological conditions of patients with solid tumors. PNI is calculated based on the total lymphocyte count and serum albumin level. There is not an optimal well established cutoff value. Low PNI has been associated with lower overall and disease-free survival (OS and DFS) in breast cancer patients, however, there is no information regarding this prognostic value in patients from Mexico. The aim of this study was to analyze the association between PNI and survival of breast cancer patients from Mexico. Methods. We retrospectively analyzed medical records of patients with histologically confirmed breast cancer treated at Medica Sur Oncology Center in Mexico City between January 2008 to December 2019. PNI was calculated using the following formula: 10 × serum albumin value (g/dL) + 0.005 × total lymphocyte count (mm3). Receiver operating characteristic (ROC) curve analysis was performed to determine the optimal PNI cutoff value. The primary endpoint was OS. The secondary endpoint was DFS. Statistical analysis was performed with SPSS v25, the associations between PNI and clinicopathologic characteristics were analyzed using Pearson's χ2 test, survival curves were calculated with Kaplan-Meier method, and comparison among groups with log-rank. Proportional Cox model was used to perform multivariate analysis. A p value &amp;lt;0.05 was significant. Results. A total of 110 patients were included in the analysis, and classified into two groups: low and high PNI (ROC curve analysis showed an optimal cutoff value of 32.1). Median follow-up was 65 months. Mean PNI at diagnosis was 39.3 (SD 6.7). All patients had infiltrating ductal carcinoma, 15.5% had metastatic disease, 18.2% had triple negative breast cancer, 23.6% had HER 2 overexpression, and around 51% where positive for hormone receptors. Mean PNI in patients with locally advanced disease was significantly lower than in patients with localized disease, (p= 0.044), no other statistically significant associations were found between mean PNI and clinical characteristics. Median OS was not reached in the high PNI group vs 48.5 months (mo) in the low PNI group, while 5 -year OS rates were 89% and 41%, respectively (p= 0.03). The high PNI group had better DFS than the low PNI group (median DFS 65 mo vs 22.5 mo, 5-year DFS rates 65% vs 45% (p = 0.024). In univariate and multivariate analysis, triple negative histological subtype and low PNI were independent prognostic indicators for poor survival. Conclusion. High PNI in breast cancer patients is associated with superior DFS and OS. PNI is an independent prognostic factor for DFS and OS. PNI is an accessible prognosis factor that uses only regular laboratory assessment in patients with cancer. Citation Format: Pamela Denisse Soberanis-Piña, Edgar Varela-Santoyo, Andres Mauricio Arroyave-Ramirez, Hector Hugo Buerba-Vieregge, Daniel Motola-Kuba. Association of the prognostic nutritional index and survival of patients with breast cancer in a third-level care hospital in Mexico [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS6-57.

Low Prognostic Nutritional Index Indicates Dismal Prognosis in Patients with Diffuse Large B Cell Lymphoma

Background: Prognostic nutritional index (PNI) is calculated based on serum albumin concentration and absolute lymphocyte count, and its prognostic value has been established in various human malignancies. However, whether PNI can be applied in predicting the prognosis of patients with diffuse large B-cell lymphoma (DLBCL) remains to be clarified. The aim of the present study is to explore the prognostic value of baseline PNI in DLBCL. Methods: We retrospectively reviewed the medical records of 98 patients with DLBCL treated at the Southeast University-affiliated Zhongda Hospital between January 2013 and November 2019. The optimal cut-off value of PNI was determined using a receiver operating characteristic (ROC) curve and the Youden index. The relationship of high and low PNI with the clinical characteristics of the patients and prognosis were analyzed. Results: Patients with low PNI tended to have a worse event-free survival (EFS) and overall survival (OS) (EFS, P=0.029; OS, P&lt;0.001). For patients treated with R-CHOP（Rituximab-cyclophosphamide, doxorubicin, vincristine, and prednisone), PNI proved to be predictive for survival (EFS, P= 0.020; OS, P&lt;0.001), while no significant effect was found in DLBCL patients who received CHOP chemotherapy (EFS, P=0.639; OS, P=0.114). Multivariate analysis showed that PNI was an independent risk factor for OS and EFS of all 98 DLBCL patients after adjusting for model a (OS: adjust for age, gender, body mass index, performance status, B symptoms, international prognostic index, hemoglobin；EFS：adjust for age, gender, Ann Arbor stage, international prognostic index, lactate dehydrogenase, treatment, absolute lymphocyte count, hemoglobin). PNI remained an independent risk factor for both OS and EFS in patients after adjusting for model b (adjust for all items). Conclusion: PNI is a simple and useful marker to predict survival outcome in DLBCL patients, and low PNI is an independent predictor of a better outcome in terms of EFS and OS outcome in DLBCL, suggesting that PNI is an effective prognostic factor in patients with DLBCL.

The prognostic value of the prognostic nutritional index in patients with metastatic colorectal cancer.

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.

Low Prognostic Nutritional Index Predicts Poor Clinical Outcomes in Patients with Stage IIIB Non-small-cell Lung Carcinoma Undergoing Chemoradiotherapy.

PurposeTo investigate the prognostic utility of the prognostic nutritional index (PNI) in stage IIIB non-small-cell lung carcinoma (NSCLC) patients undergoing concurrent chemoradiotherapy (CRT).MethodsA total of 358 stage IIIB NSCLC patients who received a total dose of 60–66 Gy (2 Gy/fraction) radiotherapy and ≥1 cycle(s) of platinum-based chemotherapy were analyzed. The receiver operating curve analysis was utilized to identify the optimal PNI cut-off value demonstrating a significant connection with the overall survival (OS), locoregional progression-free survival (LRPFS), and progression-free survival (PFS).ResultsAt a median follow-up time of 22.5 months (range: 2.4–123.5), 30.2% and 14% of the patients were still alive and free of disease progression, respectively.The median OS, LRPFS, and PFS were 25.2 [95% confidence interval (CI): 36.3–46.6 months], 15.4 (95% CI: 26.6–35.3 months), and 10.7 (95% CI: 36.8–69.9 months), individually, for the whole study accomplice. The ROC analysis revealed an optimum rounded cut-off that associated meaningfully with each of the OS [area under the curve (AUC): 84.1%; sensitivity: 75.9%;72.4% specificity], LRPFS (AUC: 92.4%; sensitivity: 87.9%; 85.1% specificity), and PFS (AUC: 80.1%; sensitivity: 73.7%; 71.6% specificity) at a value of 40.5. Comparative analyses revealed that the patients presenting with PNI≤40.5 had significantly inferior OS (16.8 vs 36.7; P<0.001), LRPFS (11.5 vs 19.5; P<0.001), and PFS (8.6 vs 13.6; P<0.001) outcomes compared to patients with PNI>40.5. In univariate analyses, lower T-stage (1–2 vs 3–4; P< 0.001), lower N-stage (N2 vs N3; P< 0.001), anemia status (absent vs present; P< 0.001), weight loss status (<5% vs ≥5%; P< 0.001), and PNI group (≤40.5 vs >40.5; P<0.001) were the factors found to be associated with OS, LRPFS and PFS results. The results of multivariate analysis exhibited that the PNI was independently associated with each of the OS (P<0.001), LRPFS (P<0.001), and PFS (P<0.001) outcomes.ConclusionThe pretreatment PNI appears to be a robust novel prognostic factor that stratifies patients with stage IIIB NSCLC into two significantly distinct survival groups after CRT.

Low pretreatment PNI correlates with worse survival in patients with stage III/IV NSCLC who received chemotherapy.

The aim of this study was to investigate the prognostic value of the prognostic nutritional index (PNI) on the long-term survival of non-small cell lung cancer (NSCLC) patients who received platinum-based chemotherapy. Data on nutritional parameters and clinicopathological characteristics [e.g., albumin, total protein, body mass index (BMI), eastern cooperative oncology group (ECOG) performance status, stage, pathology, treatment strategy] were analyzed and retrospectively correlated with overall survival (OS). The PNI was calculated based on the concentration of albumin and lymphocyte count [10 × albumin, (g/dl) + 0.005 × lymphocyte (count/mm3)]. A receiver operating characteristic curve (ROC) analysis was used to find the optimal cut-off value of PNI. Univariate and multivariate analyses were used to evaluate the prognostic value of PNI. A total of 186 patients met the inclusion criteria. The optimal cut-off value for PNI was 50.45. Compared with the parameters of the low PNI group (n=76), high PNI was significantly associated with adenocarcinoma type, stage III, better ECOG and comprehensive treatment modality. The univariate analysis demonstrated that OS was superior when PNI ≥50.45, albumin ≥35 g/l, platelet-lymphocyte ratio (PLR) ≥163 and ECOG <2, and when the patient received a comprehensive treatment modality. In the multivariate analysis, PNI, TNM stage and treatment strategy were identified as independent predictors of survival in this study. This retrospective study demonstrated that a low PNI was related to worse overall survival in patients with stage III/IV NSCLC who received platinum-based chemotherapy. These data provided a conceptual basis for further research on the clinical application of the PNI index for patients receiving chemotherapy for intermediate- and advanced-stage NSCLC.

Value of Prognostic Nutritional Index as a Predictor of Lymph Node Metastasis in Gastric Cancer.

This study examined whether the prognostic nutritional index (PNI) is a useful predictor of pathological lymph node metastasis (pN+) in gastric cancer (GC). This study retrospectively examined 167 patients with advanced GC (cT2-T4) undergoing curative gastrectomy. The predictive ability of PNI for pN+ was evaluated in comparison with that of clinical lymph node metastasis (cN+) determined by computed tomography (CT). The optimal cut-off value of PNI for predicting pN+ was 46 according to the receiver operating characteristic curve analysis. Multivariate analysis revealed a PNI<46 [odds ratio (OR)=2.905; 95% confidence interval (CI)=1.347-6.638, p=0.006], cN+ (OR=2.323; 95%CI=1.204-4.579, p=0.012), and undifferentiated-type adenocarcinoma (OR=2.032; 95%CI=1.060-3.947, p=0.033) to be independent predictors of pN+. PNI detected pN+ with a higher specificity (84.9%) and positive predictive value (PPV) (75.6%) than cN+ (68.5% and 68.1%, respectively). When the subjects were limited to patients with cN+, the specificity and PPV of a PNI<46 for pN+ became markedly high (91.3% and 90.5%, respectively). PNI predicts pN+ with a high specificity in patients with a clinical diagnosis of advanced GC; therefore, PNI may aid in the definitive diagnosis of pN+, especially in combination with CT findings.

The prognostic nutritional index might predict clinical outcomes in patients with idiopathic dilated cardiomyopathy

Background and aimsThe prognostic nutritional index (PNI) had been associated with adverse outcomes in numerous clinical conditions. However, its influence on idiopathic dilated cardiomyopathy (DCM) was not determined. This aim of this study was to determine the predictive ability of PNI in patients with idiopathic DCM. Methods and resultsA total of 1021 consecutive patients with idiopathic DCM were retrospectively included and divided into three groups based on admission PNI tertiles: <41.7 (n = 339), 41.7–47.3 (n = 342), >47.3 (n = 340). The association of PNI with in-hospital major adverse clinical events (MACEs) and death during follow-up was evaluated. In-hospital mortality (2.9% vs. 1.5% vs. 0.0%, respectively; p = 0.006) and MACEs (13.6% vs. 6.7% vs. 3.5%, respectively; p < 0.001) decreased from the lowest to the highest PNI tertile. The optimal cut-off value of PNI to predict in-hospital MACEs was 44.0 (area under the curve: 0.689; 95% confidence interval [CI]: 0.626–0.753; p < 0.001). Multivariate analysis showed that a PNI≤44.0 was an independent risk factor of in-hospital MACEs (odd ratio: 2.86; 95% CI: 1.64–4.98; p < 0.001) and all-cause mortality at a median follow-up of 27 months (hazard ratio: 1.67; 95% CI: 1.11–2.49; p = 0.013). In addition, patients with a PNI≤44.0 had a lower cumulative survival rate during follow-up (log-rank: 35.62; p < 0.001). ConclusionThe PNI was an independent risk factor for in-hospital MACEs and all-cause mortality at a median follow-up of 27 months in patients with idiopathic DCM; hence, it may be considered a tool for risk assessment.