Prognostic Inflammatory And Nutritional Index Research Articles

Early Detection of Inflammation and Malnutrition and Prediction of Acute Events in Hemodialysis Patients through PINI (Prognostic Inflammatory and Nutritional Index).

Protein-energy wasting and inflammation are major risk factors for complications in hemodialysis patients. As these risk factors are triggered by a pro-inflammatory state, oxidative stress and hemodynamic dysfunction, which overlap in hemodialyzed subjects, we aimed to assess the efficacy of a cost-effective and straightforward screening tool, the Prognostic Inflammatory and Nutritional Index (PINI), in regularly screening maintenance hemodialysis (MHD) patients, to detect early signs of inflammation and malnutrition. A 12-month follow-up was carried out on a cohort of 102 adult patients undergoing maintenance dialysis, during which the Prognostic Inflammatory and Nutritional Index (PINI) was calculated using the formula alpha1-Acid Glycoprotein (AGP) × C-reactive protein (CRP)/albumin (ALB) × transthyretin (TTR). A PINI score < 1 was considered normal. The patients were stratified based on their PINI score: 66 patients (64.70%) had a normal score, below 1, while 36 patients (35.30%) had a PINI score ≥ 1. Despite the absence of clinical evidence of inflammation at enrollment, the latter group exhibited higher levels of CRP. During the follow-up period, all patients with a PINI score ≥ 1 experienced at least one acute event, compared to only 6% of patients with a normal PINI score, which presented COVID-19 infection as an acute event. The evaluation of the PINI can effectively identify the silent malnutrition-inflammation syndrome and predict the risk of acute events. This straightforward test appears to be a rapid tool that is independent of the examiner's experience and subjectivity, thereby potentially reducing hospitalization costs.

The Role of the Prognostic Inflammatory and Nutritional Index (PINI) in the Evolution of Patients with Chronic Kidney Disease and Other Pathologies.

Protein-energy loss and inflammation are the main risk factors in the occurrence of complications in hemodialysis patients. The Prognostic Inflammatory and Nutritional Index (PINI) is a simple, inexpensive test to identify the early onset of inflammation and malnutrition in hemodialysis patients, critically ill subjects and those with malignancies. A systemic review of English literature was conducted on the topic published between 1985 and 2022. A focused and sensitive search strategy was applied to the PUBMED database to identify relevant scientific articles in English. Once articles were identified, a detailed quality and bias assessment was performed. Two independent researchers analyzed the detailed data extraction. PINI proved to be a sensitive, powerful, low-cost and simple test. PINI has been useful in assessing evolution and prognostics in clinical care, with values above one being associated with a high risk of mortality and morbidity. It is useful in cases with surgical and postoperative complications, long hospitalization, as well as increased associated expenses. This is the first review of the literature on the above-mentioned topic (PINI) and is a valuable candidate for validating prognosis in patients with different pathologies.

Revisiting PINI Scoring in Light of Recent Biological Advances.

The prognostic inflammatory and nutritional index (PINI) is a simple scoring formula allowing the follow-up of dietary protein restriction and infectious complications affecting critically ill patients hospitalized in medical and surgical wards. The World Health organization (WHO) has recently recommended using the binary CRP (C-reactive protein) and AGP (α1-acid glycoprotein) numerators of the PINI formula in underprivileged inhabitants of developing countries to evaluate their (sub)clinical infectious states making their chronic malnutrition worse. These studies, mainly located in Africa and Asia, demonstrate that children and women enduring the combined effects of infectious burden and (micro)nutrient deprivation (principally retinol and iron) usually manifest persistent refractoriness and slackened recovery throughout dietary rehabilitation. The additive measurement of ALB (albumin) and TTR (transthyretin) composing the denominator of the PINI formula is shown to be helpful in grading the downsizing of lean body mass (LBM), a cornerstone of bodybuilding. The confrontation of these four objective parameters thus allows the quantification of the respective importance of nutritional and inflammatory components of any disease process, taking into account that TTR is the sole plasma protein remaining highly correlated to the fluctuations of LBM. The below review highlights the prevailing roles played by protein nutritional states in the release of plasma retinol to target tissues and to the restoration of iron-deficient anemias.

Biological Markers of Undernutrition and Risk of Complications in Children Hospitalized at the Teaching Hospital of Brazzaville

Introduction: Undernutrition is a condition frequently encountered in pediatrics. It leads to an increased morbidity and mortality regardless of the underlying condition or other risk factors such as age. In countries with limited resources such as ours, the diagnosis of undernutrition is often limited to the clinical presentation, and the contribution of biology is not often taken into account. Objectives: To establish the relationship between anthropometric parameters and biological markers in the diagnosis and classification of undernutrition and to assess the risk of infectious complications during undernutrition in children. Materials and Methods: A cross-sectional study conducted in Brazzaville among undernourished children aged 1 - 59 months between October 2018 and April 2019. Clinical diagnosis was based on WHO growth charts. The CRP, orosomucoid, albumin and transthyretin were obtained using the Cobas c311 analyzer, which enabled the calculation of Prognostic Inflammatory and Nutritional Index (PINI). The comparison of the means of the biological markers used the Student’s t-test, the risk of infectious complications the chi-square. The correlation of the diagnostic value of Z-score weight/height and PINI was also investigated. The significance level was set at 0.05. Results: Of the 95 children enrolled 63 (66.3%) were clinically severely malnourished, including 26 acute (41.3%) and 37 chronic (58.7%). The PINI revealed severe undernutrition in 85 children (89.4%) including 50 acute (58.8%) and 35 chronic (41.2%). CRP and orosomucoid were statistically higher in severe acute undernutrition (p < 0.001). Serum albumin levels varied between severe and non-severe undernutrition only in the acute form (p < 0.001); transthyretin was decreased to a lesser degree (p < 0.05) in both forms of undernutrition. All children with severe undernutrition were at risk of infectious complications (p < 0.05). PINI had a positive predictive value for the detection of severe undernutrition of 87%. Conclusion: Anthropometric parameters have a front-line advantage for assessing and classifying undernutrition. However, biological markers of undernutrition with PINI should be systematized in the diagnosis and management of undernutrition.

Impact of Dietary Diversification on the Prognostic Inflammatory and Nutritional Index in School-Age Children in the Nawa Region (Côte d’Ivoire)

The objective of this work was to study the impact of food diversification based on sweet potato, soybean, and cowpea on the prognostic inflammatory and nutritional index (PINI) in school-aged children in the Nawa region. This study took place from October 2017 to May 2018 among 240 pupils aged 6 to 12, divided into four groups of 60. Four types of meals were proposed: rice with tomato soup and fish (group 1), sweet potato porridge enriched with green soybeans (group 2), sweet potato porridge enriched with white cowpea (group 3), or sweet potato porridge accompanied by white cowpea with green soybeans (group 4). There were three blood samples: before eating meals (phase 0), the end of the first trimester (phase 1), and the end of the second trimester (phase 2). Blood assay for C-reactive protein (CRP), orosomucoid, albumin, and prealbumin was performed using COBAS c311 analyzer. PINI was calculated. Groups 3 and 4 showed a slight increase in albumin values (42.24 ± 0.95 g/L and 41.51 ± 1.71 g/L, respectively) compared to group 1. CRP decreased from phase 1 for group 1 (2.06 ± 0.26 mg/L) and group 4 (2.38 ± 0.36 mg/L). Orosomucoid increased insignificantly (p &gt; 0.05) in group 3 (0.74 ± 0.04 g/L) and group 4 (0.71 ± 0.04 g/L). PINI was reduced by 0.37 (group 1), 0.36 (group 2), 0.46 (group 3) and 0.44 (group 4). Food diversification based on sweet potato and white cowpea has a positive impact on PINI in more than 80% of pupils.

SO047HEMODIAFILTRATION DECREASES RISE OF LEPTIN AND RESISTIN IN PROTEIN ENERGY WASTING (PEW) WITHOUT HARMFULL EFFECT ON ALBUMIN CONCENTRATION

Abstract Background and Aims The role of adipocytokines (ADCK), and particularly of anorectic leptin and of resistin in the mortality of PEW is strongly suspected. Convective techniques (ol-HDF) decrease leptin concentrations but induce a concomitant albumin loss which could be potentially harmful in malnourished patients. The aim of the prospective multicentric randomized study performed in France by the NUTRIPEPA GROUP is to compare one year evolution of 4 ADCK and seric albumin using HDF or HD and membranes with different cut-off. Method 47 patients responding to both criteria of albumin &amp;lt;35 g/l (mean of 3 dosages) and prognostic inflammatory and nutritional index (PINI)≥ 1 were randomized to be treated using either polyester polyarylate (PEPA Nikkiso Japan) or polysufone, polyethersulfone dialyser (control) and followed for one year. Treatment consists in 3*4 hours HD session or in 3 HDF sessions with more than 20 liters reinjection/session. 24 patients were treated with HDF (HDF gr) : 11 with PEPA, 13 with control, and 23 with HD (HD gr) : 13 with PEPA, 10 with control. Oral nutritional supplementation was systematic, eventually completed by intradialytic parenteral nutrition. Albumin, leptin, adiponectin, ghrelin and resistin concentrations were determined at M0, M6, M9, M12. Delta concentration M0-M12 of albumin and of the 4 ADCK were compared with Wilcoxon test. Results At 12 months, decrease of leptin and of resistin was significantly higher in HDF group compare to HD group. There was no significant variation of adiponectin, ghrelin and albumin concentrations regardless of the technic or of dialyser cut-off. Conclusion In PEW, on a one year practice and regardless of the cut-off of the dialyser, HDF decreases both the anorexigenic adipokine leptin and resistin, adipokine implicated in insulin resistance, without harmfull incidence on seric albumin concentration. The decrease of concentrations of leptin and resistin obtained using ol-HDF could explain, at least in part, the reduction of one year mortality that we reported last year in preliminary results of NUTRIPEPA study.

Bioimpedance phase angle is associated with serum transthyretin but not with prognostic inflammatory and nutritional index during follow-up of women submitted to bariatric surgery

Phase angle (PhA) has been used as a prognostic indicator in several clinical situations. However, the use of PhA as a prognostic tool in bariatric patients is less known. The aim of this study was to evaluate PhA as a prognostic index and its correlation with the prognostic inflammatory and nutritional index (PINI) during follow-up of women subjected to bariatric surgery. Twenty female volunteers were studied. Body weight, body mass index (BMI), PhA, and biochemical components of PINI [serum C-reactive protein, alpha-1-acid glycoprotein, albumin, and transthyretin (TTR) concentrations] were evaluated at three time points: before (T0) and approximately 2-3 (T1) and 6 (T2) months after surgery. One-way repeated measures ANOVA or the Friedman test with Tukey's post hoc test was used depending on data normality. The associations between PhA and the other parameters were evaluated using Spearman's (nonparametric data) or Pearson's (parametric data) correlation coefficient. Phase angle reduction was accompanied by a significant decrease in body weight and BMI at T1 (P<0.05), but not at T2 (P>0.05). PINI indicated low-risk complications during the preoperative period and no risk during the postoperative period (T1 and T2). No significant correlation was observed between PhA and PINI (P>0.05). Regarding its association with the biochemical components of PINI, lower PhA values were significantly correlated with lower serum TTR concentrations (r=0.633, P<0.001). Phase angle was not associated with PINI, although lower values were correlated with lower serum TTR, suggesting that PhA reduction is associated with an increased nutritional risk.

Role of nutritional status in the early postoperative prognosis of patients operated for retroperitoneal liposarcoma (RLS): A single center experience

PurposeTo assess the nutritional status and its role in the outcome of patients operated for retroperitoneal liposarcoma (RLS). Material and methodsRetrospective study on consecutive patients operated with en bloc compartment resection for primary or local recurrence of RLS between 2016 and 2017. Preoperative nutritional and laboratory assessment comprising serum albumin, serum transthyretin, orosomucoid, and CRP was systematically performed. The following preoperative parameters were analysed: weight, body mass index (BMI), significant weight loss (>5% in one month and/or >10% in 6 months), serum albumin, transthyretin, CRP, orosomucoid. PINI (prognostic inflammatory and nutritional index) was calculated. ResultsThere were 40 patients operated for RLS: 22 women and 18 men with a median age of 61 years (34–90). Median tumour was 280 mm (80–530). Median preoperative BMI was 24.8 (18–42) and median postoperative BMI was 23 (17.8–44). Twenty-one patients (52.5%) were considered to be malnourished: 3 with biological signs of malnutrition and 18 with weight loss. Eleven (47.6%) in the group of malnourished patients and 4 (26.3%) in the group with satisfactory nutritional status developed postoperative complications (p = 0.042). A PINI score>1 was related to significantly longer hospitalisation time 21.8 days (10–58) in comparison with 14.9 [9–30] in patients with PINI < 1, p = 0.003. ConclusionsThe malnourished patients with RLS experienced more postoperative complications and longer hospitalisation. Nutritional status and biological markers contribute to the global management of RLS with improved postoperative behaviour including fewer complications and shorter hospitalisation. A prospective larger study with longer follow-up is necessary to refine these results.

Leptin and adiponectin as new markers of undernutrition in cancer

ObjectivesTo evaluate leptin and adiponectin as markers of undernutrition in cancer patients, and compare their performances with those of other biomarkers. Design and methodsThis was a prospective and observational study of 132 patients with various types of cancer. Following the recommended professional criteria, we diagnosed undernutrition at the time of blood sampling for the biological analysis of leptin, adiponectin, paraoxonase (hydrolysis rate of three substrates: paraoxon (PON), phenylacetate (ARE) and thiolactone (LAC)), and the calculation of the Prognostic Inflammatory and Nutritional Index (PINI). Patients were monitored for one year to establish the mortality rate of the group. Relationships between biological variables and undernutrition were evaluated using univariate and multivariate logistic regression models. The Kaplan Meier method was used to analyse survival curves. Hazard ratios for death were calculated according to the quartiles of each biological variable. ResultsIn the case of undernutrition, a decrease was observed in levels of leptin and in the lactonase activity (LAC) of paraoxonase, while adiponectin levels increased. Besides PINI, leptin was the only parameter that was independently related to undernutrition. While no relation was found between survival and leptin or adiponectin levels, evidence was found that PINI, LAC and ARE were associated with survival, even in multivariate analysis. ConclusionsLeptin and PINI are good markers of installed undernutrition, and PINI and ARE or LAC are reliable markers of the risk of death in patients suffering from cancer.

Biomarkers in immunonutrition programme, is there still a need for new ones? A brief review.

Background and aimsPre-existing malnutrition is one the most important factors affecting postsurgical complications, especially in cancer patients. The consequences of this on the immune function as well as on outcome could be reversed by immunonutrition. To help the clinician as a researcher, a routinely available biomarker (derived from clinical or biological data) would be of great importance.MethodsWe reviewed the potential markers that may routinely be used in perioperative immunonutrition programmes. A comprehensive approach was used to identify and discuss the potential markers, focusing on body mass and serum biomarkers.ResultsBody mass (including weight loss and body mass index) are predictive of complications, but not specifically to malnutrition. Serum markers, such as albumin, transthyretin, white blood cells counts, and C-reactive protein are not more specific. Composite scores, including the Nutritional Risk Index (NRI), the Prognostic Inflammatory and Nutritional Index (PINI), the modified Glasgow Prognostic Score (mGPS), the neutrophil-to-lymphocyte ratio (NLR), CD4 and CD8 lymphocytes counts, the platelet-to-lymphocyte ratio (PLR), the Prognostic Index (PI), and the Prognostic Nutritional Index (PNI) are prognostic factors of outcome, but are not always correlated to immunonutrition effect.ConclusionsIn conclusion, there remains a lack of efficient and widely available monitoring of the effects of immunonutrition. To predict and monitor the effect of immunonutrition on immunity, efforts should be directed to the validation of routinely available tools to aid the implementation of advanced immune monitoring (like lymphocytes subpopulations counts) in clinical practices.

Circulating tumor cell thresholds and survival scores in advanced metastatic breast cancer: The observational step of the CirCe01 phase III trial

The clinical validity of circulating tumor cell (CTC) count changes during chemotherapy in metastatic breast cancer patients has been validated, but its clinical utility remains to be demonstrated. We report here the non-randomized run-in phase of the CirCe01 trial which was designed to evaluate CTC changes and thresholds to other palliative prognostic scores and establish CTC thresholds to be used in the randomized part of the study. CTC count (CellSearch®) and other prognostic parameters (serum albumin level, lymphocyte level, LDH level, prognostic inflammatory and nutritional index (PINI) and Barbot's score) were assessed in 56 metastatic breast cancer patients before the first cycle of third line chemotherapy. Early changes of CTC count were correlated with treatment outcome. Independent prognostic markers in multivariate analysis were: low serum albumin (HR = 11.1), poor performance status (HR = 3.8), ≥5 CTC/7.5 ml (HR = 3.8) and triple negative subtype (HER2+ and hormone positive vs triple negative: both HR = 0.2). Among patients with ≥5 CTC/7.5 ml at baseline, a composite criteria (<5 CTC/7.5 ml or relative decrease ≥−70% of the baseline CTC count) showed better prognostication for PFS (p = 0.002).

Évaluation du statut nutritionnel chez les patients présentant un glioblastome en récidive

IntroductionNutritional status is a major clinical parameter in multiple cancers. Indeed, nutritional status is a prognostic factor and a predictor of response and toxicity to treatments in breast and lung cancers for instance. To our knowledge, in patients suffering from malignant primary brain tumors, nutritional status has been poorly investigated. MethodsNutritional status of 26 glioblastoma patients relapsing after a first line of treatment was studied. The body mass index (BMI), the prognostic inflammatory and nutritional index (PINI) and the instant nutritional score (INS) were assessed. ResultsThe BMI was abnormal in 12 patients, two were malnourished while 10 were overweight. The BMI was not correlated to age of patients. Overweight status did not impact patient survival but it was associated with reduced performance status. The PINI was abnormal in three patients. Finally, the INS was abnormal in 24 patients, noted 2 (n=22) or 4 (n=4). Conclusions/discussionOur results were not in favor of systematic nutritional support in patients with recurrent glioblastoma after a first line of treatment. Being overweight does not influence prognosis but may influence performance status. Steroid therapy and chemotherapy (inducing sodium and water retention and lymphopenia) weaken the relevance of BMI and INS for nutritional assessment in patients with recurrent glioblastoma. Further studies using additional nutritional tests in larger, independent and prospective cohorts of patients are warranted to obtain more details.

Leptin as a marker of undernutrition in breast cancer recurrence

ObjectiveTo relate leptin concentration with undernutrition and survival time in breast cancer recurrence.Design and methodsLeptin and other markers of undernutrition were measured in 49 patients who experienced disease recurrence for breast cancer. Undernutrition was clinically assessed by a weight loss of ≥10% between primary diagnosis and recurrence or ≥5% within the last month and/or the prescription of food supplements. Results were compared between patients with (21) or without (28) undernutrition by logistic regression models. The effect of biological variables on survival rate was assessed by the Kaplan‐Meier method.ResultsLeptin was significantly and negatively associated with undernutrition (OR=0.45 [0.23–0.87], p=0.018), while PINI (Prognostic Inflammatory and Nutritional Index, OR=1.24 [0.94–1.63], p=0.130) did not reach significance. The survival distributions across quartiles of leptin (Log rang test, p=0.048) and PINI (Log rank test, p=0.0001) were significantly different. However, as assessed by the Cox proportional hazards models, quartiles of leptin did not differ between each other while quartiles of PINI were all significantly different from quartile 1.ConclusionIn case of breast cancer recurrence, leptin is a good marker of undernutrition but is a poor marker of survival time, while PINI is a poor marker of undernutrition but is a good marker of survival time.

Prognostic value of PINI index in patients with multiple myeloma

The Prognostic Inflammatory and Nutritional Index (PINI) is a simple scoring system that aggregates two blood markers of inflammatory [C-reactive protein (CRP) and orosomucoid] and of nutritional (albumin and prealbumin) states. It is used in routine practice in geriatric medicine, especially in hospitalized elderly patients. This study was undertaken to evaluate the usefulness of PINI index in multiple myeloma (MM), a malignancy of the elderly. The PINI score was determined in 231 previously untreated patients with MM, of whom 112 were ≥65 yrs old. The serum albumin, prealbumin, orosomucoid (human α1-acid glycoprotein), and hsCRP are measured routinely by immunonephelometry. In the overall population and the elderly subset, PINI ≥ 4 ('high PINI') was correlated with a shorter median survival, 26 vs. 65 months in the high and low PINI groups, respectively. The prognostic impact of PINI index was dramatic in the elderly MM subgroup, 6 and 45 months, respectively. The high PINI index also predicted for shorter survival in various groups with good prognostic, such as low International Staging System (ISS) stages, low b2m, and absence of del17p and t(4;14), further demonstrating its prognostic impact on overall survival. In multivariate analysis, PINI index provided additional survival prognostic information to b2m in a b2m/PINI model. PINI index appears to be a useful and easy-to-perform marker in routine to determine the prognosis of patients with MM, especially in the elderly population. PINI might represent an alternative to ISS score, especially in elderly patients, in the future.

Effects of preoperative feeding with a whey protein plus carbohydrate drink on the acute phase response and insulin resistance. A randomized trial

BackgroundProlonged preoperative fasting increases insulin resistance and current evidence recommends carbohydrate (CHO) drinks 2 hours before surgery. Our hypothesis is that the addition of whey protein to a CHO-based drink not only reduces the inflammatory response but also diminish insulin resistance.MethodsSeventeen patients scheduled to cholecystectomy or inguinal herniorraphy were randomized and given 474 ml and 237 ml of water (CO group) or a drink containing CHO and milk whey protein (CHO-P group) respectively, 6 and 3 hours before operation. Blood samples were collected before surgery and 24 hours afterwards for biochemical assays. The endpoints of the study were the insulin resistance (IR), the prognostic inflammatory and nutritional index (PINI) and the C-reactive protein (CRP)/albumin ratio. A 5% level for significance was established.ResultsThere were no anesthetic or postoperative complications. The post-operative IR was lower in the CHO-P group when compared with the CO group (2.75 ± 0.72 vs 5.74 ± 1.16; p = 0.03). There was no difference between the two groups in relation to the PINI. The CHO-P group showed a decrease in the both CRP elevation and CRP/albumin ratio (p < 0.05). The proportion of patients who showed CRP/albumin ratio considered normal was significantly greater (p < 0.05) in the CHO-P group (87.5%) than in the CO group (33.3%).ConclusionsShortening the pre-operative fasting using CHO and whey protein is safe and reduces insulin resistance and postoperative acute phase response in elective moderate operations.Trial registrationClinicalTrail.gov NCT01354249

New prognosis inflammatory and nutritional indexes: comparison with the Prognostic Inflammatory and Nutritional Index as reference index

The Prognostic Inflammatory and Nutritional Index (PINI) was previously developed to improve the diagnosis and monitoring of patients with inflammation and/or malnutrition in terms of morbidity and mortality risk, especially in ICU patients [1]. The formula includes the determination of four serum protein concentrations: PINI = (C-reactive protein (CRP) (mg/l) × orosomucoid (OROSO) (g/l))/(albumin (ALB) (g/l) × transthyretin (TTR) (g/l)). Since CRP may be considered now as the gold standard for assessing and monitoring inflammatory states in clinical practice, OROSO is generally unavailable for PINI calculation. Elsewhere, the strong and rapid changes in CRP levels (0 to 600 mg/l) in acute inflammation may lead to an overestimation of the risk of morbidity and mortality suggested by the PINI. The aim of this study was to evaluate alternative biological formulas by removing OROSO from the PINI and replacing CRP value by its logarithm (Log), in order to reduce the mathematical weighting of this biomarker.

Abstract P6-11-06: Correlation Comprehensive Geriatric Assessment (CGA) and Inflammation and Nutrition Parameters with Outcome Measures in the Phase III PELICAN Trial for Metastatic Breast Cancer (MBC)

Abstract Background: PELICAN is a phase III trial of pegylated liposomal doxorubicin (PLD) vs capecitabine (CAP) as first-line therapy of patients (pts) with MBC. In the elderly pts, a CGA and analyses on biologic parameters on inflammation and nutrition, incorporated in the Prognostic Inflammatory and Nutritional Index (PINI) and Glasgow Prognostic Scale (GPS), were performed and results correlated to time to progression (TTP), overall survival (OS), time to treatment failure (TTF), and toxicity. Methods: CGA comprised data on activities of daily living (ADL), instrumental activities of daily living (IADL), ECOG and Karnofsky performance score (KPS), comorbidity (CIRS-G), and comedication. According to CGA, pts were classified into groups 1-3, ranging from fit to frail (Balducci 2000). For biologic assessment, blood samples of 86 pts were collected and centrally analysed. PINI was defined as [(CRP (mg/L) x A1GP (mg/L)]/[albumin (g/L) x prealbumin (mg/L)]. For GPS: pts were allocated a score of 2 if CRP &amp;gt;10mg/L and albumin &amp;lt;35g/L; a score of 1 if one parameter abnormal; and score of 0 if no abnormal values. Results: 210 pts (PLD:105; CAP:105) were randomized, stratified by age &amp; prior anthracycline. Median age was 62y (22-85). Pts received a median of 5 cycles each of PLD and CAP. Median TTP was comparable in both arms (6.7mo PLD vs 7.1mo CAP, p=0.346). There was an insignificant trend for higher GPS and PINI in pts ≥65y. According to CGA, 102 pts were considered fit (group 1, 72%), 21 compromised (group 2, 15%), and 19 frail (group 3, 13%). CGA did not correlate with therapy efficacy. Pts with good KPS of ≥90% (n=46) had a significantly longer TTP vs pts with a worse KPS (n=44) (median KPS 100%: 8.7mo; 90%: 8.6mo; ≥90%: 3.8mo; p=0.0027). Pts with GPS of 0 or 1 had a significantly longer TTP and TTF vs pts with a GPS of 2 (median TTP score 0: 8.3mo, score 1: 9.2mo, score 2: 2.8mo, p=0.0002). Grouping of pts by PINI values (&amp;lt;1; 1-10; &amp;gt;10) showed no correlation with TTP or TTF, and a nonsignificant trend for shorter OS for pts with PINI &amp;gt;10 (p=0.056). Among the analyzed laboratory parameters as single values, CRP showed a significant correlation with TTP (median TTP ≥5mg/L: 10.4mo, &amp;gt; 5 mg/l: 6.2mo, p=0.031) as did serum amyloid A (SAA, median TTP ≥6.8mg/L: 10.4mo, &amp;gt;6.8mg/L: 6.0mo, p=0.026) and serum albumin (median TTP ≥35g/L: 8.3mo, &amp;lt;35g/L: 2.8mo, p=0.009). No significant differences were observed with regard to frequency of AEs or AE-related if stratified according to GPS or PINI. Neither PINI nor GPS correlated with occurrence of overall toxicity grade 3-5; GPS correlated significantly with occurrence of constitutional symptoms (p=0.019). Conclusions: First-line chemotherapy of MBC pts using PLD or CAP showed similar efficacy with respect to TTP. Incorporation of CGA into a phase III trial is feasible and yields information that would otherwise have been missed. Prospective analyses of parameters of systemic inflammation and nutrition may have prognostic significance regarding TTP, TTF, and potentially OS in pts with breast cancer. Results of CGA, PINI and GPS need to be validated prospectively in treatment algorithms for this population. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-11-06.

Effects of branched amino acids supplementation in malnourished elderly with catabolic status.

Among various nutrients branched amino acids (BCAAS) have been shown to be the most responsible for the stimulation of protein synthesis in various situations including catabolic states. We evaluated the effect of a small amount of proteins enriched with BCAAs (0.4 g/kg/day and 0.2 g/kg/day BCAAs) on body weight and composition; nitrogen balance, energy intake and inflammation after 2 weeks of supplementation in acute elderly with catabolic status. Two weeks randomized controlled trial. Geriatric department of teaching hospital. Thirty patients with malnutrition and inflammatory process (MNA < 24, albumin < 30 g/l and CRP > or = 20 mg/l) who agreed to participate in the study were consecutively included. Body composition was determined by labelled water dilution method; resting energy expenditure (REE) was determined by indirect calorimetry; energy intake was calculated for a 3 days period at D1 and D12. Nutritional and inflammatory proteins and cytokines (IL-6 and TNF) were measured at day 1 and 14. No difference was observed at day 14 between supplemented (S) and control (C) group for weight (S: 58.0 +/- 11.8 kg and C: 60.0 +/- 15.9 kg); fat free mass (S: 40.7 +/- 8.3 kg and C: 40 +/- 8.2 kg); nitrogen balance (S: 1.34 +/- 2.21 g/day and C: 0.59 +/- 4.47 g/day); and energy intake (S: 20 +/- 3.6 kcal/day and C: 20.5 +/- 8.6 kcal/day). Energy intake was at similar level than REE and clearly less than energy requirement in C and S. A significant decrease was observed for orosomucoid and Prognostic Inflammatory and Nutritional Index (PINI) in S. Our results do not confirm improvement of nutritional status with enriched BCAAs supplementation as suggested in the literature. Persistence of inflammatory condition may be an explanation despite an improvement of inflammatory status was observed in the supplemented group. Those results show clearly that energy requirements are not covered in acute hospitalized elderly people. The fact that not only energy intake but also REE are decreased brings a new insight on catabolic situations.

Prognostic Value of PINI in Elderly Patients with Multiple Myeloma (MM).

Abstract 2493Poster Board II-470 Background.The Prognostic Inflammatory and Nutritional Index (PINI) is a simple scoring system which aggregates two blood markers of inflammatory (C reactive protein and orosomucoid) and of nutritional (albumin and prealbumin) states. This marker is predictive of nearest lethality and chronic institutionalization in geriatric routine practice for hospitalized elderly patients. MM is a malignant plasma cell disorder with a median age around 70 years old at diagnosis, a population characterized with several comorbid conditions that indirectly determine the prognosis and the treatment decision. The current most powerful adverse prognostic markers in MM are the adverse karyotypic abnormalities, such as 17p deletion and (4;14) translocation, and the high serum beta-2 microglobulin (b2m) that corresponds to the high International Staging System (ISS) group in combination with albumin. However, approximately 70% of MM patients have no know adverse karyotypic abnormalities, and high b2m and ISS are essentially informative for a minority of patients. We have sought to evaluate the prognostic value of PINI in MM in a large retrospective study. Method.The PINI score was determined in 226 previously untreated MM patients from sera collected at diagnosis before treatment, of whom 112 pts were 65 or older. The Serum albumin, prealbumin, orosomucoid (human α1-acid glycoprotein) and hsCRP were measured by immunonephelometry. PINI is calculated with the following formula: PINI=[orosomucoid (mg/L) × CRP (mg/L)]/[albumin (g/L) × prealbumin (mg/L)]. To avoid inadequate value of CRP, patients with fever and documented infection at diagnosis were excluded from the study. Results.Main patients characteristics at sample collection for the overall population were as follows: median age=64, ISS 2 and 3 of 29% and 21%, respectively. 35% of pts had chromosome 13 deletion (del13q). These characteristics were similar in pts older than 65. With a median follow-up of 57 months, median (+/-se) overall survival (OS) were 57 (+/-7) and 40 (+/-5) months in the overall and elderly population, respectively. The median (min-max) value of PINI were 0,29 (0,01-123) and 0,47 (0,01-123), respectively. The most informative PINI cut-off was determined at 4 and corresponded to its best impact on survival; 14% and 12.5% of pts had PINI ≥ 4, in the overall and elderly population, respectively. PINI correlated with markers of tumour burden such as high b2m level, low hemoglobin level and, high creatinin value. PINI ≥ 4 was also related to high ISS score (II + III), in 46% and 32% of pts, respectively. PINI did not correlate to del13q. In univariate analysis, median OS (+/-se) was significantly lower in patients with PINI ≥ 4 (number of death/number of pts in the group (O/N)=24/31) than pts with PINI <4 (O/N=99/195), 26 (±12) vs. 65 (±7) months, [p=0.0003; OR=2.21] respectively. This adverse prognostic impact was even more dramatic in elderly patients, 6 (±7) months (O/N=14/112) vs. 45 (±7) months (O/N=60/96), p<0.0001, respectively. Other markers, age above 65, low haemoglobin value below 10g/dL, b2m above 4mg/L, presence of del13q and ISS score II +III remained significant but with a lower impact. Interestingly, PINI ≥ 4 identified a subgroup of patients characterized with intermediate prognostic in pts with low b2m (< 4 mg/L) [PINI ≥ 4: O/N=8/12, 50 (±29) vs. PINI <4: O/N=53/123, 79 (±6), p=0.02], hemoglobin value ≥ 10g/dL [PINI ≥ 4: O/N=9/12, 13 (±10) vs. PINI <4: O/N=54/135, 79 (±8), p=0.0003] and absence of del13q [PINI ≥ 4: O/N=10/15, 50 (±18) vs. PINI <4: O/N=36/86, 80 (±13), p=0.0018]. In multivariate analysis, factors evaluated for association with high PINI were age (>65years), hemoglobin (<10g/dL), platelet count (<100 ×109/L), b2M (≥4mg/L) and ISS (II+III). Modeling results showed a significant association of PINI with elevated b2M and del13q, with 51% (17/33) vs. 72% (16/22) of patients with high PINI in b2M < 4 mg/L vs. ≥ 4 mg/L (OR=2.4, p=0.003), and with 56% (34/60) vs. 85% (6/7) of patients with high PINI in absence vs. presence of del13q (OR=2.3, p=0.001). Conclusion.PINI appeared to be a useful and easy-to-perform marker in routine practice to determine the prognosis of patients with MM, especially in the elderly population with no know adverse karyotypic abnormalities and low b2m/ISS. The study of PINI should be performed in future prospective clinical trials to validate these results. Disclosures:No relevant conflicts of interest to declare.

The usefulness of the prognostic inflammatory and nutritional index (PINI) in a haemodialysis population

Background and aim Protein–Energy Wasting and inflammation are the principal risk factors of haemodialysis complications. We evaluated the reliability of a simple and non expensive test, the Prognostic Inflammatory and Nutritional Index (PINI), for regular screening of maintenance haemodialysis (MHD) patients in order to detect early onset of inflammation and malnutrition. Methods and results 121 adult patients on maintenance dialysis were followed up for 32 months and screened every 6 months for PINI, calculated as alpha1-Acid Glycoprotein (α1-AG) × C-Reactive Protein (CRP)/Albumin × Transthyretin. PINI score ≤1 was considered normal. Patients were stratified according to their PINI score: 86 patients (71.66%) had a normal score, whereas 35 (28.33%) had PINI ≥ 1. The latter also had higher CRP levels, despite no clinical evidence of inflammation at the time of enrolment. Survival in patients with normal PINI was similar to patients with normal CRP, while in patients with abnormal PINI it was significantly lower than in patients with low serum albumin ( p < 0.05) or elevated CRP ( p < 0.05). After follow-up, all surviving MHD patients with PINI ≥ 1 had at least one cardiovascular event vs 2.5% of patients with PINI ≥ 1. Conclusion The assessment of PINI can reliably identify MHD patients at higher risk of mortality and morbidity even in the absence of overt Malnutrition-Inflammation Complex Syndrome (MICS). This simple test appears to be more sensitive and specific of the single components, and not expensive, so that it could be routinely used to identify patients with sub-clinical inflammation and/or malnutrition.