Prognostic Nutritional Index as a Novel Biomarker for Predicting Prognosis in Sepsis-Associated Encephalopathy: A...

Sepsis-associated encephalopathy (SAE) has a high mortality rate with limited prognostic biomarkers. We investigated the relationship between the Prognostic Nutritional Index (PNI) and SAE outcomes.

This multicenter cohort study (2008-2019) enrolled 3202 SAE patients. The primary outcome was 28-day all-cause mortality. Multivariable-adjusted analyses (logistic regression, propensity score matching, and inverse probability weighting) assessed PNI's prognostic value, supplemented by generalized additive models (GAMs), Kaplan-Meier, and ROC analyses. External validation was performed.

PNI independently predicted 28-day mortality (adjusted OR: 0.85; 95% CI: 0.77-0.93). The GAM identified PNI = 34 as the optimal prognostic threshold. Patients with PNI < 34 had higher 28-day mortality than those with PNI ≥ 34 in both original and validation cohorts (p < 0.001). ROC analysis demonstrated strong discrimination in the original cohort (AUC = 0.879; sensitivity = 0.878; specificity = 0.880) and the validation cohort (AUC = 0.724). Higher PNI correlated with better neurological function (Glasgow Coma Scale, p < 0.001).

This multicenter study establishes the PNI as an independent predictor of 28-day mortality in patients with SAE. We identified that SAE patients with PNI < 34 exhibited significantly higher 28-day mortality rates and worse neurological function.