Prognostic nutritional index and systemic inflammation index as predictors of cirrhosis severity: a cross-sectional...

We assessed whether the Prognostic Nutritional Index (PNI) and the Systemic Inflammation Index (SII) are associated with cirrhosis severity and decompensation.

Cirrhosis severity is routinely staged with MELD and Child-Pugh scores, which only partially capture nutritional and inflammatory status.

We conducted a cross-sectional study of 202 cirrhotic adults at Shahid Beheshti University hospitals (2018-2022). Demographic, clinical, and lab data were obtained from records. PNI (10 × albumin + 0.005 × lymphocytes) and SII (platelets × neutrophils ÷ lymphocytes) were calculated. Associations with MELD, Child-Pugh, and complications were analyzed (α = 0.05; SPSS).

Higher SII was associated with greater disease severity, including higher MELD (P = 0.040) and higher Child-Pugh class (overall P = 0.010), with SII levels higher in Child-Pugh class C than in class B (P = 0.001). PNI showed an inverse relationship with MELD, consistent with better nutritional status at lower severity. PNI was higher in patients without ascites (P = 0.020). Both indices differed in patients with hepatic encephalopathy versus those without (P = 0.010). Moreover, SII did not differ across variceal grades (P = 0.891), whereas PNI was lower in higher grades (overall P = 0.005).

PNI and SII exhibit significant associations with established severity measures in cirrhosis. These indices may complement MELD and Child-Pugh by integrating nutritional and inflammatory information into routine assessment. Prospective, externally validated studies are warranted to determine predictive utility and clinical impact.