Prognostic nutritional index predicts 1-year hospitalization and mortality in outpatients with cirrhosis

Malnutrition is prevalent in patients with cirrhosis and is linked to negative clinical outcomes. However, research on the prognostic nutritional index (PNI) and the burden of hospitalization over one year in stable outpatients remains limited. This study aimed to assess the relationship between PNI and liver-related hospitalization outcomes, as well as 12-month mortality, in outpatients with cirrhosis. In this retrospective single-center study, 125 adult patients with stable cirrhosis were analyzed, focusing on baseline demographic, clinical, laboratory, and 12-month follow-up data. Logistic regression was employed to evaluate the incidence of hospitalization in the entire cohort, while Poisson regression assessed hospital admission counts among patients with complete follow-up, and linear regression investigated the total length of stay for hospitalized patients.The results indicated that lower PNI values were significantly correlated with an increased likelihood of hospitalization and a higher frequency of hospital admissions within one year. In multivariable analysis, PNI remained an independent predictor of hospitalization (odds ratio [OR] = 0.655, 95% confidence interval [CI]: 0.530-0.809, p < 0.001) and admission frequency (incidence rate ratio [IRR] = 0.90, 95% CI: 0.848-0.955, p < 0.001), while no significant association was found with the length of hospital stay. Each 5-unit increase in PNI corresponded to substantially lower odds of hospitalization (OR = 0.121, 95% CI: 0.042-0.347) and a reduced admission rate (IRR = 0.59, 95% CI: 0.444-0.794). Additionally, PNI exhibited significant negative correlations with the Model for End-Stage Liver Disease-Sodium (MELD-Na) and Child-Turcotte-Pugh scores (all p < 0.001). PNI also demonstrated strong predictive validity for 12-month cirrhosis-related mortality, with an area under the curve (AUC) of 0.873 (95% CI: 0.802-0.943) and an optimal cut-off value of 38.5. Patients with a PNI ≤38.5 experienced significantly reduced 12-month survival (log-rank p < 0.001). These findings suggest that PNI may serve as a straightforward and accessible marker for nutritional assessment and early risk stratification in stable outpatients with cirrhosis.