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Prognostic nutritional index at discharge as a practical bedside tool for long-term all-cause mortality risk in
Zhenwei Zhai1, Junyu He1, Jingxia Sun1
1Department of Endocrinology and Metabolism, National Key Clinical Construction Specialty, Guangxi Academy of Medical Sciences & The People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China.
Insights
The prognostic nutritional index (PNI) effectively predicts long-term mortality in sepsis survivors. Lower PNI scores indicate a higher risk of death, suggesting its use as a bedside prognostic tool.
Area of Science:
- Critical Care Medicine
- Nutritional Immunology
- Prognostic Biomarkers
Background:
- Sepsis research often overlooks long-term outcomes, focusing primarily on ICU mortality.
- Limited data exists on predicting all-cause mortality post-sepsis discharge.
- The prognostic nutritional index (PNI) reflects nutritional and immune status.
Purpose of the Study:
- To assess the prognostic value of PNI for long-term all-cause mortality in pneumonia-induced sepsis survivors.
- To compare PNI's predictive performance against established prognostic scores.
Main Methods:
- A multicenter ambispective longitudinal cohort study of 461 sepsis survivors.
- Follow-up for a median of 36 months, stratifying patients by discharge PNI tertiles.
- Comparison with CONUT, mGPS, BAR, NLR, and PLR using Cox regression and ROC analysis.
Main Results:
- An inverse relationship was found between PNI and mortality risk (p < 0.001).
- Lowest PNI tertile showed a 54.8% higher mortality risk (p for trend = 0.043).
- PNI outperformed other indicators, with a diagnostic cutoff of 39.00 (AUC = 0.672).
Conclusions:
- PNI is a valuable bedside tool for estimating long-term mortality in sepsis survivors.
- Supports personalized clinical decision-making and routine care as an auxiliary prognostic indicator.
Objectives:
Existing research has predominantly focused on short-term outcomes of sepsis during intensive care unit (ICU) admission, with limited evidence on long-term all-cause mortality. This multicenter ambispective longitudinal cohort study aimed to evaluate the prognostic value of the prognostic nutritional index (PNI), a composite marker reflecting nutritional and immune-inflammatory status, for long-term all-cause mortality in pneumonia-induced sepsis survivors.
Methods:
A total of 461 pneumonia-induced sepsis survivors with recurrence-free status for at least 3 months post-discharge were retrospectively enrolled and prospectively followed for a median of 36 months. Participants were stratified into tertiles based on discharge PNI scores. The association between PNI and long-term all-cause mortality was assessed, and its prognostic performance was compared with established indicators, including the Controlling Nutritional Status (CONUT) score, modified Glasgow Prognostic Score (mGPS), blood urea nitrogen-to-albumin ratio (BAR), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR).
Results:
Restricted cubic spline (RCS) analysis revealed an inverted L-shaped, dose-dependent negative association between PNI and long-term all-cause mortality risk (p for overall < 0.001). Multivariate Cox regression analysis showed that participants in the lowest PNI tertile had a 54.8% higher mortality risk than those in the highest tertile (p for trend = 0.043). Subgroup analyses confirmed consistent prognostic value across diverse populations (all interaction p-values > 0.05). Kaplan-Meier analysis demonstrated that lower PNI levels were significantly associated with higher cumulative mortality (log-rank, p < 0.001). Multivariate linear regression further indicated that each one-tertile increase in PNI corresponded to a quantifiable reduction [calculated as |β| × tertile interval (5.9)] in related nutritional and inflammatory markers, in model III, including a reduction of 1.0585 in COUNT score (β = -0.1794), 0.1398 in mGPS (β = -0.0237), 0.0378 in BAR (β = -0.0064), 45.6619 in PLR (β = -7.7393), and 2.8951 in NLR (β = -0.4907) (all p < 0.001). Receiver operating characteristic (ROC) curve analysis identified a PNI clinical diagnostic cutoff of 39.00 for long-term all-cause mortality, with an area under the curve (AUC) of 0.672 (p < 0.001) and a sensitivity of 0.64, outperforming the established indicators.
Conclusions:
These findings suggest that PNI may serve as a practical bedside tool for estimating long-term post-hospital all-cause mortality among survivors of pneumonia-induced sepsis, supporting personalized clinical decision-making and routine care as an auxiliary prognostic indicator.
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