Prognostic nutritional index predicts nintedanib outcomes in idiopathic pulmonary fibrosis

BackgroundMalnutrition is common in patients with idiopathic pulmonary fibrosis (IPF), and potentially affects the tolerability of antifibrotic therapy and survival. The prognostic nutritional index (PNI) is a validated prognostic marker in various diseases; however, its role in antifibrotic therapy remains unclear.ObjectivesTo investigate associations between the PNI and adverse effects associated with nintedanib, treatment discontinuation, and survival in patients with IPF.DesignMulticenter retrospective study.MethodsData from 167 Japanese patients with IPF who received nintedanib therapy were retrospectively analyzed. Information on clinical characteristics, laboratory data, and adverse events was collected, and the PNI was calculated. The optimal PNI cut-off value was determined using receiver operating characteristic (ROC) curves. Risk factors for treatment discontinuation and survival were identified using Cox proportional hazards models.ResultsThe median treatment duration and survival time were 18 and 55 months, respectively. The PNI was significantly higher in patients who experienced nintedanib-associated adverse effects than in those who did not. ROC curve analysis identified an optimal PNI cut-off value of 47.3. Patients with a high PNI had significantly longer treatment durations and survival than those with a low PNI. Multivariate analyses identified the PNI as the only factor independently associated with both time to nintedanib discontinuation and survival.ConclusionThe PNI predicted treatment feasibility and survival in patients with IPF. These findings highlight the clinical utility of the PNI as a dual biomarker of nutritional status and demonstrate its potential to guide individualized treatment strategies based on nutritional status.