Comparative Prognostic Performance of Nutritional Indices in Acute Myeloid Leukemia

Background/Objectives: Malnutrition adversely affects the clinical course of acute myeloid leukemia (AML), yet comparative data on objective nutritional indices remain limited. Methods: This study evaluated the prognostic performance of four indices-Controlling Nutritional Status (CONUT), Simple CONUT, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI)-on overall survival (OS) alongside the European LeukemiaNet (ELN) 2022 risk classification. Pre-treatment parameters of 236 newly diagnosed AML patients were retrospectively analyzed using Receiver Operating Characteristic (ROC) curves and multivariate Cox regression models. Results: In ROC analysis, only NRI demonstrated significant discriminative performance in predicting OS (Area Under the Curve = 0.637, p < 0.001), whereas CONUT, Simple CONUT, and PNI lacked statistical significance. Patients with low NRI scores had significantly worse survival than the high NRI group (median OS: 16.8 months versus not reached, p = 0.004), particularly within the ELN favorable risk category (2-year OS: 59.6% versus 93.5%, p = 0.022). Multivariate analysis established NRI as an independent predictor of mortality (Hazard Ratio = 0.967, p = 0.009) alongside age and ELN risk. Conclusions: In conclusion, NRI outperforms other nutritional indices and serves as an independent prognostic factor in AML, offering a more holistic and effective approach to clinical risk stratification.