Associations between systemic inflammation and intestinal permeability with Onodera's prognostic nutritional index in critically ill patients

Abstract

Background: Malnutrition is a potentially costly problem in critically ill patients admitted to the intensive care unit (ICU). The aim of this study is to evaluate the relationships between the Onodera's prognostic nutritional index (OPNI) and intestinal permeability and between OPNI and systemic inflammation in critically ill patients.Methods: This was a cross-sectional study conducted in the general ICU of a university-affiliated hospita l. A total of 162 ICU-hospitalized adult patients admitted between May 2018 and December 2019, was in cluded in the study sample. The OPNI was calculated at admission and categorized as ≤40 or >40. We ass essed plasma endotoxin and zonulin concentrations as markers of intestinal permeability as well as serum interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hs-CRP) as markers of systemic inflammatio n upon admission under stringent conditions. The relationships between these markers and OPNI were ass essed after adjusting for potential confounders through estimation of a binary logistic regression model.Results: Median (interquartile range) hs-CRP, IL-6 zonulin, and endotoxin were significantly greater in t he low OPNI subgroup than in the high OPNI subgroup (all P<0.05). Multivariate analyses showed signifi cant association between serum IL-6 (odds ratio [OR], 0.88; 95% confidence interval [CI], 0.64-0.96), ser um hs-CRP (OR, 0.77; 95% CI, 0.53-0.92), plasma endotoxin (OR, 0.81; 95% CI, 0.72-0.93), and plasm a zonulin (OR, 0.83; 95% CI, 0.75-0.98) levels with OPNI in the overall population. Conclusions:Our results provide evidence that higher plasma endotoxin, zonulin, IL-6, and hs-CRP level s are associated with progressively lower OPNI in mixed ICU populations, particularly in surgical ICU pa tients.

Association of malnutrition status with 30-day mortality in patients with sepsis using objective nutritional indices: a multicenter retrospective study

“…PNI is a commonly used nutritional index that is associated with systemic inflammation. Ardehali et al [ 11 ] reported that critically ill patients with low PNI scores had higher serum levels of interleukin-6 and high-sensitivity C-reactive protein. Therefore, PNI scores are considered a prognostic factor for patients with sepsis.…”

“…Patients were grouped into risk categories of absent (score 0–1), mild (2–4), moderate (5–8), and severe (9–12) malnutrition based on the comprehensive score [ 9 ]. PNI scores were calculated as 5×lymphocyte count (×109/L)+10×serum albumin concentration (g/dl), with absent, moderate, and severe malnutrition risk is defined as >38, 35–38, and <35, respectively [ 11 ]. Details of the nutritional assessment methods are described in more detail in Supplementary Table 1 .…”

“…They incorporate parameters such as serum albumin and total cholesterol concentrations, and peripheral lymphocytes to provide a more comprehensive assessment of an individual's nutritional health. These indices are widely used to assess nutrition in patients with malignancies [ 7 , 8 ], stroke [ 9 , 10 ], and sepsis [ 11 ]. Moreover, early nutrition status is associated with the duration of mechanical ventilation [ 12 ].…”

Practical parameters that can be used for nutritional assessment in patients hospitalized in the intensive care unit with the diagnosis of chronic obstructive pulmonary disease

“…PNI was first developed by Onodera et al [13] PNI is an objective indicator calculated using serum albumin level and lymphocyte count [20] . While PNI was initially used for the postoperative risk assessment of patients, it has also been used for the evaluation of prognosis in other patient groups and patients hospitalized in the intensive care unit in recent years [6,12,21,22] . Studies investigating the effect of PNI on prognosis tried to find cut-off values for different patient groups.…”

“…[ 20 ] While PNI was initially used for the postoperative risk assessment of patients, it has also been used for the evaluation of prognosis in other patient groups and patients hospitalized in the intensive care unit in recent years. [ 6 , 12 , 21 , 22 ] Studies investigating the effect of PNI on prognosis tried to find cut-off values for different patient groups. In these studies, the cut-off value for PNI ranged between 35 and 53.85.…”