Prognostic nutritional index is associated with disease severity and relapse in ANCA‐associated vasculitis

Abstract

Aim The prognostic nutritional index (PNI), calculated by serum albumin and peripheral blood lymphocyte count, is considered to reflect immune‐related nutritional status. In this study, we first investigated the clinical significance of PNI in patients with antineutrophil cytoplasmic antibody‐associated vasculitis (AAV). Method Medical records of 160 patients classified as AAV from October 2000 to September 2017 were reviewed. We calculated the Birmingham vasculitis activity score (BVAS) and collected laboratory data including erythrocyte sedimentation rate (ESR), C‐reactive protein (CRP) level, white blood cell, lymphocyte, and platelet counts, and serum albumin, aspartate aminotransferase, and alanine aminotransferase levels at diagnosis. PNI at diagnosis was calculated as (10 × serum albumin [g/dL] + 0.005 × lymphocyte count [/mm3]). Associations between laboratory variables, PNI, and BVAS were assessed by linear regression analyses, and Cox proportional hazard analysis was used to evaluate factors associated with disease relapse. Results The mean age was 55.2 years and 48 patients (30.0%) were male. In univariable linear regression analysis, BVAS was positively correlated with ESR and CRP and negatively with lymphocyte count, serum albumin, and PNI (r = −0.307). In multivariable linear regression analysis, among ESR, CRP, and PNI, PNI was associated with BVAS (β = −0.299). PNI also significantly correlated with the included laboratory data. In Cox proportional hazard analysis, myeloperoxidase—antineutrophil cytoplasmic antibody positivity (odds ratio [OR] 2.875, P = 0.003) and PNI ≤36.75 (OR 2.066, P = 0.042) revealed to be independent predictors of disease relapse during the follow‐up period. Conclusions Prognostic nutritional index at diagnosis might be useful for assessing disease severity and predicting the prognosis of AAV patients.

Serum albumin, prealbumin, and ischemia-modified albumin levels in patients with ANCA-associated vasculitis: A prospective cohort study

“…Studies have reported that the decrease in Alb is suitable for assessing the severity of disease in rheumatoid arthritis, systemic lupus erythematosus, and ulcerative colitis [ 25 – 28 ]. Interestingly, the observations from this study confirmed the previously obtained data of our group, which showed hypoalbuminemia at AAV diagnosis was associated with disease activity and lymphocyte count [ 29 ]. Furthermore, the correlation coefficient between BVAS and Alb (BVAS vs. Alb: r = -0.664; 95% CI: -0.787, -0.492; p<0.001) was higher than that of BVAS with ESR (BVAS vs. ESR: r = 0.576; 95% CI: 0.375, 0.725; p<0.001) and BVAS with CRP (BVAS vs. CRP: r = 0.416; 95% CI: 0.180, 0.608; p = 0.001).…”

New body mass index for predicting prognosis in patients with antineutrophil cytoplasmic antibody‐associated vasculitis

“…Our team had previously evaluated prognostic nutritional index, an index that reflects nutritional status, in patients with AAV and revealed that it correlated with the BVAS and predicted relapse. 30 Similarly, we demonstrated that a poor nutritional status was associated with a higher BVAS, and that it was a risk factor for ESRD occurrence. 31 One explanation for these findings is that underweight patients are at an increased risk of low muscle mass, 32 , 33 and muscle mass is associated with chronic kidney disease.…”

“…The exact mechanism underlying these associations is unclear. Our team had previously evaluated prognostic nutritional index, an index that reflects nutritional status, in patients with AAV and revealed that it correlated with the BVAS and predicted relapse 30 . Similarly, we demonstrated that a poor nutritional status was associated with a higher BVAS, and that it was a risk factor for ESRD occurrence 31 .…”

Increased Frequencies of Switched Memory B Cells and Plasmablasts in Peripheral Blood from Patients with ANCA-Associated Vasculitis

“…Multiple biomarkers of disease activity in AAV have been proposed, including platelet count [31], lung involvement [32], and prognostic nutritional index [33]. A rise in or persistence of ANCAs during remission is only modestly predictive of future disease relapse [34].…”