The use of prognostic nutritional index (PNI) and selected inflammatory indicators for predicting malnutrition in COVID-19 patients: A retrospective study

Al-Shami, Islam; Hourani, Huda M. Al; Alkhatib, Buthaina

doi:10.1016/j.jiph.2022.12.018

Cited by 13 publications

(5 citation statements)

References 35 publications

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“…[ 29 ] Additional research also demonstrated the utility of PNI for prognosis prediction in COVID-19. [ 30 , 31 ] Collectively, these data substantiate PNI as a robust marker of immune-nutritional deficiencies associated with mortality risk in critical illness, including COVID-19. Interventions aimed at correcting hypoalbuminemia and lymphopenia may confer survival benefits in patients with low PNI.…”

Section: Discussionmentioning

confidence: 61%

“…Since all the patients included in this study were elderly patients with severe COVID-19, so there was no significant age difference between the death group and the patients who were successfully discharged. However, compared to survivors, the patients who died had more underlying diseases, such as hypertension (47 [58.0%] vs 30…”

Section: Characteristics Of Patients In This Trialmentioning

confidence: 99%

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The prognostic value of prognostic nutritional index and renal function indicators for mortality prediction in severe COVID-19 elderly patients: A retrospective study

Cao,

Luo,

Wang

et al. 2024

Medicine

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Identifying prognostic factors in elderly patients with severe coronavirus disease 2019 (COVID-19) is crucial for clinical management. Recent evidence suggests malnutrition and renal dysfunction are associated with poor outcome. This study aimed to develop a prognostic model incorporating prognostic nutritional index (PNI), estimated glomerular filtration rate (eGFR), and other parameters to predict mortality risk. This retrospective analysis included 155 elderly patients with severe COVID-19. Clinical data and outcomes were collected. Logistic regression analyzed independent mortality predictors. A joint predictor “L” incorporating PNI, eGFR, D-dimer, and lactate dehydrogenase (LDH) was developed and internally validated using bootstrapping. Decreased PNI (OR = 1.103, 95% CI: 0.78–1.169), decreased eGFR (OR = 0.964, 95% CI: 0.937–0.992), elevated D-dimer (OR = 1.001, 95% CI: 1.000–1.004), and LDH (OR = 1.005, 95% CI: 1.001–1.008) were independent mortality risk factors (all P < .05). The joint predictor “L” showed good discrimination (area under the curve [AUC] = 0.863) and calibration. The bootstrapped area under the curve was 0.858, confirming model stability. A combination of PNI, eGFR, D-dimer, and LDH provides useful prognostic information to identify elderly patients with severe COVID-19 at highest mortality risk for early intervention. Further external validation is warranted.

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Section: Discussionmentioning

confidence: 61%

Section: Characteristics Of Patients In This Trialmentioning

confidence: 99%

The prognostic value of prognostic nutritional index and renal function indicators for mortality prediction in severe COVID-19 elderly patients: A retrospective study

Cao,

Luo,

Wang

et al. 2024

Medicine

View full text Add to dashboard Cite

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“…Protein intake amount, renal failure, lymphocyte and AST were independent influencing factors for COVID-19 "repositive" in malnourished older adults. Previous studies have shown that energy consumption and protein breakdown are accelerated in COVID-19 infection patients, 34 resulting in a reduction of available protein in the body, leading to a decrease in the number of functional active immunoglobulins and intestinal-associated lymphoid tissue, hindering the role of intestinal mucosal defense against infection; 35,36 another study 37 found that patients with comorbidities were more likely to have re-positive after discharge, compared with those with normal liver or kidney function, re-positive patients with liver or kidney function impairment had a 2.32-fold higher risk of developing severe cases, [38][39][40] and the tendency of severity and mortality risk increased significantly. Therefore, adequate intake of high-quality protein is essential for antibody production, 41 while for patients with liver or kidney dysfunction, protein intake should be strictly and standardized controlled.…”

Section: Discussionmentioning

confidence: 99%

Predicting COVID-19 Re-Positive Cases in Malnourished Older Adults: A Clinical Model Development and Validation

Chen,

Luo,

Sun

et al. 2024

CIA

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Purpose Building and validating a clinical prediction model for novel coronavirus (COVID-19) re-positive cases in malnourished older adults. Patients and Methods Malnourished older adults from January to May 2023 were retrospectively collected from the Department of Geriatrics of the Affiliated Hospital of Chengdu University of Traditional Chinese Medicine. They were divided into a “non-re-positive” group and a “re-positive” group based on the number of COVID-19 infections, and into a training set and a validation set at a 7:3 ratio. The least absolute shrinkage and selection operator (LASSO) regression analysis was used to identify predictive factors for COVID-19 re-positivity in malnourished older adults, and a nomogram was constructed. Independent influencing factors were screened by multivariate logistic regression. The model’s goodness-of-fit, discrimination, calibration, and clinical impact were assessed by Hosmer-Lemeshow test, area under the curve (AUC), calibration curve, decision curve analysis (DCA), and clinical impact curve analysis (CIC), respectively. Results We included 347 cases, 243 in the training set, and 104 in the validation set. We screened 10 variables as factors influencing the outcome. By multivariate logistic regression analysis, preliminary identified protective factors, risk factors, and independent influencing factors that affect the re-positive outcome. We constructed a clinical prediction model for COVID-19 re-positivity in malnourished older adults. The Hosmer-Lemeshow test yielded χ 2 =5.916, P =0.657; the AUC was 0.881; when the threshold probability was >8%, using this model to predict whether malnourished older adults were re-positive for COVID-19 was more beneficial than implementing intervention programs for all patients; when the threshold was >80%, the positive estimated value was closer to the actual number of cases. Conclusion This model can help identify the risk of COVID-19 re-positivity in malnourished older adults early, facilitate early clinical decision-making and intervention, and have important implications for improving patient outcomes. We also expect more large-scale, multicenter studies to further validate, refine, and update this model.

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“…14 Additionally, PNI could be used to assess the survival outcomes of patients with infectious diseases from the perspective of immune status. 15 Generally speaking, the predictive performance of the joint index is higher than any single index in clinical practice. Hence, the CRP‐to‐PNI ratio (CRP/PNI) represents the inflammatory and immune statuses of the body.…”

Section: Introductionmentioning

confidence: 99%

“…The prognostic nutritional index (PNI), initially designed to assess the surgical risk for patients with gastrointestinal tumors, consists of serum albumin and absolute lymphocyte count 14 . Additionally, PNI could be used to assess the survival outcomes of patients with infectious diseases from the perspective of immune status 15 . Generally speaking, the predictive performance of the joint index is higher than any single index in clinical practice.…”

Section: Introductionmentioning

confidence: 99%

High CRP/PNI levels predict an unfavorable prognosis in severe fever with thrombocytopenia syndrome: A propensity score matching study

Guo,

Wang,

Wang

et al. 2024

Immunity Inflam & Disease

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BackgroundThis study aimed to identify a novel inflammatory index and construct a nomogram for predicting in‐hospital mortality due to severe fever with thrombocytopenia syndrome (SFTS).MethodsThis cohort included 610 patients with SFTS hospitalized in Wuhan Union Hospital between March 2017 and November 2022. The ratio of C‐reactive protein (CRP) to the prognostic nutritional index (PNI) was calculated and used to reflect patients' inflammatory status. Propensity score matching (PSM) was utilized to balance confounding factors between the low‐ and high‐CRP/PNI groups. SFTS individuals from Jinyinhu Hospital were used as the validation cohort.ResultsPatients with SFTS and high CRP/PNI were significantly correlated with a higher percentage of severe and critical SFTS types and higher in‐hospital mortality rates than those with low CRP/PNI. CRP/PNI was the potent risk indicator for in‐hospital mortality in individuals with SFTS. The CRP/PNI nomogram showed a good predictive value for in‐hospital mortality in patients with SFTS. After PSM, the predictive performance of CRP/PNI for 28‐day mortality was excellent. Finally, the CRP/PNI could still assess patients with SFTS at different risks based on SFTS data from another medical center.ConclusionThe CPR/PNI ratio exhibited a strong positive correlation with the SFTS disease type and could predict in‐hospital mortality in the early stages of SFTS. The CPR/PNI ratio could substantially help clinicians facilitate the early identification of patients with high‐risk SFTS and the timely initiation of intensive therapy.

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The use of prognostic nutritional index (PNI) and selected inflammatory indicators for predicting malnutrition in COVID-19 patients: A retrospective study

Cited by 13 publications

References 35 publications

The prognostic value of prognostic nutritional index and renal function indicators for mortality prediction in severe COVID-19 elderly patients: A retrospective study

The prognostic value of prognostic nutritional index and renal function indicators for mortality prediction in severe COVID-19 elderly patients: A retrospective study

Predicting COVID-19 Re-Positive Cases in Malnourished Older Adults: A Clinical Model Development and Validation

High CRP/PNI levels predict an unfavorable prognosis in severe fever with thrombocytopenia syndrome: A propensity score matching study

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