A Clinical Epidemiological Analysis of Prognostic Nutritional Index Associated with Diabetic Retinopathy

Abstract

Purpose Prognostic nutritional index (PNI) is an effective tool to evaluate the nutritional conditions and predict prognosis, but clinical data are limited for the use of PNI in diabetic retinopathy (DR). This study aimed to investigate the relationship of PNI with the prevalence and severity of DR in patients with type 2 diabetes mellitus (T2DM). Patients and Methods This cross-sectional analysis enrolled 1023 individuals with T2DM hospitalized between 2017–2020. PNI was calculated as 10 × serum albumin (g/l) + 0.005 × total lymphocyte count (cells/mL). DR severity was categorized as no, nonproliferative, and vision-threatened DR (VTDR) according to the modified Airlie House classification. Multivariate-adjusted odds ratio (OR) with 95% confidence interval (CI) for the prevalent DR in the top (Q4) compared with the bottom quartile (Q1) of PNI levels were estimated by using logistic regression analyses. Results PNI levels were significantly lower in individuals with VTDR than those with no and nonproliferative DR (both P < 0.001), and the proportions of individuals with DR were significantly decreased in the top quartile compared with the bottom quartile of PNI levels ( P < 0.001). After adjustments for age, gender, DM duration, obesity-related risk factors and clinical biochemical parameters, the higher levels of PNI were significantly associated with a lower prevalence of DR (Q4 vs Q1: OR = 0.402, 95% CI: 0.250–0.649, P < 0.001), with a 5.9% reduction in the prevalence of DR for a per-unit increment in the levels of PNI (OR = 0.941, 95% CI: 0.911–0.972, P < 0.001). The association of PNI and obesity-related indexes (body mass index and waist circumference) with the severity of DR was independent of each other (P<0.001). Conclusion PNI was inversely and independently associated with the severity and prevalence of DR, which suggested that PNI could likely be used to predict DR prognosis in clinical practice.

The Importance of Prognostic Nutritional Index in Predicting Acute Renal Failure After On-Pump Coronary Artery Bypass Operations in Patients with Insulin-Dependent Diabetes Mellitus

“…The authors included 1023 DM patients in the study. As a result of the study, they found that low PNI values were an independent predictor of retinopathy, its presence and severity in patients with DM [Yang 2021]. In our current study, we determined the PNI value in patients with insulin-dependent diabetes as an independent predictor of postoperative AKI.…”

Association Between Serum Albumin Level and Microvascular Complications of Type 2 Diabetes Mellitus

“…None of the previous studies on sALB and DR excluded patients with co-morbidity of DR and DKD. 9,34 The occurrence of this situation in our study may be related to the insufficient sample size of patients in the DR only group because some patients with DR are divided into the DR + DKD group, and the sALB level in the DR + DKD group is significantly lower than that in the DKD only, DR only, and control group. However, patients with DR and DKD comorbidities may have different pathophysiological mechanisms from those with DR or DKD alone.…”

“… 6 Oxidative stress, as an “important promoter” of occurrence and development of diabetic microvascular complications, 7 so in recent years, the relationship between sALB and diabetic microvascular complications has attracted attention. Studies have found that hypoalbuminemia is associated with poorer renal prognosis in patients with diabetic nephropathy; 8 and sALB in non-proliferative DR and vision-threatening DR was significantly lower than that in patients without DR, and the prognostic nutritional index calculated based on sALB was inversely and independently correlated with the severity and prevalence of DR. 9 However, both DKD and DR are microvascular complications of diabetes, and to our knowledge, their association with sALB has not been comprehensively simultaneously analyzed in one study.…”

Prognostic nutritional index (PNI) and risk of non-alcoholic fatty liver disease and advanced liver fibrosis in US adults: Evidence from NHANES 2017–2020

“…The origin of the PNI paradigm can be traced back to a study by Buzby et al In their purview [ 23 ], the assessment of gastrointestinal surgery risks incorporated the appraisal of peripheral blood lymphocyte counts and serum albumin levels, emerging as indicators of systemic immunonutrition and inflammatory status. Numerous studies have shown that PNI can be used as a predictive or prognostic biomarker for various cancers such as gastric cancer, hepatocellular carcinoma, nasopharyngeal carcinoma, colorectal cancer [ [24] , [25] , [26] , [27] ], heart failure, acute pancreatitis, and diabetic retinopathy, among others [ 15 , [28] , [29] , [30] ].…”