Can prognostic nutritional index predict mortality in intensive care patients with COVID‐19?

Abstract

Objectives PNI is a calculated parameter using the albumin and the lymphocyte count from the CBC, which demonstrates the immunological and nutritional status of the patient. The aim of this study is to show the relationship between PNI and mortality in COVID‐19 patients and to reveal a PNI cut‐off value for mortality. Materials and Methods Data of 690 PCR positive COVID‐19 ICU patients were recorded. COVID‐19 ICU patients were divided into two groups; the first group consisted of survivors, while the second group consisted of patients who died in the ICU. Patients were also evaluated in two groups according to the PNI cut‐off value that predicted mortality (PNI ≤ 42.00, PNI ≥ 43) and were compared in terms of demographics, laboratory parameters, clinical findings and mortality rates. Results When 690 COVID‐19 patients were divided into two groups as survivors (50.6%) and deceased (49.4%) in intensive care, PNI value was significantly lower in the deceased group compared to the surviving group (P < .001). The PNI cut‐off value predicting mortality was determined as ≤42. Patients were classified into two groups according to the PNI cut‐off value. PNI ≤42 was determined as an independent risk factor for mortality (OR:2.9 P < .001). AUC values for PNI, albumin, and lymphocyte were 0.628, 0.612, and 0.590, respectively; P < .001 for all. Conclusion PNI is an inexpensive method that can be easily calculated on the basis of routine laboratory parameters. We believe that the PNI value of COVID‐19 patients on admission to the ICU may be an independent factor to predict mortality.

Nutritional Risk Assessment Scores Effectively Predict Mortality in Critically Ill Patients with Severe COVID-19

“…Since its initial validation, its predictive capabilities have been documented in various clinical scenarios, including oncology [ 23 ], cardiology [ 24 ], and critical care [ 25 ]. In the setting of COVID-19, previously published articles have reported that a lower PNI score was associated with a more severe disease form [ 26 , 27 ] and higher COVID-19-related mortality [ 28 , 29 , 30 ]. The two previously reported cut-off values for predicting mortality were slightly discrepant, as one study suggested a cut-off below 33.4 [ 28 ], and the other 42 [ 30 ].…”

“…In the setting of COVID-19, previously published articles have reported that a lower PNI score was associated with a more severe disease form [ 26 , 27 ] and higher COVID-19-related mortality [ 28 , 29 , 30 ]. The two previously reported cut-off values for predicting mortality were slightly discrepant, as one study suggested a cut-off below 33.4 [ 28 ], and the other 42 [ 30 ]. Our study’s cut-off value with the best discriminative capabilities (AUROC of 0.77) was 28, significantly lower than the other values.…”

Association of Prognostic Nutritional Index with Severity and Mortality of Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis

“…Following the further exclusion of 144 records during screening of their titles and abstracts, six more articles were excluded after full-text assessment because of being a review article ( n = 1), abstract ( n = 3), lack of available outcomes ( n = 2), or focusing on disease progression instead of severity or mortality ( n = 1) [ 27 ]. Finally, 13 studies involving 4204 patients published between 2020–2021 were eligible for quantitative syntheses [ 11 , 19 , 20 , 21 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ].…”

“…The characteristics of the studies are shown in Table 1 . Twelve studies reported the period for patient inclusion (i.e., all was conducted in 2020) [ 11 , 19 , 20 , 21 , 28 , 29 , 30 , 31 , 32 , 33 , 35 , 36 ], while one study did not provide this information [ 34 ]. The age of participants ranged from 44 to 74 years with the proportion of males between 42.3% and 61.5%.…”

“…The sensitivity analysis demonstrated the robustness of the results from the two approaches. [19,21,28,29,32,34,36], (b) Forest plot demonstrating a negative correlation between risk of mortality and PNI as a continuous parameter (odds ratio: 0.84, 95% CI: 0.79 to 0.9, p < 0.001, I 2 = 67.3%) [11,[19][20][21]29,34,36], and (c) Forest plot showing a negative association between risk of mortality and PNI as a binary parameter (odds ratio: 7, 95% CI: 3.44 to 14.23, p < 0.001, I 2 = 65.7%) [11,20,28,29,32,36]. CI, confidence interval.…”