Clinical significance of prognostic nutrition index in hospitalized patients with COVID‐19: Results from single‐center experience with systematic review and meta‐analysis

Rashedi, Sina; Keykhaei, Mohammad; Pazoki, Marzieh; Ashraf, Haleh; Najafi, Atabak; Kafan, Samira; Peirovi, Niloufar; Najmeddin, Farhad; Jazayeri, Seyed Aboozar; Kashani, Mehdi; Moharari, Reza Shariat; Montazeri, Mahnaz

doi:10.1002/ncp.10750

Cited by 13 publications

(38 citation statements)

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“…The worst nutritional status (low PNI) observed in the present study was significantly associated with increased COVID-19 severity, notably in severe patients requiring high-flow oxygen therapy compared to severe with nasal cannula oxygen therapy or moderate illness with no oxygen therapy. Our results are in agreement with individual studies ( 16 , 26 – 28 ) and pooled effect ( 16 ) demonstrating a significantly greater disease severity at the worst PNI scores.…”

Section: Discussionsupporting

confidence: 92%

“…To date, the knowledge of PNI in patients with COVID-19 has been limited to cross-sectional ( 15 , 16 ), small-scale cohort ( 14 ), retrospective observational ( 2 , 15 ), or systematic review ( 16 ) studies. Patients with lower PNI had a higher risk of in-hospital mortality in the multivariate logistic regression of a retrospective design ( 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…According to a recent meta-analysis ( 16 ), the pooled odds ratios for in-hospital mortality and disease severity were 20 and 22% lower in favor of high PNI values compared to reduced ones, respectively, reaffirming PNI as an independent predictor of in-hospital mortality and disease severity in COVID-19 patients. In addition, cross-sectional data from the aforementioned authors ( 16 ) reported lower PNI, higher LDH, and higher D-dimer levels as independent risk indicators of in-hospital mortality. In addition, patients with a history of diabetes mellitus, reduced PNI, and elevated serum levels of lactate dehydrogenase showed a higher tendency to develop severe diseases.…”

Section: Introductionmentioning

confidence: 93%

“…The prognostic nutritional index (PNI) is based on serum albumin concentration and lymphocyte count ( 5 ), both usual prognostic markers of the immune system that allow a feasible and objective assessment of nutritional status avoiding poor outcomes ( 6 , 7 ). This index has been widely adopted as an important tool in patients undergoing renal ( 8 ) and cardiac ( 9 )surgery, in acute heart failure ( 10 ), in different neoplasms ( 11 , 12 ), including those undergoing radiotherapy ( 13 ), and hospitalized patients with COVID-19 ( 14 – 16 ). In a small-scale cohort study ( 14 ), De Lorenzo et al evaluated the relationship between percentage of fat mass and immune-inflammatory response of 22 adult patients with COVID-19 from baseline to 10th day at the intensive care unit (ICU).…”

Section: Introductionmentioning

confidence: 99%

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Prognostic Nutritional Index and Oxygen Therapy Requirement Associated With Longer Hospital Length of Stay in Patients With Moderate to Severe COVID-19: Multicenter Prospective Cohort Analyses

et al. 2022

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PurposeTo evaluate whether the prognostic nutritional index (PNI) is related to the oxygen therapy requirement at hospital admission and to ascertain the prognostic effect of the PNI and the oxygen therapy requirement as predictors of hospital length of stay in patients with moderate to severe coronavirus disease 2019 (COVID-19).MethodsThis is a post-hoc analysis in hospitalized patients with moderate to severe COVID-19. The participants were categorized: (1) non-oxygen therapy (moderate COVID-19 not requiring oxygen therapy); (2) nasal cannula therapy (severe COVID-19 requiring nasal cannula oxygen therapy); and (3) high-flow therapy (severe COVID-19 requiring high-flow oxygen therapy). PNI was calculated for each patient according to the following equation: serum albumin [g/dL] × 10 + total lymphocyte count [per mm3] × 0.005. The participants were categorized into malnutrition (PNI <40), mild malnutrition (PNI 40–45), and non-malnutrition (PNI > 45).ResultsAccording to PNI, malnutrition was more prevalent in the high-flow therapy group (94.9%; P < 0.001) with significantly lower PNI compared to both groups even after adjusting for the center and C-reactive protein. Patients in the high-flow therapy group [9 days (95% CI 7.2, 10.7), P < 0.001] and malnutrition status [7 days (95% CI 6.6, 7.4), P = 0.016] showed a significant longer hospital length of stay compared to their counterparts. The multivariable Cox proportional hazard models showed significant associations between both oxygen therapy requirement and PNI categories and hospital discharge.ConclusionIn addition to oxygen therapy requirement, low PNI was associated with longer hospital length of stay. Our findings suggest that PNI could be useful in the assessment of nutritional status related to the prognosis of patients with moderate to severe COVID-19.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Prognostic Nutritional Index and Oxygen Therapy Requirement Associated With Longer Hospital Length of Stay in Patients With Moderate to Severe COVID-19: Multicenter Prospective Cohort Analyses

et al. 2022

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“…3 The metaanalysis by Rashedi et al, on 504 hospitalized patients with COVID-19 revealed the significance of prognostic nutrition index, which includes peripheral lymphocyte count and serum albumin measurements. 4 However, although they constitute the most vulnerable population among the infected individuals, studies that specifically address older adults are limited. [5][6][7] Because of anorexia of aging and reduced food intake, the nutrition state of older adults is frequently compromised.…”

Section: Introductionmentioning

confidence: 99%

Nutrition risk assessed by Nutritional Risk Screening 2002 is associated with in‐hospital mortality in older patients with COVID‐19

et al. 2022

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Background Although numerous studies have been performed to determine predictors of coronavirus disease 2019 (COVID‐19) mortality, studies that address the geriatric age group are limited. The aim of this study was to investigate the utility of the Nutritional Risk Screening 2002 (NRS‐2002) and the Geriatric 8 (G8) screening tools in predicting clinical outcomes in older adults hospitalized with COVID‐19. Methods Patients aged ≥60 years who were hospitalized with COVID‐19 in the second wave of the pandemic were included in the study. COVID‐19 infection was demonstrated by a positive real‐time reverse transcriptase–polymerase chain reaction on nasopharyngeal swab or positive radiological findings. Disease severity was determined as defined by the National Institutes of Health. Patient demographics, laboratory values on admission, comorbidities, and medications were recorded. The NRS‐2002 and the G8 screening tools were performed for all patients by the same geriatrician. Primary outcome was in‐hospital mortality. Results A total of 121 patients were included. Mean age was 75 ± 9 years, and 51% were female. Mean body mass index was 27 ± 4.5 kg/m2. Sixty‐nine percent of the patients had nutrition risk according to the NRS‐2002. Eighty‐nine percent of the patients had a G8 score ≤14. In‐hospital mortality occurred in 26 (22%) patients. Older age and having nutrition risk as determined by the NRS‐2002 were independently associated with a higher risk of in‐hospital mortality in older patients with COVID‐19. Conclusion The NRS‐2002 tool provides rapid assessment for risk stratification in hospitalized older patients with COVID‐19.

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Prognostic nutritional index: Is it associated with the prognosis of Crimean Congo hemorrhagic fever

Ulusoy

Hekimoğlu²,

Kayhan

et al. 2022

Journal of Medical Virology

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Introduction The prognostic nutritional index (PNI) is calculated using total serum lymphocyte counts and albumin levels. We aimed to analyze the role of PNI in predicting intensive care unit (ICU) referral and mortality in patients with Crimean Congo hemorrhagic fever (CCHF). Materials and Methods Our target population was adult (age >18) patients who presented between March 2015 and October 2021 within 5 days of symptom emergence and were diagnosed with CCHF. The predictive value of PNI was analyzed by the receiver operating curve analysis. The patients were categorized based on the severity grading scores (SGS) as mild, moderate, and severe. The relationship between PNI and ICU referral and mortality was analyzed by logistic regression analysis. Results Overall, 115 patients with the diagnosis of CCHF were included. 13.9% (n = 16) of the patients were referred to ICU while 11.3% (n = 13) died. A comparison of the patients with different SGS grades revealed that they were significantly different regarding PNI (p < 0.001). There was a significant negative correlation between PNI and SGS (r = −0.662; p < 0.001). PNI had a PV regarding ICU referral and mortality ([area under the curve [AUC] = 0.723, 95% confidence interval [CI]: 0.609–0.836, p = 0.004 [AUC = 0.738, 95% CI: 0.613–0.863, p = 0.005]). The PNI threshold was 36.1 for ICU referral and mortality. The rates of female patients, hospitalization periods longer than 1 week, platelet apheresis replacement, diabetes mellitus, bleeding history, ICU admission, and mortality were significantly higher in patients with a PNI of lower than 36.1 (p < 0.05). Conclusion PNI can predict ICU referral and mortality in patients admitted due to CCHF.

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Clinical significance of prognostic nutrition index in hospitalized patients with COVID‐19: Results from single‐center experience with systematic review and meta‐analysis

Cited by 13 publications

References 52 publications

Prognostic Nutritional Index and Oxygen Therapy Requirement Associated With Longer Hospital Length of Stay in Patients With Moderate to Severe COVID-19: Multicenter Prospective Cohort Analyses

Prognostic Nutritional Index and Oxygen Therapy Requirement Associated With Longer Hospital Length of Stay in Patients With Moderate to Severe COVID-19: Multicenter Prospective Cohort Analyses

Nutrition risk assessed by Nutritional Risk Screening 2002 is associated with in‐hospital mortality in older patients with COVID‐19

Prognostic nutritional index: Is it associated with the prognosis of Crimean Congo hemorrhagic fever

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