The relationship between prognostic nutritional index and mortality in patients hospitalized with COVID-19 Pneumonia

Abstract

Objective: We aimed to investigate the ability of the Prognostic Nutritional Index (PNI) score to predict the prognosis and mortality of patients hospitalized for COVID-19 Pneumonia. Methods: One hundred seventy-three patients were included in the study. The patients were grouped as patients with or without pneumonia, those who were hospitalized in the ward or intensive care unit, who were discharged, or who died. The ability of the PNI score, which was calculated according to the results at the time of admission, to predict hospitalization and mortality in the intensive care unit was evaluated. Results: The mean age of the patients was found to be 53.9 years. Pneumonia was detected in 72.3% of the patients. The need for intensive care developed in 26% of them. The PNI score was found to be significantly lower (p<0.05) in patients with pneumonia compared to patients without pneumonia. The PNI score of the patients hospitalized in the intensive care unit was found to be significantly (p<0.05) lower than the patients hospitalized in the ward. The PNI score of the patients who died was found to be significantly lower (p<0.05) than the patients who were discharged. The cut-off value of the PNI score was found to be 46. Conclusion: The PNI score which are among routine blood tests, was found to be effective in predicting intensive care unit admission and mortality. We believe that using the PNI score together with other biomarkers will be beneficial for clinicians in the prediction of the prognosis of patients.

Keywords

• Albumin
• COVID-19
• Lymphopenia
• Prognostic Nutritional Index
• Prognosis

References

1. Guo YR, Cao QD, Hong ZS, Tan YY, Chen SD, Jin HJ, et al.The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak - an update on the status. Mil Med Res. 2020 Mar 13;7 (1):11. doi: 10.1186/s40779-020-00240-0. PMID: 32169119; PMCID: PMC7068984.)
2. Stokes EK, Zambrano LD, Anderson KN, Marder EP, Raz KM, El Burai Felix S, et al. Coronavirus Disease 2019 Case Sur-veillance - United States, January 22-May 30, 2020. MMWR Morb Mortal Wkly Rep. 2020 Jun 19;69 (24):759-765. http://dx.doi.org/10.15585/mmwr.mm6924e2
3. Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus-Infected Pneumonia in Wuhan, China. JAMA. 2020 Mar 17;323 (11):1061-1069. http://doi.org/10.1001/jama.2020.1585
4. Chang MC, Park YK, Kim BO, Park D. Risk factors for disease progression in COVID-19 patients. BMC Infect Dis. 2020 Jun 23;20 (1):445. http://doi.org/10.1186/s12879-020-05144-x
5. Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z, et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet. 2020 Mar 28;395 (10229):1054-1062. http://doi.org/10.1016/S0140-6736 (20)30566-3
6. Xu J, Yang X, Yang L, Zou X, Wang Y, Wu Y, et al. Clinical course and predictors of 60-day mortality in 239 critically ill patients with COVID-19: a multicenter retrospective study from Wuhan, China. Crit Care. 2020 Jul 6;24 (1):394. http://doi.org/10.1186/s13054-020-03098-9
7. Fang B, Meng QH. The laboratory’s role in combating COVID-19. Crit Rev Clin Lab Sci. 2020 Sep;57 (6):400-414. http://doi.org/10.1080/10408363.2020.1776675
8. Yang AP, Liu JP, Tao WQ, Li HM. The diagnostic and predictive role of NLR, d-NLR and PLR in COVID-19 patients. Int Immunopharmacol. 2020 Jul;84:106504. http://doi.org/10.1016/j.intimp.2020.106504

9. Okui M, Horio H, Asakawa A, Yamamichi T, Harada M. The prognostic nutritional index in resected high-grade pulmo-nary neuroendocrine carcinoma. Gen Thorac Cardiovasc Surg. 2020 Jan;68 (1):43-48. http://doi.org/10.1007/s11748-019-01150-2
10. Wang D, Hu X, Xiao L, Long G, Yao L, Wang Z, et al. Prognostic Nutritional Index and Systemic Immune-Inflammation Index Predict the Prognosis of Patients with HCC. J Gastrointest Surg. 2021 Feb;25 (2):421-427. http://doi.org/10.1007/s11605-019-04492-7
11. Mirili C, Yılmaz A, Demirkan S, Bilici M, Basol Tekin S. Clinical significance of prognostic nutritional index (PNI) in ma-lignant melanoma. Int J Clin Oncol. 2019 Oct;24 (10):1301-1310. http://doi.org/10.1007/s10147-019-01461-7
12. Wang Z, Wang Y, Zhang X, Zhang T. Pretreatment prognostic nutritional index as a prognostic factor in lung cancer: Review and meta-analysis. Clin Chim Acta. 2018 Nov;486:303-310. http://doi.org/10.1016/j.cca.2018.08.030
13. Xiao FK, Wang L, Zhang WC, Wang LD, Zhao LS. Preoperative Prognostic Nutritional Index is a Significant Predictor of Survival in Esophageal Squamous Cell Carcinoma Patients. Nutr Cancer. 2021;73 (2):215-220. http://doi.org/10.1080/01635581.2020.1757129
14. Oba T, Maeno K, Ono M, Ito T, Kanai T, Ito KI. Prognostic Nutritional Index Is Superior to Neutrophil-to-lymphocyte Ratio as a Prognostic Marker in Metastatic Breast Cancer Patients Treated With Eribulin. Anticancer Res. 2021 Jan;41 (1):445-452. http://doi.org/10.21873/anticanres
15. Yasar HA, Bir Yucel K, Arslan C, Ucar G, Karakaya S, Bilgin B, et al. The relationship between prognostic nutritional in-dex and treatment response in patients with metastatic renal cell cancer. J Oncol Pharm Pract. 2020 Jul;26 (5):1110-1116. http://doi.org/10.1177/1078155219883004
16. Bailón-Cuadrado M, Pérez-Saborido B, Sánchez-González J, Rodríguez-López M, Velasco-López R, C Sarmentero-Prieto J, et al. Prognostic Nutritional Index predicts morbidity after curative surgery for colorectal cancer. Cir Esp (Engl Ed). 2019 Feb;97 (2):71-80. English, Spanish. http://doi.org/10.1016/j.ciresp.2018.08.015
17. https://covid19.saglik.gov.tr/Eklenti/43095/0/covid-19rehberieriskinhastayonetimivetedavi-12042022pdf.pdf (Da-te of access: 28/11/2022)
18. Hua X, Long ZQ, Huang X, Deng JP, He ZY, Guo L, et al. The Value of Prognostic Nutritional Index (PNI) in Predicting Survival and Guiding Radiotherapy of Patients With T1-2N1 Breast Cancer. Front Oncol. 2020 Jan 30;9:1562. doi: 10.3389/fonc.2019.01562. PMID: 32083015; PMCID: PMC7002465.
19. Long B, Carius BM, Chavez S, Liang SY, Brady WJ, Koyfman A, et al. Clinical update on COVID-19 for the emergency clinician: Presentation and evaluation. Am J Emerg Med. 2022 Apr;54:46-57. doi: 10.1016/j.ajem.2022.01.028. Epub 2022 Jan 21. PMID: 35121478; PMCID: PMC8779861.
20. Zhang JJ, Dong X, Liu GH, Gao YD. Risk and Protective Factors for COVID-19 Morbidity, Severity, and Mortality. Clin Rev Allergy Immunol. 2023 Feb;64 (1):90-107. doi: 10.1007/s12016-022-08921-5. Epub 2022 Jan 19. PMID: 35044620; PMCID: PMC8767775.
21. Alharthy A, Aletreby W, Faqihi F, Balhamar A, Alaklobi F, Alanezi K, et al. Clinical Characteristics and Predictors of 28-Day Mortality in 352 Critically Ill Patients with COVID-19: A Retrospective Study. J Epidemiol Glob Health. 2021 Mar;11 (1):98-104. doi: 10.2991/jegh.k.200928.001.
22. Malik P, Patel U, Mehta D, Patel N, Kelkar R, Akrmah M, et al. Biomarkers and outcomes of COVID-19 hospitalisa-tions: systematic review and meta-analysis. BMJ Evid Based Med. 2021 Jun;26 (3):107-108. http://doi.org/10.1136/bmjebm-2020-111536
23. Rokni M, Ahmadikia K, Asghari S, Mashaei S, Hassanali F. Comparison of clinical, para-clinical and laboratory findings in survived and deceased patients with COVID-19: diagnostic role of inflammatory indications in determining the severity of illness. BMC Infect Dis. 2020 Nov 23;20 (1):869. https://doi.org/10.1186/s12879-020-05540-3
24. Huang I, Pranata R, Lim MA, Oehadian A, Alisjahbana B. C-reactive protein, procalcitonin, D-dimer, and ferritin in se-vere coronavirus disease-2019: a meta-analysis. Ther Adv Respir Dis. 2020 Jan-Dec;14:1753466620937175. http://doi.org/10.1177/1753466620937175
25. Wei W, Wu X, Jin C, Mu T, Gu G, Min M, et al. Predictive Significance of the Prognostic Nutritional Index (PNI) in Pati-ents with Severe COVID-19. J Immunol Res. 2021 Jul 9;2021:9917302. http://doi.org/10.1155/2021/9917302
26. Song F, Ma H, Wang S, Qin T, Xu Q, Yuan H, et al. Nutritional screening based on objective indices at admission pre-dicts in-hospital mortality in patients with COVID-19. Nutr J. 2021 May 25;20 (1):46. http://doi.org/10.1186/s12937-021-00702-8
27. Doganci S, Ince ME, Ors N, Yildirim AK, Sir E, Karabacak K, et al. A new COVID-19 prediction scoring model for in-hospital mortality: experiences from Turkey, single center retrospective cohort analysis. Eur Rev Med Pharmacol Sci. 2020 Oct;24 (19):10247-10257. http://doi.org/10.26355/eurrev_202010_23249
28. Nalbant A, Demirci T, Kaya T, Aydın A, Altındiş M, Güçlü E. Can prognostic nutritional index and systemic immune-inflammatory index predict disease severity in COVID-19? Int J Clin Pract. 2021 Oct;75 (10):e14544. http://doi.org/10.1111/ijcp.14544
29. Arslan K. , Baş S. The relationship between the prognostic nutritional index and the clinical course of COVID-19: a single-center experience. Journal of Medicine and Palliative Care. 2022; 3 (2): 92-97.