1. Predictive Significance of the Prognostic Nutritional Index (PNI) in Patients with Severe COVID-19
- Author
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Guorong Gu, Yi Han, Tong Mu, Xingyue Wu, Chaoyuan Jin, Sucheng Mu, Wei Wei, and Min Min
- Subjects
Blood Platelets ,Male ,medicine.medical_specialty ,China ,Article Subject ,Immunology ,030204 cardiovascular system & hematology ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,medicine ,Risk of mortality ,Immunology and Allergy ,Humans ,Hydro-Lyases ,Aged ,Retrospective Studies ,APACHE II ,Quinine ,Proportional hazards model ,business.industry ,SARS-CoV-2 ,Malnutrition ,COVID-19 ,Retrospective cohort study ,General Medicine ,Nomogram ,Middle Aged ,RC581-607 ,Prognosis ,Survival Analysis ,Nutrition Assessment ,030220 oncology & carcinogenesis ,Predictive value of tests ,Cohort ,Female ,Immunologic diseases. Allergy ,business ,Cohort study ,Research Article - Abstract
Background. The prognostic nutritional index (PNI) has been reported to significantly correlate with poor survival and postoperative complications in patients with various diseases, but its relationship with mortality in COVID-19 patients has not been addressed. Method. A multicenter retrospective study involving patients with severe COVID-19 was conducted to investigate whether malnutrition and other clinical characteristics could be used to stratify the patients based on risk. Results. A total of 395 patients were included in our study, with 236 patients in the training cohort, 59 patients in the internal validation cohort, and 100 patients in the external validation cohort. During hospitalization, 63/236 (26.69%) and 14/59 (23.73%) patients died in the training and validation cohorts, respectively. PNI had the strongest relationships with the neutrophil-lymphocyte ratio (NLR) and lactate dehydrogenase (LDH) level but was less strongly correlated with the CURB65, APACHE II, and SOFA scores. The baseline PNI score, platelet (PLT) count, LDH level, and PaO2/FiO2 (P/F) ratio were independent predictors of mortality in COVID-19 patients. A nomogram incorporating these four predictors showed good calibration and discrimination in the derivation and validation cohorts. A PNI score less than 33.405 was associated with a higher risk of mortality in severe COVID-19 patients in the Cox regression analysis. Conclusion. These findings have implications for predicting the risk of mortality in COVID-19 patients at the time of admission and provide the first direct evidence that a lower PNI is related to a worse prognosis in severe COVID-19 patients.
- Published
- 2021