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Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis

High mortality in dialysis patients is linked to malnutrition and inflammation. Prognostic nutritional index (PNI), calculated from serum albumin level and total lymphocyte count, has been developed as a prognostic marker for cancer patients. We investigated the clinical utility of PNI in predicting...

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Autores principales: Miyasato, Yoshikazu, Hanna, Ramy M., Morinaga, Jun, Mukoyama, Masashi, Kalantar-Zadeh, Kamyar
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9865495/
https://www.ncbi.nlm.nih.gov/pubmed/36678182
http://dx.doi.org/10.3390/nu15020311
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author Miyasato, Yoshikazu
Hanna, Ramy M.
Morinaga, Jun
Mukoyama, Masashi
Kalantar-Zadeh, Kamyar
author_facet Miyasato, Yoshikazu
Hanna, Ramy M.
Morinaga, Jun
Mukoyama, Masashi
Kalantar-Zadeh, Kamyar
author_sort Miyasato, Yoshikazu
collection PubMed
description High mortality in dialysis patients is linked to malnutrition and inflammation. Prognostic nutritional index (PNI), calculated from serum albumin level and total lymphocyte count, has been developed as a prognostic marker for cancer patients. We investigated the clinical utility of PNI in predicting mortality in patients undergoing hemodialysis. Thus, 101,616 patients who initiated hemodialysis in United States dialysis centers between 2007 and 2011 were included in this retrospective cohort study. Using the Cox regression model, we assessed the relationship between PNI and mortality. Further, the predictive value of PNI for one-year mortality was compared with that of its constituent using area under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement. Higher PNI quartiles were incrementally associated with lower mortality; in patients with PNI values of 39.5–<43.1, 43.1–<46.6, and ≥46.6 (reference: PNI < 39.5), case-mix adjusted hazard ratios (95% confidence intervals) were 0.66 (0.64, 0.68), 0.49 (0.48, 0.51), and 0.36 (0.34, 0.37), respectively. PNI predicted mortality better than serum albumin level or total lymphocyte count alone. In the subgroup analysis, PNI performed well in predicting mortality in patients aged < 65 years. Our results indicate that PNI is a simple and practical prognostic marker in patients undergoing hemodialysis.
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spelling pubmed-98654952023-01-22 Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis Miyasato, Yoshikazu Hanna, Ramy M. Morinaga, Jun Mukoyama, Masashi Kalantar-Zadeh, Kamyar Nutrients Article High mortality in dialysis patients is linked to malnutrition and inflammation. Prognostic nutritional index (PNI), calculated from serum albumin level and total lymphocyte count, has been developed as a prognostic marker for cancer patients. We investigated the clinical utility of PNI in predicting mortality in patients undergoing hemodialysis. Thus, 101,616 patients who initiated hemodialysis in United States dialysis centers between 2007 and 2011 were included in this retrospective cohort study. Using the Cox regression model, we assessed the relationship between PNI and mortality. Further, the predictive value of PNI for one-year mortality was compared with that of its constituent using area under the receiver operating characteristic curve, net reclassification improvement, and integrated discrimination improvement. Higher PNI quartiles were incrementally associated with lower mortality; in patients with PNI values of 39.5–<43.1, 43.1–<46.6, and ≥46.6 (reference: PNI < 39.5), case-mix adjusted hazard ratios (95% confidence intervals) were 0.66 (0.64, 0.68), 0.49 (0.48, 0.51), and 0.36 (0.34, 0.37), respectively. PNI predicted mortality better than serum albumin level or total lymphocyte count alone. In the subgroup analysis, PNI performed well in predicting mortality in patients aged < 65 years. Our results indicate that PNI is a simple and practical prognostic marker in patients undergoing hemodialysis. MDPI 2023-01-08 /pmc/articles/PMC9865495/ /pubmed/36678182 http://dx.doi.org/10.3390/nu15020311 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Miyasato, Yoshikazu
Hanna, Ramy M.
Morinaga, Jun
Mukoyama, Masashi
Kalantar-Zadeh, Kamyar
Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis
title Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis
title_full Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis
title_fullStr Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis
title_full_unstemmed Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis
title_short Prognostic Nutritional Index as a Predictor of Mortality in 101,616 Patients Undergoing Hemodialysis
title_sort prognostic nutritional index as a predictor of mortality in 101,616 patients undergoing hemodialysis
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9865495/
https://www.ncbi.nlm.nih.gov/pubmed/36678182
http://dx.doi.org/10.3390/nu15020311
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