Value of the prognostic nutritional index and weight loss in predicting metastasis and long-term mortality in nasopharyngeal carcinoma

Abstract Funding Acknowledgements Type of funding sources: None. Background The benefit of implantable cardiac defibrillator (ICD) in patients with heart failure and reduced ejection fraction (HFrEF) could be limited in a particular group of patients. Low prognostic nutritional index (PNI) indicates malnutrition and pro-inflammatory condition. We sought to investigate the value of PNI in predicting long-term mortality among HFrEF patients with ICD. Methods Electronic database was searched for identifying patients with HFrEF who were implanted ICD in our institution between 2009 and 2019. Demographic and clinical characteristics of included patients were recorded. PNI was calculated according to the formula: 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (per mm3). Patients were divided into the quartiles according to PNI values. Differences between the groups were analysed by the log-rank test. A forward Cox proportional regression model was used for multivariable analysis. Results One thousand and hundred patients were included to the study. The underlying heart failure etiology was ischemic and non-ischemic in 77.3% and 22.7% of patients respectively. Mortality rate in Q1 (5.1%) was considered as the reference. In the unadjusted model the mortality rate was 9.5% [hazard ratio (HR) 1.76, 95% confidence interval (95% CI) (0.92 – 3.38)] in Q2, 10.2% (HR 1.88, 95% CI 0.99 – 3.58) in Q3 and 39.6% (HR 8.12, 95% CI 4.65 – 14.17) in Q4. The same trend was consistent in the age- and sex-adjusted, comorbidities-adjusted and covariates-adjusted models. Conclusion Among patients who were implanted ICD secondary to HFrEF, lower PNI value predicted all-cause mortality during long-term follow up. This is the first study demonstrating the value of PNI in this population. Table 1Admission Prognostic Nutritional Index (n = 1100)Q1 (n = 275)Q2 (n = 275)Q3 (n = 275)Q4 (n = 275)Long-term mortalityNumber of deaths142628109Mortality, %5.19.510.239.6Mortality, HR (%95 CI)Model 1: unadjusted1[Reference]1.76 (0.92 - 3.38)1.88 (0.99 - 3.58)8.12 (4.65 - 14.17)Model 2: adjusted for age, sex1[Reference]1.70 (0.90 - 3.48)1.79 (0.94 - 3.42)7.76 (4.42 - 13.61)Model 3: adjusted for comorbiditesa1[Reference]1.85 (0.96 - 3.55)1.89 (0.99 - 3.60)9.02 (4.34 - 14.12)Model 4: adjusted for covariatesb1[Reference]1.66 (0.88 - 3.21)1.60 (0.80 - 3.05)6.45 (3.61 - 12.5)Cox proportional analysis and logistic regression models for the long-term mortality by the prognostic nutritional indexAbstract Figure 1

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Age, Prognostic Nutritional Index, and Charlson Comorbidity Index Were Independent Risk Factors for Postoperative Long-Term Mortality in Chinese Geriatric Patients Who Sustain Hip Fracture

Journal of the American Medical Directors Association ◽

10.1016/j.jamda.2021.08.001 ◽

2021 ◽

Author(s):

Long Feng ◽

Shihui Fu ◽

Yao Yao ◽

Weixiu Yuan ◽

Yali Zhao

Keyword(s):

Risk Factors ◽

Hip Fracture ◽

Charlson Comorbidity Index ◽

Geriatric Patients ◽

Prognostic Nutritional Index ◽

Nutritional Index ◽

Comorbidity Index ◽

Independent Risk Factors ◽

Long Term Mortality

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Abstract P290: Short-term Weight Change and Long-term Mortality in the Trials of Hypertension Prevention

Circulation ◽

10.1161/circ.133.suppl_1.p290 ◽

2016 ◽

Vol 133 (suppl_1) ◽

Author(s):

Nancy R Cook ◽

Lawrence J Appel ◽

Paul K Whelton

Keyword(s):

Weight Loss ◽

Weight Change ◽

Phase 1 ◽

Total Mortality ◽

Weight Loss Intervention ◽

Phase 2 ◽

Short Term ◽

Hypertension Prevention ◽

Long Term Mortality

Introduction: Although weight loss has favorable effects on intermediate outcomes, such as blood pressure and insulin resistance, few studies have examined its effects on long-term outcomes including total mortality. Methods: In the Trials of Hypertension Prevention (TOHP) individuals aged 30-54 years with high normal BP were randomized to a weight loss intervention, to one of several other lifestyle or dietary supplement interventions, or to usual care. All participants from Phase 1 (1987-90) and Phase 2 (1990-5) were followed for mortality through 2013. The association of weight change during any of the interventions with long-term mortality up to 18-24 years after the trial periods was examined among 3828 participants who fell into a high baseline weight stratum, defined as body mass index at least 26 kg/m2 in men and 24 kg/m2 in women. Results and Conclusions: There were 1477 high-weight participants in Phase 1 and 2351 in Phase 2, of whom 21% and 50%, respectively, were assigned to a weight loss intervention. Overall, mean weight change during the trial period was -1.8 lbs (-0.8% of baseline body weight) over 1.5 years in Phase 1 and 1.6 lbs (0.8%) over 3-4 years in Phase 2. A total of 556 (15%) lost > 5%, 1,101 (29%) lost <=5%, 1,567 (41%) gained less than 5%, and 604 (16%) gained > 5% in body weight. Corresponding hazard ratios (HRs) for total mortality were 0.82 (95% confidence interval (CI)=0.57-1.18), 0.94 (95% CI=0.72-1.23), 1.00 (reference), and 1.29 (95% CI=0.92-1.80) (p-trend = 0.046). There was a direct linear relationship with percent change in weight during the trial period and later mortality (HR=1.14 per 5% change, 95% CI=1.02-1.28, p=0.019). This association persisted throughout the course of mortality follow-up (Figure). In these healthy individuals taking part in lifestyle and nutrition supplement trials , short-term weight change was directly associated with mortality about two decades later. These results are consistent with a long-term beneficial effect of presumed intentional weight loss on total mortality.

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PS02.238: POSTOPERATIVE PROGNOSTIC NUTRITIONAL INDEX CAN PREDICT A LONG-TERM PROGNOSIS OF ESOPHAGEAL CANCER

Diseases of the Esophagus ◽

10.1093/dote/doy089.ps02.238 ◽

2018 ◽

Vol 31 (Supplement_1) ◽

pp. 189-190

Author(s):

Jun Takahashi ◽

Masaaki Saito ◽

Tamotsu Obitsu ◽

Daisuke Ishioka ◽

Hirokazu Kiyozaki ◽

...

Keyword(s):

Esophageal Cancer ◽

Conflicts Of Interest ◽

Prognostic Nutritional Index ◽

Pathological Stage ◽

Radical Esophagectomy ◽

Esophagus Cancer ◽

Nutritional Index ◽

Long Term Prognosis ◽

Advanced Pathological Stage

Abstract Background Recent reports indicate the nutritional and immune status often affect the long-term prognosis of patients with cancer. The preoperative prognostic nutritional index(PNI) is used as an evaluation of the perioperative nutritional status, and it is reported that the PNI level correlates with postoperative results. However, only a handful of reports have discussed the predictive prognostic potential of postoperative PNI. The aim of this study is to clarify the correlation of postoperative PNI level and long-term prognosis of patients with esophagus cancer who underwent esophagectomy. Methods A total of 29 patients with esophageal cancer who received neoadjuvant chemotherapy followed by radical esophagectomy from January 2011 to December 2014 were retrospectively reviewed. The calculation of PNI level is as follows: 10 × serum albumin level (g/dL) + 0.005 × total lymphocyte count (/mm3). The postoperative PNI level was measured three months after radical esophagectomy. The patients were stratified by postoperative PNI level by two groups using calculated cutoff level (PNI = 43.9) by receiver operating characteristic curve. The correlation of 3-year disease-free survival (DFS) and postoperative PNI level was evaluated. Results Of the total, 25 were male and 4 were female. The median age of patients was 68 years (31–79 years). Overall, patients received 1–2 cycles of preoperative chemotherapy with 5-FU and cisplatin. Of these 29 patients, 9 (31.0%) responded to chemotherapy (8 patients had a partial response and 1 had a complete response). The median postoperative PNI level was 47.2 (38.0–58.9). Univariate analyses showed that 3-year DFS was worse in patients with low postoperative PNI level (P = 0.017), advanced pathological stage (P = 0.029) and younger age (< 70 years) (P = 0.02). Multivariate analyses showed that low postoperative PNI level[hazard ratio (HR) 0.224, 95% confidence interval (CI) 0.060–0.83, P = 0.026] and advanced pathological stage (HR 3.197, 95% CI 1.13–9.06, P = 0.029) were independent predictors of 3-year DFS. Conclusion Our findings suggest that the postoperative PNI level may be a useful marker to predict a prognosis of patients with esophagus cancer. Nutrition intervention for undernourished patients after surgery may improve prognosis of patients with esophagus cancer. Disclosure All authors have declared no conflicts of interest.

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The Preoperative Prognostic Nutritional Index Predicts Short-Term and Long-Term Outcomes of Patients with Stage II/III Gastric Cancer: Analysis of a Multi-Institution Dataset

Digestive Surgery ◽

10.1159/000497454 ◽

2019 ◽

Vol 37 (2) ◽

pp. 135-144 ◽

Cited By ~ 8

Author(s):

Masahiro Sasahara ◽

Mitsuro Kanda ◽

Seiji Ito ◽

Yoshinari Mochizuki ◽

Hitoshi Teramoto ◽

...

Keyword(s):

Gastric Cancer ◽

Area Under The Curve ◽

Prognostic Nutritional Index ◽

Stage Ii ◽

Long Term Outcomes ◽

Short Term ◽

Nutritional Index ◽

Appropriate Treatment ◽

Disease Free

Background/Aims: Identification of nutritional indicators to predict short-term and long-term outcomes is necessary to provide appropriate treatment to patients with gastric cancer. Methods: We designed an analysis of a multicenter dataset of patients with gastric cancer who underwent gastrectomy between 2010 and 2014. We enrolled 842 eligible patients who had stage II/III gastric cancer. The area under the curve (AUC) values were compared among prognostic nutritional index (PNI), calculated as 10 × albumin g/dL + 0.005 × total lymphocyte count/mm3, and its constituents, and the predictive value of preoperative PNI for postoperative short-term and long-term outcomes was evaluated. Results: Preoperative PNI exhibited higher AUC values (0.719) for 1-year survival than its constituents, and the optimal cutoff value was 47. The disease-free and overall survival of patients in the PNI-low group were significantly shorter compared with those in the PNI-high group. The prognostic difference between the PNI-high and PNI-low groups was significantly greater in the subgroup of patients who underwent total gastrectomy. Clinically relevant postoperative complications were more frequently observed in the PNI-low group. Conclusions: The preoperative PNI is a useful predictor reflecting the incidence of complications after gastrectomy and the prognosis of patients with stage II/III gastric cancer.

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