Correlation between prognostic nutritional index and in-hospital outcomes in geriatric trauma patients

Xu Zhikai; Qi Siyuan; Hou Chaoyao; Xie Weiming; Wu Qiqi; Li Zhanfei; Bai Xiangjun

doi:10.3969/j.issn.1009-4237.2025.11.010

Abstract：Objective To investigate the relationship between prognostic nutritional index(PNI)and clin-ical outcomes and prognosis in geriatric trauma patients.Methods A total of 1,025 trauma patients aged≥65 years hospitalized in Tongji Hospital from May 2018 to May 2022 were included.PNI was calculated based on initial serum albumin concentration and lymphocyte count after admission.Patients were divided into survival group(n=965)or death group(n=60)based on the in-hospital outcomes.Univariate analysis and multivariable logistic re-gression analysis were utilized to find independent risk factors for in-hospital death of geriatric trauma patients;re-ceiver operating characteristic(ROC)curve analysis was performed to calculate the optimal cut-off value of PNI;relative risk(RR)was calculated to assess the risk of PNI with in-hospital clinical outcomes and complications;and survival curve was drawn to investigate the prediction of PNI for in-hospital death risk.Results Among the 1,025 geriatric trauma patients,60 died during hospitalization,with a mortality of 5.9%.The PNI in patients in the death group was 35.90(range 30.05-41.44),much lower than that in the survival group(42.30,range 38.05-45.68,P<0.05).Logistic regression analysis showed that independent risk factors for in-hospital mortality of geriatric trauma patients were age(OR=1.110,95%CI:1.055-1.167),ISS(OR=1.084,95%CI:1.055-1.114),WBC(OR=1.107,95%CI:1.049-1.169),serum Na+(OR=1.134,95%CI:1.049-1.226)and PNI(OR=0.945,95%CI:0.902-0.989).The optimal cut-off value of PNI was 37.5.Patients were then divided into low-PNI and high-PNI groups based on the optimal cut-off value.Compared with the high-PNI group,the low-PNI patients showed much higher risks of in-hospital death(RR=5.788,95%CI:3.472-9.647),in-hospital pneumonia(RR=3.201,95%CI:2.571-3.984),sepsis(RR=5.843,95%CI:2.507-13.618),deep vein thrombosis(RR=2.649,95%CI:1.876-3.740),hospitalization duration≥30 d(RR=2.519,95%CI:2.009-3.159)and ICU stay≥7 d(RR=3.010,95%CI:2.509-3.611).Conclusion PNI serves as an independent risk factor for in-hospital mortality in geriatric trauma patients.A decreased PNI value is significantly associated with increased risks of death and various complications,as well as prolonged hospital stay.Therefore,incorporating PNI into the admission assessment for ear-ly evaluation of nutritional status and prognostic risk stratification of geriatric trauma patients can help identify high-risk patients and guide clinical interventions,demonstrating important predictive value for improving patient out-comes.