AUTHOR=Xu Manman , Zhang Liang , Wang Juan , Cheng Longyang , Chen Chunlei , Li Shaoya , Dai Haibin , Zhao Penglai , Hang Chunhua 

TITLE=Pre-operative prognostic nutrition index and post-operative pneumonia in aneurysmal subarachnoid hemorrhage patients

JOURNAL=Frontiers in Neurology

VOLUME=14

YEAR=2023

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2023.1045929

DOI=10.3389/fneur.2023.1045929

ISSN=1664-2295

ABSTRACT=<sec><title>Background and objective</title><p>Post-operative pneumonia (POP), a common complication, may be associated with prolonged hospitalization and long-term mortality in aneurysmal subarachnoid hemorrhage (aSAH) patients. This study aimed to explore the association between pre-operative prognostic nutrition index (PNI) and POP in aSAH patients.</p></sec><sec><title>Methods</title><p>A total of 280 aSAH patients were enrolled from Nanjing Drum Tower Hospital. PNI was calculated as follows: [10 × albumin(gr/dl)] + [0.005 × absolute pre-operative lymphocyte count (per mm<sup>3</sup>)]. We utilized multivariate analyses, restricted cubic spline, net reclassification improvement (NRI), and integrated discrimination improvement (IDI) to elucidate the role of PNI in POP.</p></sec><sec><title>Results</title><p>Pre-operative PNI levels in the POP group were higher, compared with the non-POP group (41.0 [39.0, 45.4] vs. 44.4 [40.5, 47.3], <italic>P</italic> = 0.001). When we included PNI as a categorical variable in the multivariate analysis, the levels of PNI were associated with POP (odds ratio, 0.433; 95% confidence interval, 0.253–0.743; <italic>P</italic>=0.002). In addition, when we included PNI as a continuous variable in the multivariate analysis, the PNI levels were also associated with POP (odds ratio, 0.942; 95% confidence interval, 0.892–0.994; <italic>P</italic> = 0.028). The level of albumin was also a predictor of the occurrence of POP, with a lower diagnostic power than PNI [AUC: 0.611 (95% confidence interval, 0.549–0.682; <italic>P</italic> = 0.001) for PNI vs. 0.584 (95% confidence interval, 0.517–0.650; <italic>P</italic> = 0.017) for albumin]. Multivariable-adjusted spline regression indicated a linear dose–response association between PNI and POP in aSAH participants (<italic>P</italic> for linearity = 0.027; <italic>P</italic> for non-linearity = 0.130). Reclassification assessed by IDI and NRI was significantly improved with the addition of PNI to the conventional model of POP in aSAH patients (NRI: 0.322 [0.089–0.555], <italic>P</italic> = 0.007; IDI: 0.016 [0.001–0.031], <italic>P</italic> = 0.040).</p></sec><sec><title>Conclusion</title><p>The lower levels of pre-operative PNI may be associated with the higher incidence of POP in aSAH patients. Neurosurgeons are supposed to pay more attention to pre-operative nutrition status in aSAH patients.</p></sec>