International Journal of COPD (Jun 2023)

Prognostic Nutritional Index (PNI) as a Potential Prognostic Tool for Exacerbation of COPD in Elderly Patients

  • Suzuki E,
  • Kawata N,
  • Shimada A,
  • Sato H,
  • Anazawa R,
  • Suzuki M,
  • Shiko Y,
  • Yamamoto M,
  • Ikari J,
  • Tatsumi K,
  • Suzuki T

Journal volume & issue
Vol. Volume 18
pp. 1077 – 1090

Abstract

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Eiko Suzuki,1 Naoko Kawata,1 Ayako Shimada,1,2 Hirotaka Sato,1,3 Rie Anazawa,1,4 Masaki Suzuki,1,5 Yuki Shiko,6 Mayumi Yamamoto,7 Jun Ikari,1 Koichiro Tatsumi,1 Takuji Suzuki1 1Department of Respirology, Graduate School of Medicine, Chiba University, Chiba-shi, Chiba, 260-8677, Japan; 2Department of Respirology, Shin-yurigaoka General Hospital, Kawasaki, Kanagawa, 215-0026, Japan; 3Department of Radiology, Soka Municipal Hospital, Souka-shi, Saitama, 340-8560, Japan; 4Department of Infectious Diseases, NTT Medical Center Tokyo, Tokyo, 141-8625, Japan; 5Department of Respirology, Kashiwa Kousei General Hospital, Kashiwa-shi, Chiba-ken, 277-8551, Japan; 6Biostatistics Section, Clinical Research Center, Chiba University Hospital, Chiba-shi, 260-8670, Japan; 7Department of Palliative Care Medicine, Chiba Rosai Hospital, Chiba-shi, Chiba, 290-0003, JapanCorrespondence: Naoko Kawata, Department of Respirology, Graduate School of Medicine, Chiba University, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8677, Japan, Tel +81 43 222 7171, Fax +81 43 226 2176, Email [email protected]: In COPD, exacerbation of the disorder causes a deterioration in the quality-of-life and worsens respiratory dysfunction, leading to a poor prognosis. In recent years, nutritional indices have been reported as significant prognostic factors in various chronic diseases. However, the relationship between nutritional indicators and prognosis in elderly subjects with COPD has not been investigated.Patients and methods: We enrolled 91 subjects who received COPD assessment tests (CAT), spirometry, blood tests, and multidetector computed tomography (MDCT). We divided the subjects into two groups according to age (< 75 years (n=57) and ≥ 75 years (n=34)). The prognostic nutritional index (PNI) was used to assess immune-nutritional status and was calculated as 10 x serum albumin + 0.005 x total lymphocyte count. We then examined the relationship between PNI and clinical parameters, including exacerbation events.Results: There was no significant correlation between the PNI and CAT, the FEV1%pred, or low attenuation volume percentage (LAV%). In the elderly group, there were significant differences between the groups with or without exacerbation in the CAT and PNI (p=0.008, p=0.004, respectively). FEV1%pred, neutrophil-to-lymphocyte ratio (NLR) and LAV% did not differ between the two groups. The analytical model combining CAT and PNI improved the prediction of exacerbations in the elderly subjects (p=0.0068).Conclusion: In elderly subjects with COPD, CAT were associated significantly with the risk of COPD exacerbation, with PNI also a potential predictor. The combined assessment of CAT and PNI may be a useful prognostic tool in subjects with COPD.Keywords: chronic obstructive pulmonary disease, exacerbation, prognostic nutritional index

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