Impact of Prognostic Nutritional Index (PNI) and Inflammatory Index among Critically Ill Patients with Acute Kidney Injury

Background: Prognostic nutritional index (PNI) could be used for evaluation of the immuno-nutritional status. There is possible association between nutritional and inflammatory indices and acute kidney injury (AKI) among critically ill patients. This research aimed for investingating the relationship between the PNI and all-cause mortality among critically ill patients with AKI. Methods: Sixty-nine patients with AKI who were at the intensive care units of Zagazig University hospitals in this prospective observational study were classified regarding outcome into (non survivors): 25 patients who died (36.2%), and (Survivors): 44 (63.8%) patients who recovered. The CBC, CRP, Albumin, Serum Creatinine, and Pelvi-abdominal ultrasound were assessed in all patients in addition to calculation of PNI. Results: Statistically significant positive correlations were revealed between PNI and total protein, serum calcium, C reactive protein and potassium (p<0.001, <0.001, 0.026, and 0.004). Among factors significantly related to mortality in univariate analysis, increasing white blood cell count and high APACHE II score independently increase risk of mortality by 1.211 and 4.763 folds respectively. Total protein (unstandardized β=2.111, p=0.001), calcium (unstandardized β=1.158, p=0.006), and CRP (unstandardized β=0.009, p=0.038), significantly independently associated with PNI. Phosphorus level (unstandardized β=1017.1, p=0.002), significantly independently associated with inflammatory index Conclusion: PNI and SII were comparable between died and survivors among Critically Ill Patients with AKI however, Neutrophil/lymphocyte ratio was significantly higher among died patients compared to survivors. PNI and SII still could be important risk factors associated with increased mortality.