Background Evidence on the association between prognostic nutritional index (PNI) and prognosis in acute graft-versus-host disease (aGVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is limited. Objective This study aims to investigate the relationship between PNI levels and prognosis in patients experiencing aGVHD following allo-HSCT. Methods We conducted a retrospective cohort study of patients who underwent allo-HSCT at Henan Cancer Hospital from January 2019 to December 2024. Eligible patients were those diagnosed with aGVHD following allo-HSCT. Data on PNI levels, clinical outcomes, and demographics were extracted from medical records. The primary outcomes were overall survival (OS) and event-free survival (EFS). Multivariable Cox regression and subgroup analyses were performed to assess the relationship between PNI levels and prognosis, adjusting for confounders. Results This study included 109 eligible patients with a mean age of 29.4 ± 15.3 years. Over a 30-month follow-up, there were 69 deaths, 3 relapses/progressions, and 37 survivors. Among the participants, 51 had Grade I-II aGVHD, and 58 had Grade III-IV aGVHD. After adjusting for confounders, the adjusted hazard ratios (HR) for PNI and OS in T2 (35.8–42.5) and T3 (42.5–59.7) were 0.52 (95% CI: 0.23–0.86, p = 0.049) and 0.43 (95% CI: 0.18–0.73, p = 0.013), respectively, compared to individuals with lower T1 (20.2–35.8). For EFS, the adjusted HR values for PNI in T2 (35.8–42.5) and T3 (42.5–59.7) were 0.32 (95% CI: 0.17–0.59, p = 0.026) and 0.31 (95% CI: 0.16–0.56, p = 0.021), respectively, when compared to those with lower T1 (20.2–35.8). These results suggest a potential association between lower PNI levels and poorer prognosis. Kaplan–Meier analysis demonstrated poorer OS ( p = 0.047) and EFS ( p = 0.078) in the lower PNI group. Subgroup and interaction analyses revealed no significant interactions by age, sex, CD34+ count and ABO match (all p 0.05), confirming the stability of the association. Sensitivity analyses further supported this consistent association. Conclusion Our study underscores the association between lower PNI levels and poorer prognosis in aGVHD patients following allo-HSCT, emphasizing the need for further research to validate PNI as a reliable prognostic biomarker.
Zhang et al. (2025) studied this question.