E128 Feeding the flame, measuring the calm: the nutritional imprint of lupus activity

Background/Aims Systemic lupus erythematosus (SLE) is a chronic autoimmune disease characterised by multisystem involvement and unpredictable disease flares. Accurate assessment of disease activity remains crucial for optimal patient management. The Prognostic Nutritional Index (PNI), which reflects both nutritional and immunological status, has emerged as a potential marker in various autoimmune conditions. However, its relationship with disease activity in SLE patients has not been extensively studied. This study aimed to evaluate the correlation between PNI and disease activity as measured by the Systemic Lupus Erythematosus Disease Activity Index (SLEDAI) scores in patients with SLE. Methods A descriptive cross-sectional study was conducted at the Department of Clinical Immunology and Rheumatology, ESIC Medical College and Hospital, Hyderabad, between May 2023 and May 2024. Fifty-seven patients fulfilling the 2019 ACR/EULAR classification criteria for SLE were enrolled. Patients aged 18 years or above were included, while those with diabetes, malignancies, severe liver disease, active infections, pregnancy, or coexisting autoimmune diseases were excluded. Disease activity was assessed using the SLEDAI-2K score. Blood samples were collected for complete blood count, serum albumin, fibrinogen, ESR, CRP, and complement levels. PNI was derived from serum albumin and total lymphocyte count. Statistical analysis included Spearman correlation, Kruskal-Wallis test, regression analysis, and ROC curve analysis Results The study population had a mean age of 32±9 years with a mean SLEDAI score of 9.65±4.82. The mean PNI was 69.64±22.90. There was a significant negative correlation between PNI and SLEDAI scores (ρ=-0.351, p = 0.007). Patients with mild disease activity had significantly higher PNI levels (90.84±33.78) compared to those with severe disease (64.10±18.30, p = 0.021). Multiple regression analysis showed that PNI remained an independent predictor of SLEDAI scores (β=-0.076, p = 0.016). ROC analysis revealed good discriminatory ability with an AUC of 0.766 (95% CI: 0.608-0.925). A PNI cutoff of 60.7 demonstrated 100% specificity and 50% sensitivity for detecting active disease. (Table 1). Conclusion Lower PNI values correlate with higher disease activity in SLE patients. PNI may serve as a useful adjunct biomarker for assessing disease severity and monitoring disease activity in clinical practice.