The Prognostic Nutritional Index predicts poor postoperative outcomes in patients undergoing video-assisted thoracic surgery for an infectious etiology

BACKGROUND: The Prognostic Nutritional Index (PNI) as a prognostic tool for the postoperative outcomes in patients undergoing thoracic surgery due to an infectious etiology remains unexplored. OBJECTIVE: To evaluate the PNI as predictor of poor postoperative outcomes in patients undergoing surgery for a thoracic infection. MATERIAL AND METHODS: A retrospective analysis in patients undergoing VATS during January 2019 to December 2023, including 61 patients. We performed a ROC curve analysis to identify the optimal PNI cut-off value to classify the patients into groups: A high (HR) and low-risk (LR) group. Chi-square, Fisher exact, and Mann-Whitney tests were used to compare them. A multivariate analysis with Cox regression was also performed. RESULTS: The optimal PNI cut-off value was 28.69, with AUC 0.860 (p = 0.001), sensitivity 88.9%, specificity 78.8%. 42 patients were low-risk, while 19 high-risk. There was a significant difference in 30-day mortality between groups (HR 42% vs LR 2%, p < 0.001) as well as in 30-day major complications (HR 68% vs LR 16%, p < 0.001). A multivariate analysis revealed that PNI-based risk group was an independent predictor of mortality (p = 0.008) and major complications (p < 0.001). CONCLUSIONS: The PNI is a valid predictor of poor postoperative outcomes in patients undergoing VATS for a thoracic infection.