• Toshinori Tsukahara, Nobuyuki Horita, Ken Tashiro, Kenjiro Nagai, Masaharu Shinkai, Masaki Yamamoto, Takashi Sato, Yu Hara, Hideyuki Nagakura, Yuji Shibata, Hiroki Watanabe, Kentaro Nakashima, Ryota Ushio, Akimichi Nagashima, Misako Ikeda, Atsuya Narita, Katsuhito Sasaki, Nobuaki Kobayashi, Makoto Kudo, and Takeshi Kaneko.
• Department of Pulmonology, Yokohama City University Graduate School of Medicine, Japan.
• Intern. Med. 2017 Dec 15; 56 (24): 3277-3282.

AbstractObjective Onodera's Prognostic Nutritional Index (PNI), determined as "10× albumin (g/dL) + 0.005× lymphocyte count (/μL)," was originally designed to determine the risk of complications following gastrointestinal surgery. This single-center, retrospective observational study was designed to investigate whether or not the PNI can predict the treatment outcome. Methods We consecutively reviewed HIV-negative pulmonary tuberculosis adults in an isolation ward. Most patients were being treated with standard three- or four-drug regimens. Patients were discharged after consecutive negative smears/cultures were confirmed. The risk of all-cause death was assessed using a multivariable Cox proportional hazard model and a log-rank trend test. Results During the observation period, we observed 371 consecutive patients with a median age of 72 (interquartile range [IQR]: 54-82) years. In our cohort, 295 (79.5%) patients were discharged alive, and 76 (20.5%) died in-hospital. Patients who died in-hospital had a lower PNI [median 21.2 (IQR: 18.5-25.9)] than those who were discharged alive [median 35.1 (IQR: 28.0-43.3); p<0.001]. The area under the receiver operating characteristic curve was 0.87. After dividing the patients based on the baseline PNI quartile, those patients with a lower PNI showed a poorer survival than those with a higher PNI (log-rank trend p<0.001). After adjusting for other baseline variables, the baseline PNI was still associated with in-hospital death with a hazard ratio of 0.86 (95% confidence interval: 0.82-0.91, p<0.001). Conclusion Our results showed that a low PNI was clearly related to a poor survival prognosis in smear-positive HIV-negative pulmonary tuberculosis inpatients.

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