Prognostic Performance of Prognostic Nutritional Index, Subjective Global Assessment, and Nutritional Risk Screening 2002 as Predictors of Inpatient Sepsis Mortality: a Prospective Cohort Study
Keywords:
seps, Mortality, Malnutrition, Prognostic Nutritional Index, subjective global assessment, Nutritional Risk Screening 2002Abstract
Background and Aim: Sepsis is a leading cause of infection-related mortality. Various factors contribute to sepsis-related mortality, including age, comorbidities, Sequential (Sepsis-Related) Organ Failure Assessment (SOFA) score, serum lactate levels, and nutritional status. Several parameters are available to assess nutritional status, including the Prognostic Nutritional Index (PNI), Subjective Global Assessment (SGA), and Nutritional Risk Screening 2002 (NRS 2002). The SGA and NRS 2002 parameters are standard tools for evaluating nutritional status, while the PNI is very simple and objective. This study aimed to evaluate the accuracy of these three nutritional parameters as predictors of in-hospital mortality in patients with sepsis and to analyze the extent to which malnutrition contributes to sepsis-related mortality among other factors. Methods: This was a prospective cohort study. The inclusion criteria were patients aged 18 years or older who were hospitalized with a diagnosis of sepsis. The exclusion criteria were patients who could not be interviewed or those who were pregnant. Dropout criteria included patients who were discharged against medical advice. Sampling was conducted using consecutive sampling. Nutritional status and other clinical parameters were assessed within the first 48 hours of sepsis diagnosis. In-hospital outcomes were recorded as either mortality or survival. Cut-off points for numerical variables were determined using ROC curves. Bivariate analysis was performed using Chi-square or Fisher’s exact test, and multivariate analysis was conducted using binary logistic regression. Results: A total of 158 subjects were included in the study. The mortality rate was 62.7%. As predictors of mortality, PNI had a positive predictive value (PPV) of 72.7% and a negative predictive value (NPV) of 54.2% with a cut-off point of 30.55, while SGA had a PPV of 70.4% and an NPV of 54.0%, and NRS 2002 had a PPV of 64.7% and an NPV of 75.0%. Regarding sepsis mortality, malnutrition status based on PNI had an aRR 3.0 (95% CI 1.4-6.6), SGA had an aRR 2.4 (95% CI 1.1-5.3), and NRS 2002 had an aRR 1.6 (95% CI 0.2-10.1). Other variables that were also significantly associated with sepsis mortality included comorbidity score, SOFA score, and serum lactate level. Pathogen resistance was not identified as a significant factor contributing to sepsis-related mortality in this study. Conclusion: Malnutrition was significantly associated with in-hospital sepsis mortality. Both PNI and SGA are equally effective in predicting sepsis mortality. The NRS 2002 is the least predictive to both PNI and SGA in predicting sepsis mortality. Other factors that also have significant association with in-hospital sepsis mortality are Charlson Comorbidity Index (CCI) score, SOFA score, and serum lactate level. Keywords: Sepsis, mortality, malnutrition, Prognostic Nutritional Index, Subjective Global Assessment, Nutritional Risk Screening 2002References
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