Association between prognostic nutritional index and clinical outcomes in patients with pyogenic liver abscess: a retrospective multicenter study.

BACKGROUND & AIMS: Despite advances in therapeutic strategies, pyogenic liver abscess (PLA) remains a life-threatening bacterial infection associated with substantial mortality. The Prognostic Nutritional Index (PNI), a marker of immuno-nutritional status, has been shown to predict outcomes in various diseases. However, its prognostic value in patients with PLA remains unclear. METHODS: A total of 405 patients diagnosed with PLA were enrolled in this study. Based on the median PNI value at admission, patients were stratified into the high-PNI group (PNI ≥ 37.15) and low-PNI group (PNI < 37.15). Clinical characteristics, laboratory data, imaging findings, presumed clinical route of PLA, previous hepatobiliary/pancreatic procedure history, treatment modalities, and clinical outcomes were analyzed to evaluate the association between PNI and prognosis. RESULTS: Patients in the low-PNI group were significantly older than those in the high-PNI group (59.07 ± 13.30 years vs. 54.20 ± 13.92 years, P < 0.001) and a higher prevalence of fever (92.08% vs. 85.15%, P = 0.028) was seen in patients with low PNI. The low-PNI group also had a higher frequency of SIRS at admission (32.51% vs. 17.33%, P < 0.001), higher rate of abscess formation with a diameter > 10 cm (16.75% vs. 6.44%, P < 0.001) and a higher frequency of gas formation in abscess (18.22% vs. 6.93%, P = 0.001). Additionally, patients with low PNI had significantly higher complication rates; particularly for formation of pleural effusion and abdominal effusion. Moreover, the length of hospital stay was significantly prolonged (15.70 ± 8.94 days vs. 13.46 ± 7.16 days, P = 0.006), and treatment costs were higher (4130.76 ± 3227.45 USD vs. 3388.60 ± 2975.95 USD, P = 0.017) in the low-PNI group. Multivariate logistic regression analysis revealed that low PNI was associated with prolonged temperature recovery time (OR = 1.589, 95% CI: 1.022-2.470, P = 0.040) and prolonged hospital stay (OR = 1.580, 95% CI: 1.033-2.415, P = 0.035). CONCLUSION: PNI may serve as a useful marker for early clinical risk stratification in patients with PLA. CLINICAL TRIAL: Not applicable.