Association between Prognostic Nutritional Index and community-acquired pneumonia in children with parapneumonic effusion: A retrospective analysis

Prognostic Nutritional Index and parapneumonic effusion

Authors

  • Özlem Erdede University of Health Sciences, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, Department of Pediatrics, İstanbul, Turkey https://orcid.org/0000-0002-5490-5361
  • Erdal Sarı University of Health Sciences, Zeynep Kamil Maternity and Children’s Disease Training and Research Hospital, Department of Pediatrics, İstanbul, Turkey https://orcid.org/0000-0002-9967-1669

DOI:

https://doi.org/10.5281/zenodo.8350562

Keywords:

Children, lobar pneumonia, parapneumonic effusion, Prognostic Nutritional Index

Abstract

Objective: Biomarkers for predicting disease severity in patients with clinical pneumonia have been increasingly reported. The association of Prognostic Nutritional Index (PNI), an inflammation-based marker, with community-acquired pneumonia (CAP) is uncertain. This study ascertained the relationship between PNI and CAP in children with parapneumonic effusion (PPE).

Methods: This single-center study retrospectively included 679 children hospitalized with lobar pneumonia between January 1, 2012, and July 31, 2022, and subdivided the cohort by PPE presence (n=209) or absence (n=470). The length of hospital stay and PNI at hospitalization were compared among patients with only lobar pneumonia; pneumonia + PPE; and PPE + use of chest tube drainage (PPE+tube drainage).

Results: Significant intergroup differences (p=0.0001) in PNI were observed among the lobar pneumonia, PPE, and PPE+tube drainage groups: PNI in the PPE+tube drainage group was significantly lower than that in the lobar pneumonia and PPE groups, and PNI of the PPE group was significantly lower than that in the lobar pneumonia group. The area under the PNI receiver operating characteristics curve (with 95% CI) was 0.671 (0.633–0.707) and 0.921 (0.894–0.943) for PPE and PPE+tube drainage, respectively. A PNI cut-off ≤38.01 for PPE+tube drainage showed sensitivity of 87.88, specificity of 88.30, positive predictive value of 34.50, negative predictive value of 99.00, and likelihood ratio (+) of 7.51. The length of hospital stay (days) was longer in the PPE+tube drainage group.

Conclusion: PNI at admission may constitute an independent predictor of CAP prognosis in patients who require tube drainage.

References

Marangu D, Zar HJ. Childhood pneumonia in low-and-middle-income countries: An update. Paediatr Respir Rev. 2019; 32:3-9.

Niederman MS, Mandell LA, Anzueto A, Bass JP, Broughton WA, Campbell GD, et al. Guidelines for the management of adults with community-acquired pneumonia. Diagnosis, assessment of severity, antimicrobial therapy, and prevention. Am J Respir Crit Care Med. 2001; 163:1730-54.

Mandell LA, Bartlett JG, Dowell SF, File TM Jr, Musher DM, Whitney C, et al. Update of practice guidelines for the management of community-acquired pneumonia in immunocompetent adults. Clin Infect Dis. 2003; 37:1405-33.

Dalhoff K. Worldwide guidelines for respiratory tract infections: community-acquired pneumonia. Int J Antimicrob Agents. 2001;18:39-44.

Hoare Z, Lim WS. Pneumonia: update on diagnosis and management. BMJ. 2006; 332:1077-9.

Masarweh K, Gur M, Toukan Y, Bar-Yoseph R, Kassis I, Gut G, et al. Factors associated with complicated pneumonia in children. Pediatr Pulmonol. 2021;56:2700-6.

Harris M, Clark J, Coote N, Fletcher P, Harnden A, McKean M, et al. British Thoracic Society Standards of Care Committee. British Thoracic Society guidelines for the management of community acquired pneumonia in children: update 2011. Thorax. 2011;66:2:ii1-23.

Tuğcu GD, Özsezen B, Türkyılmaz İ, Pehlivan Zorlu B, Eryılmaz Polat S, Özkaya Parlakay A, et al. Risk factors for complicated community-acquired pneumonia in children. Pediatr Int. 2022; 64:e15386.

Bradley JS, Byington CL, Shah SS, Averson B, Carter ER, Harrison C, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin. Inf. Dis. 2011; 53:e25-76.

Kurian J, Levin TL, Han BK, Taragin B, Weinsten S. Comparison of ultrasound and CT in the evaluation of pneumonia complicated by parapneumonic effusion in children. AJR Am J Roentgenol. 2009; 193:1648-54.

McCauley L, Dean N. Pneumonia and empyema: causal, casual or unknown. J Thorac Dis. 2015; 7:992-8.

Redden MD, Chin TY, van Driel ML. Surgical versus non-surgical management for pleural empyema. Cochrane Database Syst Rev. 2017; 17;3:CD010651.

Pacilli M, Nataraja RM. Management of paediatric empyema by video-assisted thoracoscopic surgery (VATS) versus chest drain with fibrinolysis: Systematic review and meta-analysis. Paediatr Respir Rev. 2019; 30:42-48.

Epaud R, Aubertin G, Larroquet M, Pointe HD, Helardot P, Clevent A, et al. Conservative use of chest-tube insertion in children with pleural effusion. Pediatr Surg Int. 2006; 22:357-62.

Bataev SM, Zurbaev NT, Molotov RS, Ignatiev RO, Afaunov MV, Fedorov AK, et al. The first experience of the use of hydro-surgical technologies in the treatment of children with pulmatic-pleural complications of destructive pneumonia. Khirurgiia (Mosk). 2019;7:15-23.

Breuer O, Picard E, Benabu N, Erlichman I, Reiter J, Tsabari R, et al. Predictors of prolonged hospitalizations in pediatric complicated pneumonia. Chest. 2018; 153:172-80.

Esposito S, Cohen R, Domingo JD, Pecurariu OF, Greenberg D, Heininger U, et al. Antibiotic therapy for pediatric community-acquired pneumonia: do we know when, what and for how long to treat. Pediatr Infect Dis J. 2012; 31:e78-85.

Lippi G, Meschi T, Cervellin G. Inflammatory biomarkers for the diagnosis, monitoring and follow-up of community-acquired pneumonia: clinical evidence and perspectives. Eur J Intern Med. 2011; 22:460-5.

Seligman R, Ramos-Lima LF, Oliveira Vdo A, Sanvicente C, Pacheco EF, Dalla Rosa K, et al. Biomarkers in community-acquired pneumonia: a state-of-the-art review. Clinics. 2012; 67:1321-5.

Principi N, Esposito S. Biomarkers in pediatric community-acquired pneumonia. Int J Mol Sci. 2017; 18:E447.

Kang N, Gu H, Ni Y, Wei X, Zheng S. Prognostic and clinicopathological significance of the Prognostic Nutritional Index in patients with gastrointestinal stromal tumours undergoing surgery: a meta-analysis. BMJ Open. 2022; 1;12:e064577

Beck MA, Levander OA. Host nutritional status and its effect on a viral pathogen. J Infect Dis. 2000; 182 Suppl 1:S93-6.

Keskin HA, Kurtul A, Esenboğa K, Çiçek MC, Katırcıoğlu SF. Prognostic nutritional index predicts in-hospital mortality in patients with acute Stanford type A aortic dissection. Perfusion. 2021; 36:710-6.

Schwegler I, von Holzen A, Gutzwiller JP, Schlumpf R, Mühlebach S, Stanga Z. Nutritional risk is a clinical predictor of postoperative mortality and morbidity in surgery for colorectal cancer. Br J Surg. 2010; 97:92-7.

Wada H, Dohi T, Miyauchi K, Jun S, Endo H, Doi S, et al. Relationship between the prognostic nutritional index and long-term clinical outcomes in patients with stable coronary artery disease. J Cardiol. 2018; 72:155-61.

Hayıroğlu Mİ, Keskin M, Keskin T, Uzun AO, Altay S, Kaya A, et al. A novel independent survival predictor in pulmonary embolism: Prognostic Nutritional Index. Clin Appl Thromb Hemost. 2018; 24:633-9.

Xiang W, Chen X, Ye W, Li J, Zhang X, Xie D. Prognostic Nutritional Index for predicting 3-month outcomes in ischemic stroke patients undergoing thrombolysis. Front Neurol. 2020; 11:599.

Wang R, He M, Yin W, Lia X, Whang B, Jin X, et al. The Prognostic Nutritional Index is associated with mortality of COVID-19 patients in Wuhan, China. J Clin Lab Anal. 2020; 34:e23566.

Wei L, Xie H, Li J, Li R, Chen W, Huang L, et al. The prognostic value of geriatric nutritional risk index in elderly patients with severe community-acquired pneumonia: A retrospective study. Medicine. 2020; 99:e22217.

Yanagita Y, Arizono S, Tawara Y, Domagari M, Machiguchi H, Yokomura K, et al. The severity of nutrition and pneumonia predicts survival in patients with aspiration pneumonia: A retrospective observational study. Clin Respir J. 2022; 16:522-32.

Shimoyama Y, Umegaki O, Inoue S, Agui T, Kadono N, Minami T, et al. The neutrophil to lymphocyte ratio is superior to other inflammation-based prognostic scores in predicting the mortality of patients with pneumonia. Acta Med Okayama. 2018; 72:591-3.

Moral L, Toral T, Clavijo A, Caballero M, Canals F, Fornies MJ, et al. Population-based cohort of children with parapneumonic effusion and empyema managed with low rates of pleural drainage. Front Pediatr. 2021; 9:621943.

Goldin AB, Parimi C, LaRiviere C, Garrison MM, Larison CL, Sawin RS. Outcomes associated with type of intervention and timing in complex pediatric empyema. Am J Surg. 2012; 203:665-73.

Dorman RM, Vali K, Rothstein DH. Trends in treatment of infectious parapneumonic effusions in U.S. children's hospitals, 2004-2014. J Pediatr Surg. 2016; 51:885-90.

Segerer FJ, Seeger K, Maier A, Hagemann C, Schoen C, van der Linden H, et al. Therapy of 645 children with parapneumonic effusion and empyema-A German nationwide surveillance study. Pediatr Pulmonol. 2017; 52:540-7.

Skevaki C, Fragkou PC, Cheng C, Xie M, Renz H. Laboratory characteristics of patients infected with the novel SARS-CoV-2 virus. J Infect. 2020; 81:205-12.

Soeters PB, Wolfe RR, Shenkin A. Hypoalbuminemia: Pathogenesis and clinical significance. JPEN J Parenter Enteral Nutr. 2019; 43:181-93.

Viasus D, Garcia-Vidal C, Simonetti A, Manresa F, Dorca J, Gudiol F, et al. Prognostic value of serum albumin levels in hospitalized adults with community-acquired pneumonia. J Infect. 2013; 66:415-23.

Zhang H, Tao Y, Wang Z, Lu J. Evaluation of nutritional status and prognostic impact assessed by the prognostic nutritional index in children with chronic kidney disease. Medicine (Baltimore). 2019; 98:e16713.

Shang S, Huang Y, Zhan X, Peng F, Wang X, Wen Y, et al. The relationship between the prognostic nutritional index and new-onset pneumonia in peritoneal dialysis patients. Int Urol Nephrol. 2022; 54;3017-24.

Hachisu Y, Murata K, Takei K, Tsuchiya T, Tsurumaki H, Koga Y, et al.. Prognostic nutritional index as a predictor of mortality in nontuberculous mycobacterial lung disease. J Thorac Dis. 2020; 12:3101-9.

Mohri Y, Inoue Y, Tanaka K, Hiro J, Uchida K, Kusunoki M, et al. Prognostic nutritional index predicts postoperative outcome in colorectal cancer. World J Surg. 2013; 37:2688-92.

Mori S, Usami N, Fukumoto K, Mizuno T, Kuroda H, Sakakura N, et al. The significance of the Prognostic Nutritional Index in patients with completely resected non-small cell lung cancer. PLoS One. 2015; 10:e0136897.

Caputo F, Dadduzio V, Tovoli F, Bertolini G, Cabibo G, Germa K, et al. The role of PNI to predict survival in advanced hepatocellular carcinoma treated with Sorafenib. PLoS One. 2020; 15:e0232449.

Dai Y, Fu X, Li T, Yao Q, Su L, Su H, et al. Long-term impact of prognostic nutritional index in cervical esophageal squamous cell carcinoma patients undergoing definitive radiotherapy. Ann Transl Med. 2019; 7:175.

Huang X, Hu H, Zhang W, Shao Z. Prognostic value of prognostic nutritional index and systemic immune-inflammation index in patients with osteosarcoma. J Cell Physiol. 2019; 234:18408-14.

Moon SW, Lee EH, Choi JS, Leem AY, Lee SH, Kim SY, et al. Impact of prognostic nutritional index on outcomes in patients with Mycobacterium avium complex pulmonary disease. PLoS One. 2020; 15:e0232714.

Lee JY, Kim HI, Kim YN, Hong JH, Alshomimi S, An JY, et al. Clinical significance of the Prognostic Nutritional Index for predicting short- and long-term surgical outcomes after gastrectomy: A retrospective analysis of 7781 gastric cancer patients. Medicine. 2016; 95:e3539.

Hayashi J, Uchida T, Ri S, Hamasaki A, Kuroda Y, Yamashita A, et al. Clinical significance of the prognostic nutritional index in patients undergoing cardiovascular surgery. Gen Thorac Cardiovasc Surg. 2020; 68:774-9.

Li T, Qi M, Dong G, Li X, Xu Z, Wei Y, et al. Clinical value of Prognostic Nutritional Index in prediction of the presence and severity of neonatal sepsis. J Inflamm Res. 2021;14:7181-90.

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Published

2023-09-17

How to Cite

Erdede, Özlem, & Sarı, E. (2023). Association between Prognostic Nutritional Index and community-acquired pneumonia in children with parapneumonic effusion: A retrospective analysis: Prognostic Nutritional Index and parapneumonic effusion. The Injector, 2(3), 147–156. https://doi.org/10.5281/zenodo.8350562

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