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Prognostic Nutritional Index as a Biomarker of Disease Severity and Long‐Term Outcome in Guillain–Barré Syndrome

Year: 2025

Type: article

Abstract: BACKGROUND AND AIMS: Guillain-Barré syndrome (GBS) exhibits clinical heterogeneity and variable progression. In low-resource settings, malnutrition and limited treatment worsen prognosis, underscoring the need for a simple prognostic tool. This study evaluated the Prognostic Nutritional Index (PNI) and Nutritional Risk Index (NRI) in relation to GBS severity and long-term outcomes, comparing their predictive value with standard prognostic indicators. METHODS: An observational cohort study of 252 GBS patients enrolled between 2019 and 2024 was conducted. PNI and NRI were calculated using serum albumin, lymphocyte count, and body weight. The GBS-disability score (GBS-DS) assessed baseline severity and 26-week outcomes. Statistical analysis included Chi-square tests, Mann-Whitney U tests, Spearman's ρ, and logistic regression to identify predictors. ROC analysis determined optimal PNI cut-offs, confirmed by Kaplan-Meier survival curves. RESULTS: PNI, unlike NRI, was significantly reduced in severe GBS (GBS-DS > 3) compared to mild/moderate GBS (GBS-DS ≤ 3). PNI correlated with GBS-DS (ρ = -0.62), MRC sum score (ρ = 0.5), hemoglobin (ρ = 0.53), and neutrophil count (ρ = -0.35) (all p < 0.0001). PNI independently predicted disease severity (odds ratio [OR] = 0.91; p = 0.036) and 26-week outcomes (OR = 0.93; p = 0.033). Area under the ROC curve (AUC) was 0.769 for severity and 0.719 for 26-week outcomes. PNI cut-offs of 49.395 and 45.72 predicted severe GBS and long-term poor outcome, respectively. Kaplan Meier analysis confirmed patients with PNI < 45.72 required a longer time to gain independent locomotion (p < 0.0001). INTERPRETATION: Lower PNI, but not NRI, is associated with greater GBS severity and poor long-term outcomes. PNI independently predicted disease severity and 26-week outcomes, with specific cut-offs identifying patients requiring longer recovery, supporting its prognostic utility.

Source: Journal of the Peripheral Nervous System

DOI: 10.1111/jns.70071