Association between prognostic nutritional index and mortality in older Japanese patients with severe post-stroke dysphagia requiring nutritional support: a retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background The prognostic nutritional index (PNI), calculated from serum albumin and lymphocyte count, has remained insufficiently investigated in older patients with post-stroke dysphagia (PSD). We investigated whether PNI was associated with all-cause mortality in older Japanese patients with PSD and compared its prognostic performance with that of the C-reactive protein/albumin ratio (CAR). Methods This single-center retrospective cohort study included 132 older Japanese patients with severe PSD requiring PEG or TPN between January 2014 and January 2017. Multivariable Cox regression analysis and Kaplan–Meier curves were used to estimate the associations of PNI and CAR with all-cause mortality. We assessed robustness through subgroup and sensitivity analyses. To evaluate the prognostic discrimination for 1-year mortality, we used time-dependent receiver operating characteristic (ROC) curves and assessed incremental predictive value using integrated discrimination improvement (IDI) and net reclassification improvement (NRI). Results The mean age of the cohort was 80.7 years (78 women, 54 men). In fully adjusted models, multivariable Cox regression showed that each 1-point increment in PNI was associated with a 7% reduction in all-cause mortality (HR = 0.93, 95% CI: 0.90–0.97). Compared with the lowest PNI tertile (T1), the highest tertile (T3) showed a 75% risk reduction (HR = 0.25; 95% CI: 0.10–0.60). For 1-year mortality, the time-dependent AUC was numerically higher for PNI than for CAR (0.771 vs. 0.712; p = 0.16). Adding PNI to a clinical baseline model significantly improved discrimination (IDI = 0.055, 95% CI 0.010–0.104, p < 0.001; NRI = 0.471, 95% CI 0.126–0.957), whereas adding CAR did not (IDI = 0.015, p = 0.31). Conclusion PNI was inversely associated with mortality in older Japanese patients with severe post-stroke dysphagia requiring PEG or TPN and provided incremental prognostic information beyond standard clinical variables. Whether PNI may be useful for risk stratification in this population requires prospective and external validation.
Source: Frontiers in Neurology
Authors: Wangchun Wu, Jianling Wang
Institution: Fujian Medical University
Language: English
Subfield: Speech and Hearing
Field: Health Professions
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7222915912