P4370 - Low Prognostic Nutritional Index as a Predictor of Mortality and Severity in Acute Pancreatitis: A Systematic Review

Samir Vanani, MBBS¹, Mipasha Patel, MD², Rahul Bakhle, MBBS³, Nandan Patel, MBBS⁴
1Surat Institute of Digestive Sciences Hospital, Surat, Gujarat, India; 2Abington Jefferson Hospital, Willow Grove, PA; 3Medical College Baroda, Vadodara, Gujarat, India; 4All India Institute of Medical Sciences (AIIMS), Jodhpur, Jodhpur, Rajasthan, India

Introduction: Malnutrition and systemic inflammation aggravate acute pancreatitis (AP). The Prognostic Nutritional Index (PNI) summarizes both processes; however, its ability to predict mortality and disease severity in AP has not been synthesized.

Methods: A literature search was conducted across PubMed and Google Scholar for all articles through May 2025. Of 70 titles and abstracts screened, 7 full texts were assessed and 5 were selected for detailed review. Two reviewers independently performed all steps of screening and bias assessment, with any discrepancies resolved by a third reviewer. Meta-analysis was precluded by heterogeneity in PNI cut-offs and effect metrics; findings were therefore narratively synthesised.

Results: We analyzed five observational studies with a total of 1691 patients with AP. PNI was measured on admission in five cohorts and at 48 hours in one and on day 3 and day 7 in one study. Three studies (n=1059) reported mortality. Li et al. (2017) reported that mean admission PNI was 41.7 ± 7.5 in survivors versus 34.0 ± 6.4 in non-survivors (p< 0.001); PNI ≤ 33.1 yielded an AUC of 0.781 and retained significance after adjustment (OR 2.64, 95 % CI 1.25-5.59). Akkuzu et al. (2022) observed eight deaths among 210 patients with PNI < 45 versus none among 151 with PNI ≥ 45 (crude OR 21.3, 95% CI 4.8-93.5). Efgan et al. (2024), using PNI as a continuous covariate, reported AUC of 0.758 for cut-off ≤43.45 and adjusted HR of 1.055 (1.003-1.156) per unit decrease.For severity, Li et al. (2017) found PNI < 41.1 independently associated with severe AP (OR 7.75, 3.40-17.68). Pian et al. (2021) showed decreasing median PNI throughout the initial 48 hours with minimal improvement by the end of the week in severe cases and a day-3 AUC of 0.814 for the cut-off 40.63. Akkuzu et al. (2022) showed that severe AP occurred in 31% of low-PNI versus 1% of high-PNI patients (p< 0.001); and Shi et al. (2025) demonstrated day-2 PNI ≤ 38.53 predicted severity (AUC 0.871) with adjusted OR 0.82 (0.75-0.90). Across all studies, PNI at 48 hours was most predictive of the mortality/severity of AP.

Discussion: Across 1691 patients, lower PNI consistently predicted higher in-hospital mortality and greater disease severity. Given its derivation from routinely available labs, PNI offers a low-cost, accessible tool for early risk stratification. Although consistent, multicentre prospective studies using standardised PNI measurement are warranted to validate its bedside prognostic utility.

Disclosures:
Samir Vanani indicated no relevant financial relationships.
Mipasha Patel indicated no relevant financial relationships.
Rahul Bakhle indicated no relevant financial relationships.
Nandan Patel indicated no relevant financial relationships.

Samir Vanani, MBBS¹, Mipasha Patel, MD², Rahul Bakhle, MBBS³, Nandan Patel, MBBS⁴. P4370 - Low Prognostic Nutritional Index as a Predictor of Mortality and Severity in Acute Pancreatitis: A Systematic Review, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.