Evaluating the Prognostic Nutritional Index, Naples Prognostic Score, and Osaka Prognostic Score for Predicting Acute Respiratory Distress Syndrome in Non-Diabetic Sepsis Patients: Diminished Predictive Value in Diabetic Populations - Report - MDSpire
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Evaluating the Prognostic Nutritional Index, Naples Prognostic Score, and Osaka Prognostic Score for Predicting Acute Respiratory Distress Syndrome in Non-Diabetic Sepsis Patients: Diminished Predictive Value in Diabetic Populations
Prognostic Nutritional and Inflammatory Scores Predict ARDS in Non-Diabetic Sepsis Patients
Overview
This study evaluated the predictive value of the Prognostic Nutritional Index (PNI), Naples Prognostic Score (NPS), and Osaka Prognostic Score (OPS) for acute respiratory distress syndrome (ARDS) in sepsis patients. Results showed these scores effectively predicted ARDS risk in non-diabetic patients, while NPS and OPS had diminished predictive value in diabetic populations.
Background
Sepsis is a critical condition with high mortality, often complicated by acute respiratory distress syndrome (ARDS), which significantly worsens outcomes. Nutritional and inflammatory status, assessed by scoring systems like PNI, NPS, and OPS, have been used to predict prognosis in various diseases. Diabetes mellitus alters immune and inflammatory responses in sepsis, potentially affecting the accuracy of these prognostic tools for ARDS risk prediction.
Data Highlights
Parameter
Non-ARDS (n=1772)
ARDS (n=317)
p-value
PNI Level
Higher
Lower
<0.001
NPS Score 3-4 (%)
Lower
Higher
<0.001
OPS Score 2-3 (%)
Lower
Higher
<0.001
Diabetes Mellitus Proportion
Higher
Lower
0.030
Key Findings
ARDS patients had significantly lower PNI levels compared to non-ARDS patients (p < 0.001).
Higher NPS (3-4 points) and OPS (2-3 points) scores were more common in ARDS patients (p < 0.001).
Diabetes mellitus prevalence was lower in the ARDS group than in the non-ARDS group (p = 0.030).
In non-diabetic sepsis patients, low PNI (OR 3.764), high NPS (OR 2.537), and high OPS (OR 3.189) were independently associated with increased ARDS risk.
In diabetic sepsis patients, only low PNI (OR 2.037) remained significantly associated with ARDS; NPS and OPS were not predictive.
Clinical Implications
PNI, NPS, and OPS can be useful tools for early identification of ARDS risk in sepsis patients without diabetes, aiding timely intervention. However, clinicians should be cautious when applying NPS and OPS in diabetic sepsis patients, as their predictive value is diminished in this subgroup. Tailored risk assessment strategies may be necessary for diabetic populations to improve ARDS prognostication.
Conclusion
PNI, NPS, and OPS effectively predict ARDS risk in non-diabetic sepsis patients, but NPS and OPS lose predictive accuracy in diabetic cohorts. This highlights the need for adjusted prognostic approaches in sepsis patients with diabetes.
References
Study Authors/2024 -- Evaluating the Prognostic Nutritional Index, Naples Prognostic Score, and Osaka Prognostic Score for Predicting ARDS in Sepsis
