New prognosis inflammatory and nutritional indexes: comparison with the Prognostic Inflammatory and Nutritional Index as reference index

The Prognostic Inflammatory and Nutritional Index (PINI) was previously developed to improve the diagnosis and monitoring of patients with inflammation and/or malnutrition in terms of morbidity and mortality risk, especially in ICU patients [1]. The formula includes the determination of four serum protein concentrations: PINI = (C-reactive protein (CRP) (mg/l) × orosomucoid (OROSO) (g/l))/(albumin (ALB) (g/l) × transthyretin (TTR) (g/l)). Since CRP may be considered now as the gold standard for assessing and monitoring inflammatory states in clinical practice, OROSO is generally unavailable for PINI calculation. Elsewhere, the strong and rapid changes in CRP levels (0 to 600 mg/l) in acute inflammation may lead to an overestimation of the risk of morbidity and mortality suggested by the PINI. The aim of this study was to evaluate alternative biological formulas by removing OROSO from the PINI and replacing CRP value by its logarithm (Log), in order to reduce the mathematical weighting of this biomarker.