Limits of PINI (prognostic nutritional anf inflammatory index) in the evaluation of nutritional status in children

: The prognosis inflammatory and nutritional index (PINI) is a score based on albumin, glycoprotein acid and C-reactive protein levels. PINI was developed to evaluate nutritional and inflammatory status of patients presenting inflammatory syndromes with or without denutrition. In the present study conducted over a period of 6 days in the Pediatric Department of Bambri Hospital in the Central African Republic, we evaluated the usefulness of PINI for follow-up of 25 undernourished Central African children presenting marasmus (n = 15) or kwashiorkor (n = 10) associated with a laboratory documented inflammatory process. All children received nutritional support. We assessed the influence of inflammatory and nutritional factors on PINI values. Data measured in blood samples taken from 16 patients who also presented documented inflammatory manifestations but were not undernourished. A parallel decrease in C-reactive protein and PINI was observed from D0 to D6 and an increase in albumin and prealbumin from D3. There was a positive correlation between C reactive protein values and PINI on D0, D3 and D6. There was no significance difference between PINI and C reactive protein levels in the two study groups. In contrast, a significant difference was observed between albumin and prealbumin. These findings indicate that PINI is of little value for evaluation of inflammatory processes associated with malnutrition. The two main drawbacks of PINI are first that it is more sensitive to the inflammatory than nutritional factors and second that the physical and pharmakinetic parameters used for its calculation are too different.