ArticleFrontiers in nutrition2026
Association between prognostic nutritional index and 28-day mortality in patients with sepsis-associated acute respiratory distress syndrome.
Article in Frontiers in nutrition, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and Aims: Despite advances in critical care, sepsis-associated acute respiratory distress syndrome (SA-ARDS) continues to impose a substantial clinical burden, characterized by persistently high incidence and mortality. This study aimed to investigate the association between the Prognostic Nutritional Index (PNI) and 28-day mortality in SA-ARDS patients. Methods: In this retrospective cohort study, 1,022 adult ICU patients with SA-ARDS (2020-2025) were analyzed. The primary outcome of this study was the 28-day mortality rate in patients with SA-ARDS. Multivariate logistic regression, propensity score matching (PSM), inverse probability weighting (IPW), doubly robust estimation, generalized additive models (GAM), Kaplan-Meier (KM) survival analysis, and receiver operating characteristic (ROC) curve were used to investigate the relationship between PNI and 28-day mortality in patients with SA-ARDS. Results: All statistical models consistently identified PNI as an independent protective factor for SA-ARDS prognosis (multivariate logistic regression: OR 0.41, 95% CI 0.31-0.51; PSM: OR 0.52, 0.45-0.57; IPW: OR 0.50, 0.44-0.57; doubly robust estimation: OR 0.03, 0.02-0.06). The GAM revealed a notable threshold-dependent association between PNI and 28-day mortality in SA-ARDS patients, with an optimal cutoff value of 41. Patients with PNI ≥ 41 had a markedly reduced mortality risk ( Conclusion: The PNI is an independent predictor of 28-day mortality in SA-ARDS patients. Although the predictive efficacy of standalone PNI varied across different cohorts, combining PNI with conventional SOFA and APACHE II scores steadily improved prognostic performance. As a simple laboratory-derived indicator, PNI can act as a valuable auxiliary marker to optimize risk stratification for SA-ARDS patients. Further prospective studies are required to verify its clinical utility.
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