Predictive Value of Prognostic Nutritional Index in Children with COVID-19

Background and aim: Severe malnutrition might contribute the poor outcomes in COVID-19. This study aims to investigate the relationship between prognostic nutritional index (PNI) and mortality in children with COVID-19 infection and its predictive value for predicting poor prognosis. Methods: A case control study using medical records of paediatric patients with COVID-19 was conducted from June 2020-July 2022. Subjects were divided into two groups: non-survived and survived. PNI value were calculated as 10 x serum albumin (g/dL) + 0.005 x total lymphocyte count (/mm³). PNI was compared with nutritional status and several markers that have been used in COVID-19, including (1) neutrophil to lymphocyte ratio (NLR), (2) systemic immune inflammation index (SII), and (3) platelet to lymphocyte ratio (PLR). Results: Among 124 eligible subjects, 34 (27.41%) were in the non-survived group and 90 (72.58%) children in the survived group. Children with severe malnutrition had lower albumin and a greater risk of death than those with good nutrition. PNI, NLR, and SII were significantly correlated with the mortality children with COVID-19 except for PLR; P = 0.001, P = 0.001, P = 0.021, and P = 0.118, respectively. Receiver operating characteristic curves stated that PNI (AUC = 0.741, P < 0.0001). The cut-off values of PNI were 41.975 with sensitivities of 73.5% and specificities of 73.3%. PNI value <41.975 had a 7.64 times greater risk of mortality (P < 0.0001). Conclusion: PNI might be used as predictive value for predicting poor outcome in children with COVID-19 infection.