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. 2025 Mar 15;50(6):389-394.
doi: 10.1097/BRS.0000000000005135. Epub 2024 Aug 27.

Impact of the Prognostic Nutritional Index on Outcomes in Native Spine Infection

Teeto Ezeonu  1 , Rajkishen Narayanan  1 , Samuel Alfonsi  1   2 , Yunsoo Lee  1 , John Liam Gibbons  1 , Christian McCormick  1 , Jacob Spring  1 , Gabrielle Kozlowski  1 , John J Mangan  1 , Jose A Canseco  1 , Alan S Hilibrand  1 , Alexander R Vaccaro  1 , Gregory D Schroeder  1 , Christopher K Kepler  1
Affiliations

Impact of the Prognostic Nutritional Index on Outcomes in Native Spine Infection

Teeto Ezeonu et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective cohort study.

Objective: The objective of this study was to determine if a baseline prognostic nutritional index (PNI) score could be used to predict outcomes in patients with native spine infections, including the need for operative intervention.

Summary of background data: Nutritional status is an important, potentially modifiable risk factor to consider in the native spine population. The PNI score is a tool that has demonstrated utility as a marker of preoperative nutritional status in patients undergoing surgery; however, it has not yet been studied in the context of native spine infection.

Methods: Adult patients (≥18 y) with a diagnosis of spine infection from 2017 to 2022 were retrospectively identified. Native spine infection was defined as a diagnosis of spinal infection in the absence of prior spine surgery within 3 months of diagnosis. PNI was calculated using the equation: PNI=10×serum albumin (g/dL)+0.005 total lymphocyte count (/μL). Patients were stratified into high or low PNI groups based on their PNI being above or below the average, respectively.

Results: There were 45 patients in the low PNI group and 56 patients in the high PNI group. Patients in the low PNI group were more likely to require surgery ( P =0.046), had more levels decompressed ( P =0.012), and were more likely to undergo two or more irrigation and debridement procedures ( P =0.016). Patients in the low PNI group were also less likely to be discharged home ( P =0.016). There was no difference in length of stay, inpatient complications, 90-day readmissions, 90-day ED visits, or 1-year reoperations between groups.

Conclusion: While postadmission outcomes and inpatient complications were similar across PNI groups, PNI on admission provides useful insight into the severity of infection and predicts the need for operative intervention in patients presenting with native spine infection.

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Conflict of interest statement

J.J.M. serves as a board/committee member for the North American Spine Society. J.A.C. serves as a board/committee member for the Clinical Spine Research Society and has stock/stock options in PathKeeper Surgical. He receives research support from Accelus. A.S.H. receives royalties from Biomet and CTL Amedica and has stock or stock options with Paradigm Spine. A.R.V. serves as a board/committee member of the National Spine Health Foundation. He has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. He has also served as deputy editor/editor of Clinical Spine Surgery. G.D.S. is a paid consultant for Advance Medical, Bioventus, and Surgalign. He serves on the board of Clinical Spine Surgery, AO Spine, Cervical Spine Research Society and Wolters Kluwer Health – Lippincott Williams & Wilkins. He receives research support from Cerapedics, DePuy, A Johnson and Johnson Company, and Medtronic Sofamor Danek. C.K.K. serves on the editorial board of Clinical Spine Surgery and receives royalties from Curetiva and Regeneration Technologies, Inc. The remaining authors report no conflicts of interest.

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