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The prognostic nutritional index (PNI) is independently associated with 90-day and 12-month mortality after metastatic spinal tumor surgery

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Abstract

Introduction

Estimated postoperative survival is an important consideration during the decision-making process for patients with spinal metastases. Nutritional status has been associated with poor outcomes and limited survival in the general cancer population. The objective of this study was to evaluate the predictive utility of the prognostic nutritional index (PNI) for postoperative mortality after spinal metastasis surgery.

Methods

A total of 139 patients who underwent oncologic surgery for spinal metastases between April 2012 and August 2022 and had a minimum 90-day follow-up were included. PNI was calculated using preoperative serum albumin and total lymphocyte count, with PNI < 40 defined as low. The mean PNI of our cohort was 43 (standard deviation: 7.7). The primary endpoint was 90-day mortality, and the secondary endpoint was 12-month mortality. Multivariate logistic regression analyses were performed.

Results

The 90-day mortality was 27% (37/139), and the 12-month mortality was 56% (51/91). After controlling for age, ECOG performance status, total psoas muscle cross-sectional area (TPA), and primary cancer site, the PNI was associated with 90-day mortality [odds ratio 0.86 (95% confidence interval 0.79–0.94); p = 0.001]. After controlling for ECOG performance status and primary cancer site, the PNI was associated with 12-month mortality [OR 0.89 (95% CI 0.82–0.97); p = 0.008]. Patients with a low PNI had a 50% mortality rate at 90 days and an 84% mortality rate at 12 months.

Conclusion

The PNI was independently associated with 90-day and 12-month mortality after metastatic spinal tumor surgery, independent of performance status, TPA, and primary cancer site.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Funding

No funding was received for conducting this study.

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Authors and Affiliations

  1. Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, 3316 Rochambeau Avenue, 3rd Floor, Bronx, NY, 10467, USA

    Rafael De la Garza Ramos, Jessica Ryvlin, Mousa K. Hamad, Mitchell S. Fourman, Ananth Eleswarapu, Yaroslav Gelfand, Saikiran G. Murthy & Reza Yassari

  2. Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Rafael De la Garza Ramos, Mousa K. Hamad, Yaroslav Gelfand, Saikiran G. Murthy & Reza Yassari

  3. Department of Orthopedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA

    Mitchell S. Fourman & Ananth Eleswarapu

  4. Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA

    John H. Shin

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  1. Rafael De la Garza Ramos
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  2. Jessica Ryvlin
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  6. Yaroslav Gelfand
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  9. Reza Yassari
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Contributions

All authors contributed to the study conception and design, material preparation, data collection, and analysis. The first draft of the manuscript was written by RDLGR, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Rafael De la Garza Ramos.

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Conflict of interest

The authors have no financial or non-financial interests to disclose.

Ethical approval

Ethical approval was waived by the local Ethics Committee of Albert Einstein College of Medicine in view of the retrospective nature of the study and all the procedures being performed were part of the routine care.

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De la Garza Ramos, R., Ryvlin, J., Hamad, M.K. et al. The prognostic nutritional index (PNI) is independently associated with 90-day and 12-month mortality after metastatic spinal tumor surgery. Eur Spine J 32, 4328–4334 (2023). https://doi.org/10.1007/s00586-023-07930-y

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  • DOI: https://doi.org/10.1007/s00586-023-07930-y

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