Abstract
This study examines the value of the Prognostic Inflammatory and Nutritional Index (PINI), first proposed by Ingenbleek and Carpentier in 1985,1 as a clinical assessment tool in critically ill traumatized patients. The PINI combines measurements of serum C-reactive protein (CRP), α1-acid glycoprotein (AAG), prealbumin (PA), and albumin (ALB) concentrations to produce a single score. The hypothesis is that this assessment system will be more complete because it takes into account changes in inflammatory response markers and, therefore, may be superior to other predictive indices.
This study included 15 critically ill trauma patients receiving enteral nutrition support. Patients were placed on a nutritionally complete formula providing 1.4 g of protein/kg per day and 32 kcal/kg per day 8 ± 3 days after injury and were maintained on this diet for 19 ± 8 days. The PINI decreased significantly (p < .05) from 186 ± 202 at baseline to 116 ± 86 on day 4 and 27 ± 40 on day 14. Nitrogen balance increased significantly during the same time period. Serum CRP concentration decreased significantly, whereas serum PA and ALB concentrations increased significantly and AAG concentration did not change. A statistically significant positive correlation was noted between the PINI and CRP concentration (r = .72, P = .0001) and a statistically significant negative correlation was noted between PINI and PA (r = 51, p = .0018).
This study demonstrates that the decline in PINI noted in this group of enterally fed patients is largely due to the decline in the serum CRP concentration. It is speculated that the large impact of the serum CRP concentration on the PINI, demonstrated here and in a previous study,2 could allow use of serum CRP measurements alone as a prognostic indicator in this group of critically ill patients.
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