Impact of the prognostic nutritional index on the recompensation of patients with decompensated primary biliary cholangitis

Abstract

Background: Nutrition and immunity are associated with the progression of primary biliary cholangitis (PBC); however, the connection between these factors and the prognosis of patients with decompensated PBC remains unclear.

Methods: This study adopted a retrospective cohort design, enrolling patients with decompensated PBC who received standard-dose ursodeoxycholic acid treatment. The prognostic nutritional index (PNI) was calculated based on lymphocyte count and albumin levels at admission. The Cox proportional hazards model was used to analyze the impact of PNI on the recompensation of patients with decompensated liver cirrhosis.

Results: A total of 413 patients with decompensated PBC were included, with a mean age of 60.34 ± 11.57 years, of whom 343 (83.1%) were female. During the follow-up period, 119 patients (28.8%) achieved recompensation. The median baseline PNI was higher in the recompensation group [44.5, interquartile range (IQR): 39.5-49.3] than in the non-recompensation group (33.9, IQR: 29.8-38.2). In the fully adjusted model, a higher baseline PNI score was associated with an increased probability of recompensation [hazard ratio (HR): 1.11, 95% CI: 1.08-1.15]. Subgroup analysis showed that baseline PNI was significantly associated with recompensation in patients with ascites (HR: 1.15, 95% CI: 1.11-1.20), without ascites (HR: 1.06, 95% CI: 1.01-1.12), with bleeding (HR: 1.10, 95% CI: 1.03-1.17), and without bleeding (HR: 1.13, 95% CI: 1.08-1.17). Trend analysis showed that PNI, as a continuous variable, was significantly positively correlated with the likelihood of recompensation (HR: 1.11, 95% CI: 1.08-1.15). Sensitivity analysis confirmed that after excluding patients with comorbidities, the association between PNI and recompensation remained stable (HR: 1.11, 95% CI: 1.07-1.15).

Conclusions: PNI is an independent protective factor for recompensation in patients with decompensated PBC.

Keywords: association; decompensated liver cirrhosis; primary biliary cholangitis; prognostic nutritional index; recompensation.