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Abstract

Objective: Neonatal sepsis is a critical condition with considerable mortality and morbidity. The prognostic nutritional index (PNI), calculated from serum albumin level and lymphocyte count, is a marker for assessing nutritional and inflammatory states. This study evaluates the clinical value of PNIs in predicting late-onset sepsis and mortality in late-preterm neonates. Methods: This retrospective single-center study included 210 neonates with suspected sepsis. Clinical and laboratory data were collected, and PNI was calculated using the formula: serum albumin (g/L) + 5 × total lymphocyte count (10^9/L). Of the total cohort, 130 neonates with confirmed sepsis were assigned to the sepsis group, while 80 neonates with signs of infection but no sepsis made up the control group. Multivariable logistic regression and receiver operating characteristic curve analyses were performed to determine the predictive value of PNI for neonatal sepsis and mortality. Results: The PNI value was significantly lower in the sepsis group compared with the control group. The mortality rate in the sepsis group was 25.4%, with non-survivors having significantly lower PNI values than survivors (40.26±10.35 [standard deviation, SD] vs 49.62±9.53 SD). Multivariate logistic regression analysis identified a negative independent relationship between PNI and both sepsis diagnosis and mortality. PNI was an independent risk factor for sepsis (odds ratio [OR]=6.03, 95% CI=3–12.11, p<0.001). A PNI cutoff value of 40.9 predicted sepsis-related mortality with 66.67% sensitivity, 78.3% specificity, 51.2% positive predictive value, and 87.4% negative predictive value (area under the curve=0.76, p<0.001). Each unit increase in PNI was associated with a 2.83-fold increase in survival rate (OR=2.83, 95% CI=1.37–5.86, p<0.005). Conclusion: Our study shows that PNI is a significant independent marker for predicting neonatal sepsis and associated mortality in late preterm neonates. PNI can be used as a serum biomarker for early-stage neonatal sepsis, aiding in timely intervention and potentially improving clinical outcomes.

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