Prognostic value of preoperative prognostic nutritional index and its association with systemic inflammatory response markers in chronic rhinosinusitis.

OBJECTIVE: To determine whether preoperative prognostic nutritional index (PNI) is associated with postoperative recurrence in chronic rhinosinusitis (CRS) and correlates with systemic inflammation markers. METHODS: This retrospective study analyzed 1,585 CRS patients who underwent surgery between January 2018 and June 2021, with 3-year follow-up. Based on ROC-derived PNI cutoff, PNI was categorized into high and low groups. The associations between PNI and systemic inflammatory index (SII), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-lymphocyte ratio (PLR) were assessed using Pearson correlation analysis. Kaplan-Meier survival curves and logistic regression were used to evaluate the relationship between PNI and CRS recurrence. RESULTS: 1,057 CRS patients were included, of whom 623 had high PNI. During the three-year follow-up, 366 (34.6%) patients experienced recurrence, with higher rates in low-PNI group, and PNI levels were negatively correlated with SII, PLR, and NLR (P < 0.05). Recurrent patients showed lower PNI levels and higher rates of smoking, longer disease duration, comorbid allergic rhinitis, and nasal polyps (P < 0.05). Logistic regression indicated that low PNI, smoking, longer disease duration, and comorbid allergic rhinitis and nasal polyps were independent risk factors for CRS recurrence. Kaplan-Meier analysis demonstrated higher recurrence in the low PNI group (P < 0.05). Further analysis in unadjusted and adjusted models confirmed low PNI as an independent predictor of CRS recurrence (P < 0.05). CONCLUSION: Preoperative PNI is associated with CRS recurrence and reflects systemic inflammatory burden, serving as a clinically actionable biomarker for surgical risk stratification. These findings support incorporating nutritional-inflammatory profiling into preoperative assessment protocols.