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.