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Tsunou et al. | Journal of Clinical and Translational Research 2024; 10(1): 85-92 89
males and included AED usage as a factor for our study. When the paid to adverse events occurring during the 12 months following
osteoporosis group was classified according to BMD measurements NTFx. Based on these results, the PNI appears to be a surrogate
using a T-score of 2.5 SD or less as the criterion for osteoporosis, for identifying the coexistence of osteoporosis in adult male
14 patients (47%) in the osteoporosis group had significantly patients with NI. Taken together, PNI is an indicator of adverse
lower PNI values than those without osteoporosis. Therefore, a events such as aspiration, pneumonia, fractures, NTFx, and death.
male patient with NI can be diagnosed with osteoporosis using the
PNI. A previous study showed that NTFx was associated with an 4.3. PNI cutoff values analyzed from the latest 1000 PNI-related
increased risk of 12-month mortality in adults with CP compared articles
to those without CP, and NTFx is considered a major contributor We reviewed 1000 articles on PNI studies published recently,
to functional disability [13]. Therefore, special attention should be except meta-analyses or reviews, to determine the cutoff value for
PNI in patients with NI. Among these papers, 201 indicated clear
cutoff values for both patients with cancer (125 papers) and patients
with other ailments (76 papers) (Figure 3). This reflects that the first
report of the PNI involved a study of patients with colorectal cancer.
The latest PNI-related research, published in 2023, also used
systematic reviews and meta-analyses to show that PNI is a helpful
indicator for predicting outcomes in patients with cancer [16,17].
However, among patients with other ailments, there have been no
studies on the PNI in patients with osteoporosis undergoing NI.
To the best of our knowledge, this is the first report of PNI in
a patient with NI and osteoporosis. From the comparison results
of the two box plots showing the PNI cutoff values for patients
with cancer and less frequently reported non-cancer diseases,
at least two factors were found. First, the PNI of patients with
cancer was closely scattered around 46 compared to those without
cancer, and second, the PNI cutoff for patients without cancer was
Figure 2. ROC curve analysis for determining cutoff value of PNI. significantly lower than that for patients with cancer. Furthermore,
Based on this curve, the cutoff value of PNI in adult NI patients to detect
the association of osteoporosis was below the cutoff value of 50 of PNI. in nearly 3000 PNI-related articles in addition to the 1000 papers,
The sensitivity and specificity were 0.500 and 0.857, respectively, and we analyzed, no study has examined NI and PNI in patients with
the area under the curve AUC was 0.714 (P = 0.046). osteoporosis. Therefore, we used PNI to assess patients with NI
Abbreviations: AUC: Area under curve; NI: Neurological impairment; who also had osteoporosis. This study provides valuable results
PNI: Prognostic nutritional index; ROC: Receiver operating that can be used as indicators for osteoporosis risk assessment.
characteristic. Moreover, when 75 PNI articles in the non-cancer disease group

Figure 3. Comparison of the cutoff value of PNI in patients with and without cancer. Left: PNI cutoff value in patients with cancer was 46 ± 4 (sample
size = 125). Right: PNI cutoff value in patients without cancer was 41 ± 5 (sample size = 76). The PNI cutoff for non-cancer patients was significantly
lower than that for cancer patients. Furthermore, comparing this result with the PNI cutoff value of 50.0 in NI patients with osteoporosis in this study,
PNI is a comprehensive index of nutritional status and immune competence. In addition, among the latest 1000 PNI articles, specifically, there were
201 arcs with cutoff values for PNI, of which 125 were PNI from patients with different types of cancer. This may reflect the fact that the first report
of PNI was a study of patients with colorectal cancer. On the other hand, among non-cancer patients, there were no studies of PNI in patients with
osteoporosis and NI, and this study appears to be the first report on PNI in patients with NI and osteoporosis.
Abbreviations: NI: Neurological impairment; PNI: Prognostic nutritional index.

DOI: https://doi.org/10.36922/jctr.00110