ORIGINAL RESEARCH article
Front. Nutr.
Sec. Nutritional Immunology
Association between Prognostic Nutritional Index and prognosis in acute graft-versus-host disease following allogeneic hematopoietic stem cell transplantation: a retrospective cohort study
Provisionally accepted
- Henan Cancer Hospital Affiliated Cancer Hospital of Zhengzhou University, Zhengzhou, China
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Background: Evidence on the association between prognostic nutritional index (PNI) and prognosis in acute graft-versus-host disease (aGVHD) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) is limited. Objective: This study aims to investigate the relationship between PNI levels and prognosis in patients experiencing aGVHD following allo-HSCT. Methods: We conducted a retrospective cohort study of patients who underwent allo-HSCT at Henan Cancer Hospital from January 2019 to December 2024. Eligible patients were those diagnosed with aGVHD following allo-HSCT. Data on PNI levels, clinical outcomes, and demographics were extracted from medical records. The primary outcomes were overall survival (OS) and event-free survival (EFS). Multivariable Cox regression and subgroup analyses were performed to assess the relationship between PNI levels and prognosis, adjusting for confounders. Results: This study included 109 eligible patients with a mean age of 29.4 ± 15.3 years. Over a 30-month follow-up, there were 69 deaths, 3 relapses/progressions, and 37 survivors. Among the participants, 51 had Grade I-II aGVHD, and 58 had Grade III-IV aGVHD. After adjusting for confounders, the adjusted hazard ratios (HR) for PNI and OS in T2(35.8-42.5) and T3(42.5-59.7) were 0.52(95% CI: 0.23-0.86, p=0.049) and 0.43 (95% CI: 0.18-0.73, p=0.013), respectively, compared to individuals with lower T1(20.2-35.8). For EFS, the adjusted HR values for PNI in T2(35.8-42.5) and T3 (42.5-59.7) were 0.32 (95% CI: 0.17-0.59, p=0.026) and 0.31 (95% CI: 0.16-0.56, p=0.021), respectively, when compared to those with lower T1(20.2-35.8). These results suggest a potential association between lower PNI levels and poorer prognosis. Kaplan-Meier analysis demonstrated poorer OS (p=0.047) and EFS (p=0.078) in the lower PNI group. Subgroup and interaction analyses revealed no significant interactions by age, sex, CD34+ count and ABO match (all p>0.05), confirming the stability of the association. Sensitivity analyses further supported this consistent association. Conclusion: Our study underscores the association between lower PNI levels and poorer prognosis in aGVHD patients following allo-HSCT, emphasizing the need for further research to validate PNI as a reliable prognostic biomarker.
Keywords: Prognostic nutritional index, Acute graft-versus-host disease, allogeneic hematopoietic stem cell transplantation, prognosis, Association
Received: 08 Jul 2025; Accepted: 18 Nov 2025.
Copyright: © 2025 Li, Zhang, Wang, Yuan, Li and Fu. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Yuewen Fu, zlyyfuyuewen1480@zzu.edu.cn
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