A novel role of prognostic nutritional index in predicting the effectiveness of infliximab in Crohn's disease

Objective To investigate the predictive value of the prognostic nutritional index (PNI) for the effectiveness of infliximab (IFX) in patients with Crohn's disease (CD). Methods All data were retrospectively collected from Xiangya Hospital, Central South University between January 2016 and September 2021. Clinical remission at 52 weeks is the primary endpoint. Results Altogether, 193 CD patients were enrolled. PNI can identify clinical remission (p = 0.004), and the optimal cut-off value of the PNI was 39.2. 92/116 (79.3%) and 44/77 (57.1%) in the high- and low-PNI groups were in clinical remission at week 52 (p = 0.001). Patients with low PNI have poor general health at baseline. The body mass index, hemoglobin, platelet (PLT), serum creatinine, fibrinogen, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), Crohn's disease activity index (CDAI), and location of disease significantly differed between the two groups (p < 0.05). PNI was negatively correlated with CRP, ESR, PLT and CDAI (p < 0.05). The lower PNI, smoking history, and higher CDAI at baseline were the independent risk factors of disease activity at 52 weeks (p < 0.05). The high-PNI group is less likely to develop poor outcomes (p = 0.033). Conclusion The PNI may serve as a novel and promising biomarker in predicting the effectiveness of IFX and contribute to targeted management in CD. KEY MESSAGES The prognostic nutritional index could be a prognostic indicator in identifying the effectiveness of infliximab in CD patients. The lower PNI is an independent risk factor for the poor effectiveness of infliximab in CD patients. More attention should be given to assessing the immune and nutritional statuses in CD patients.