Skip to main content

New prognosis inflammatory and nutritional indexes: comparison with the Prognostic Inflammatory and Nutritional Index as reference index


The Prognostic Inflammatory and Nutritional Index (PINI) was previously developed to improve the diagnosis and monitoring of patients with inflammation and/or malnutrition in terms of morbidity and mortality risk, especially in ICU patients [1]. The formula includes the determination of four serum protein concentrations: PINI = (C-reactive protein (CRP) (mg/l) × orosomucoid (OROSO) (g/l))/(albumin (ALB) (g/l) × transthyretin (TTR) (g/l)). Since CRP may be considered now as the gold standard for assessing and monitoring inflammatory states in clinical practice, OROSO is generally unavailable for PINI calculation. Elsewhere, the strong and rapid changes in CRP levels (0 to 600 mg/l) in acute inflammation may lead to an overestimation of the risk of morbidity and mortality suggested by the PINI. The aim of this study was to evaluate alternative biological formulas by removing OROSO from the PINI and replacing CRP value by its logarithm (Log), in order to reduce the mathematical weighting of this biomarker.


Blood samples of 106 patients hospitalized in intensive care, gastrointestinal surgery, vascular and thoracic surgery, pneumology, gastroenterology or internal medicine units were drawn to measure serum concentrations of ALB, TTR, CRP and OROSO. Proteins were determined using an immunonephelometry method (BN2; Siemens, Germany). The correlations between six new formulas and the PINI were studied - that is, CRP/ALB × TTR, Log(CRP)/ALB × TTR, CRP/TTR, Log(CRP)/TTR, CRP/ALB and Log(CRP)/ALB - using the Spearman rank test.


The relations obtained between the PINI and the experimental formulas were linear (y = ax + b) with formulas without Log and nonlinear when a Log was used (y = ax2 + bx + c or y = log(x) + b). All six formulas were correlated with the PINI (0.78 <R < 0.94, P < 0.0001). CRP/ALB × TTR, Log(CRP)/ALB and CRP/TTR showed the highest correlations, with R = 0.94, 0.91 and 0.90, respectively. The less elevated correlation was observed using CRP/ALB (R = 0.78).


Among the six new formulas compared with the PINI, that omitting only OROSO provided the best performance. The control of CRP weighting obtained with Log(CRP) in the formula Log(CRP)/ALB appears promising in current clinical practice, since it involves the most often used serum proteins to assess inflammatory and nutritional status.


  1. 1.

    Ingenbleek Y, et al.: Int J Vitam Nutr Res. 1985, 55: 91-101.

    CAS  PubMed  Google Scholar 

Download references

Author information



Corresponding author

Correspondence to F Ziegler.

Rights and permissions

This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

Ziegler, F., Codevelle, L., Houivet, E. et al. New prognosis inflammatory and nutritional indexes: comparison with the Prognostic Inflammatory and Nutritional Index as reference index. Crit Care 15, P498 (2011).

Download citation


  • Serum Protein
  • Spearman Rank
  • Acute Inflammation
  • Current Clinical Practice
  • Transthyretin