{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,28]],"date-time":"2026-10-28T18:54:34Z","timestamp":1793213674141,"version":"4.5.0"},"reference-count":50,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T00:00:00Z","timestamp":1768348800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Immunol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>The prognostic nutritional index (PNI), reflecting nutritional and immune-inflammatory status, has been linked to outcomes across a range of disorders. Its prognostic value in acute pancreatitis (AP) and the potential mediating role of systemic inflammatory response syndrome (SIRS) remain unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To investigate whether systemic inflammatory response syndrome (SIRS) mediates the linkage between the prognostic nutritional index (PNI) and risk of death from any cause during hospitalization, as well as short- and long-term outcomes, in patients with acute pancreatitis (AP).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was an international retrospective cohort study utilizing the U.S. MIMIC-IV dataset (v2.2) and a hospital-based dataset in China, encompassing 2,574 patients diagnosed with AP (MIMIC cohort: 941; Chinese cohort: 1,633). Analyses included multivariable Cox regression, receiver operating characteristic (ROC) curves, Kaplan\u2013Meier survival curves, restricted cubic spline (RCS) modeling, subgroup analysis, and mediation analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>After adjustment for age, sex, comorbidities, and BISAP scores, PNI remained to serve as a standalone protective factor among AP patients (all HR &amp;lt; 1, P &amp;lt; 0.05). PNI exhibited strong predictive performance, particularly for long-term mortality. The low PNI exhibited markedly greater mortality compared with those with high PNI at all time points (log-rank P &amp;lt; 0.01). PNI demonstrated a significant nonlinear negative correlation with mortality, with more pronounced protective effects in certain subgroups. SIRS partially mediated the PNI\u2013mortality association.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PNI is an independent determinant of mortality in AP, offering complementary prognostic value to BISAP. SIRS partially mediates this association but is not the primary pathway.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fimmu.2025.1693888","type":"journal-article","created":{"date-parts":[[2026,1,14]],"date-time":"2026-01-14T05:15:38Z","timestamp":1768367738000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":2,"title":["Inflammation mediates the association between the Prognosis Nutrition Index (PNI) and mortality in acute pancreatitis: evidence from international cohorts"],"prefix":"10.3389","volume":"16","author":[{"given":"Lingwei","family":"Huang","sequence":"first","affiliation":[{"name":"Department of Geriatrics, The Affiliated Yongchuan Hospital of Chongqing Medical University","place":["Yongchuan, Chongqing, China"]},{"name":"Chongqing Municipality Clinical Research Center for Geriatric Diseases, Yongchuan Hospital, Chongqing Medical University","place":["Yongchuan, Chongqing, 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