{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T05:18:46Z","timestamp":1787635126172,"version":"build-2736575974"},"reference-count":33,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:00:00Z","timestamp":1787616000000},"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. Nutr."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Chronic obstructive pulmonary disease (COPD) is marked by chronic airway inflammation and obstructive ventilation dysfunction. The prognostic nutritional index (PNI), an indicator for evaluating nutritional and immune status with confirmed prognostic value in most diseases, has an unclear association with short-term acute re-exacerbation of COPD. This study thus investigated the correlation between PNI levels and 90-day acute re-exacerbation in COPD patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cohort analysis was conducted on AECOPD patients, who were grouped by PNI tertiles. The primary outcome was 90-day readmission for acute re-exacerbation. Cox proportional hazards regression, Kaplan\u2013Meier survival curves (Log-rank test), restricted cubic spline plots and subgroup analysis were applied for statistical assessment and conclusion verification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      A total of 112 patients had acute re-exacerbation. Fully adjusted multivariate Cox regression identified PNI as a protective factor (HR\u202f=\u202f0.914, 95% CI: 0.877\u202f~\u202f0.952,\n                      <jats:italic>p<\/jats:italic>\n                      &amp;lt;\u202f0.001). Restricted cubic spline analysis confirmed a linear dose\u2013response between PNI and 90-day readmission risk (overall\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.0002, non-linear\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.737), with an inflection point at PNI\u202f=\u202f43.05. The cumulative incidence of readmission showed a significant difference across PNI tertile groups (Log-rank\n                      <jats:italic>p<\/jats:italic>\n                      =\u202f0.003). Subgroup analysis revealed consistent protective trends across all subgroups, with no significant interaction effects detected (all interaction\n                      <jats:italic>p<\/jats:italic>\n                      &amp;gt;\u202f0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>PNI is an independent protective factor for short-term readmission in AECOPD patients, with a significant linear dose\u2013response relationship and a clinical threshold of PNI\u202f=\u202f43.05.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fnut.2026.1835781","type":"journal-article","created":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T04:23:42Z","timestamp":1787631822000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Association between prognostic nutritional index and 90-day readmission in patients with acute exacerbation of chronic obstructive pulmonary disease: a multicenter study"],"prefix":"10.3389","volume":"13","author":[{"given":"Yong","family":"Jiang","sequence":"first","affiliation":[{"name":"Department of Respiratory, Bishan Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hongmei","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Respiratory, Bishan Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bicui","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Respiratory, Bishan Hospital of Chongqing Medical University","place":["Chongqing, China"]},{"name":"Department of Respiratory and Critical Care Medicine, Bishan Hospital of Chongqing Medical University","place":["Chongqing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"2300239","DOI":"10.1183\/13993003.00239-2023","article-title":"Global initiative for chronic obstructive lung disease 2023 report: GOLD executive summary","volume":"61","author":"Agust\u00ed","year":"2023","journal-title":"Eur Respir J"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"287","DOI":"10.1186\/1471-2458-12-287","article-title":"Vulnerability, beliefs, treatments and economic burden of chronic obstructive pulmonary disease in rural areas in China: a cross-sectional study","volume":"12","author":"Lou","year":"2012","journal-title":"BMC Public Health"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"847","DOI":"10.1136\/thorax.57.10.847","article-title":"Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease","volume":"57","author":"Donaldson","year":"2002","journal-title":"Thorax"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1418","DOI":"10.1164\/ajrccm.157.5.9709032","article-title":"Effect of exacerbation on quality of life in patients with chronic obstructive pulmonary disease","volume":"157","author":"Seemungal","year":"1998","journal-title":"Am J Respir Crit Care Med"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"e0150737","DOI":"10.1371\/journal.pone.0150737","article-title":"Readmission for acute exacerbation within 30 days of discharge is associated with a subsequent progressive increase in mortality risk in COPD patients: a long-term observational study","volume":"11","author":"Guerrero","year":"2016","journal-title":"PLoS One"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.1183\/09031936.00128008","article-title":"Systemic manifestations and comorbidities of 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mediators","volume":"87","author":"Ayala","year":"1996","journal-title":"Blood"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1007\/BF02554182","article-title":"The reappraisal of prognostic classifications for colorectal cancer","volume":"32","author":"Onodera","year":"1989","journal-title":"Dis Colon Rectum"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"111123","DOI":"10.1016\/j.nut.2020.111123","article-title":"Predictive value of the prognostic nutritional index for the severity of coronavirus disease 2019","volume":"84","author":"Hu","year":"2021","journal-title":"Nutrition"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"7105","DOI":"10.2147\/JIR.S521440","article-title":"Combined systemic immune-inflammation index-prognostic nutritional index score in evaluating the prognosis of patients with severe community-acquired pneumonia","volume":"18","author":"Chen","year":"2025","journal-title":"J Inflamm 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