Prognostic Value of Inflammation and Nutrition-Based Scores in Low-Risk Myelodysplastic Syndrome: A Retrospective Cohort Study

<b>Background/Objectives:</b> The pathogenesis of Myelodysplastic Syndrome (MDS) is diverse; however, increasing evidence suggests that inflammation and oxidative stress play a significant role in the development and progression of the disease. This study aimed to evaluate the prognostic impact of inflammation, nutritional status, and oxidative stress at diagnosis in patients with low-risk MDS. <b>Methods:</b> A retrospective analysis was conducted on 175 newly diagnosed low-risk MDS patients. <b>Results:</b> A low Prognostic Nutritional Index (PNI) and a high systemic oxidative stress (SOS) score were independently associated with poorer prognosis (PNI: HR 1.598, 95% CI 1.076-2.372, <i>p</i> = 0.02; SOS: HR 1.003, 95% CI 1.001-1.006, <i>p</i> = 0.002). The optimal PNI cut-off value for predicting mortality was identified as 47.47. Based on this cut-off, 92 patients had a low PNI score, while 83 patients had a high PNI score. The comparison between these groups revealed a statistically significant difference in median overall survival (OS), with 45.5 months for the low-PNI group and 75.1 months for the high-PNI group (<i>p</i> < 0.001). However, PNI was not significantly associated with progression to acute myeloid leukemia (AML) (<i>p</i> = 0.668). In the multivariate OS analysis, several factors were identified as independent predictors of prognosis, including a high Revised International Prognostic Scoring System (R-IPSS) score, low PNI, high SOS score, advanced age, male gender, and transformation to AML. <b>Conclusions:</b> Together, PNI and SOS may serve as simple, accessible tools to improve risk stratification in low-risk MDS patients.