Systemic Immune-Inflammation Index and Prognostic Nutritional Index as Predictors of Renal Survival in Crescentic Glomerulonephritis

Hatice Şahin,1 Fatma Ayerden Ebinç,1 Gülay Ulusal Okyay,1 Ebru Gök Oğuz,1 Ebru Şebnem Ayva,2 Arzu Sağlam Ayhan,3 Mehmet Deniz Aylı1 1Division of Nephrology, Department of Internal Medicine, Etlik City Hospital, Ankara, Turkey; 2Department of Pathology, Etlik City Hospital, Ankara, Turkey; 3Department of Pathology, Hacettepe University Faculty of Medicine, Ankara, TurkeyCorrespondence: Hatice Şahin, Division of Nephrology, Department of Internal Medicine, Etlik City Hospital, Ankara, Turkey, Tel +905322502180, Email [email protected]: Crescentic glomerulonephritis (GN) is a rapidly progressive kidney disease associated with a high risk of end-stage renal disease (ESRD). This study aimed to assess whether systemic inflammation and nutritional status, as measured by the systemic immune-inflammation index (SII) and prognostic nutritional index (PNI) at diagnosis, can predict one-year renal survival in patients with crescentic GN.Methods: This retrospective study included 82 adult patients with biopsy-proven Type 1 or Type 3 crescentic GN. Baseline SII and PNI were calculated from pre-treatment blood samples. Clinical, laboratory, and histopathological data were collected. Patients were followed for 12 months and classified into two groups based on the development of ESRD.Results: The cohort (63.4% male) had a mean age of 53.65 ± 15.87 years; 26 patients (31.7%) progressed to ESRD. Multivariate analysis identified elevated SII [OR: 1.79; 95% CI: 1.22– 18.81; p = 0.03], low PNI [OR: 0.92, 95% CI: 0.96– 0.99; p = 0.03], hypoalbuminemia [OR: 0.36, 95% CI: 0.15– 0.84; p = 0.02], reduced estimated glomerular filtration rate [OR: 0.93, 95% CI: 0.88– 0.98; p = 0.009], anemia [OR: 0.37; 95% CI: 0.22– 0.63; p < 0.001], higher crescent ratio [OR: 1.05, 95% CI: 1.02– 1.09; p = 0.02], and plasmapheresis requirement [OR: 0.074, 95% CI: 0.016– 0.349; p = 0.001] as independent predictors of ESRD. Receiver operating characteristic analysis determined cutoff values of 176.38 for SII (area under the curve [AUC]: 0.679, p = 0.01) and 31.88 for PNI (AUC: 0.650, p = 0.03). Glomerulosclerosis ratio and interstitial fibrosis/tubular atrophy were not independently associated with ESRD (p = 0.13 and p = 0.14, respectively).Conclusion: SII and PNI are independent but moderate predictors of one-year renal survival in crescentic GN. Incorporating these readily available biomarkers with histological evaluation may enhance risk stratification and help guide early, aggressive immunosuppressive therapy.Keywords: crescentic glomerulonephritis, systemic immune-inflammation index, prognostic nutritional index, end-stage renal disease