Which Nutritional Scoring System Best Predicts Transplant Outcomes in Allogeneic Stem Cell Recipients? A Comparison of Nutritional Risk Index, Prognostic Nutritional Index, and Controlling Nutritional Status

Abstract

Objectives: Nutritional status significantly impacts outcomes in allogeneic hematopoietic stem cell transplantation (allo-HSCT). Among various indices, the Nutritional Risk Index (NRI), Prognostic Nutritional Index (PNI), and Controlling Nutritional Status (CO- NUT) scores hold potential as prognostic tools. This study compares their predictive utility for transplant outcomes. Methods: A retrospective analysis was conducted on 41 patients who underwent their first allo-HSCT between October 2022 and July 2024. Nutritional scores were calculated using pre-transplant data, and their associations with mortality and non-relapse mor- tality (NRM) were assessed. Receiver operating characteristic (ROC) curves and multivariable logistic regression were employed to evaluate predictive accuracy. Results: The high CONUT score demonstrated the highest prognostic accuracy for mortality (AUC: 0.771, p=0.026) and NRM (AUC: 0.806, p=0.047). It was the sole independent predictor of mortality (OR: 2.180, p=0.028). Both the NRI (AUC: 0.737, p=0.040) and PNI (AUC: 0.803, p=0.008) were also associated with mortality but lacked independent predictive value. Higher CONUT scores cor- related with increased mortality rates. Conclusion: The CONUT score emerged as the most effective nutritional scoring system for predicting mortality in allo-HSCT patients. Its simplicity and integration of key clinical parameters make it a valuable tool for early risk stratification and targeted interventions. Further studies with larger cohorts are warranted to validate these findings and refine nutritional management strategies.