{ "abstract": "Background/Objectives: Impaired immunonutritional status is common among hospitalized older adults and may contribute to adverse outcomes through alterations in gut–brain axis pathways involving immune, microbial, and inflammatory mechanisms. The Prognostic Nutritional Index (PNI), a composite marker based on serum albumin and lymphocyte count, may identify patients with altered immunonutritional status and increased clinical vulnerability. This cross-sectional study investigated whether PNI-defined immunonutritional impairment is associated with bacterial and viral DNAemia, inflammation, and neurocognitive conditions in 1016 geriatric patients from the Report-AGE cohort. Methods: Participants were stratified according to PNI into low- and high-PNI groups. Blood bacterial DNA (BB-DNA), Torque teno virus (TTV), herpes simplex virus (HSV-1), varicella-zoster virus (VZV), leukocyte telomere length (LTL), inflammatory and neurodegeneration-related biomarkers were evaluated. Multivariable logistic regression models were used to assess the associations of BB-DNA and PNI with cognitive impairment and interRAI-derived neurocognitive conditions. Results: Low-PNI patients exhibited a higher burden of comorbidities, frailty, and systemic inflammation, alongside increased concentrations of BB-DNA, IL-6, IL-17A, GDF15, osteopontin, FGF21, follistatin, and neurofilament light chain. Among patients with low-PNI, increasing BB-DNA tertiles were associated with progressively higher TTV, HSV-1, and VZV DNAemia, elevated NLR, IL-6, and IL-17A levels, and shorter LTL. In multivariable analyses, low-PNI was independently associated with cognitive impairment (OR: 1.39, 95% CI: 1.06–1.83), easily distracted behavior (OR: 1.75, 95% CI: 1.29–2.35), and behavioral disturbances (OR: 1.80, 95% CI: 1.05–3.06), whereas BB-DNA showed an association with acute changes in mental status (OR: 1.75, 95% CI: 1.09–2.81) and behavioral disturbances (OR: 3.09, 95% CI: 1.11–8.59). Conclusions: These findings suggest that impaired immunonutritional status, bacterial and viral burden, systemic inflammation, and neurocognitive alterations may represent interconnected features of clinical vulnerability, although the cross-sectional design does not establish temporal or causal relationships among these factors.", "abstract_shown": true, "affiliations": [ "Center of Biogerontology, IRCCS INRCA, 60121 Ancona, Italy", "Department of Biology, Ecology and Earth Sciences, University of Calabria, 87036 Rende, Italy", "Department for the Promotion of Human Sciences and Quality of Life, San Raffaele University, 00166 Rome, Italy", "Laboratory of Microbiology, IRCCS San Raffaele Roma, 00166 Rome, Italy", "Department of Medicine and Technological Innovation, University of Insubria, 21100 Varese, Italy", "Laboratory of Microbiology, ASST SetteLaghi, 21100 Varese, Italy", "Laboratory of Virology and Laboratories of Biosafety, National Institute for Infectious Diseases, Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy", "Department of Clinical and Molecular Sciences (DISCLIMO), Università Politecnica delle Marche, 60126 Ancona, Italy", "Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60121 Ancona, Italy", "Geriatrics and Clinical Epidemiology, IRCCS INRCA, 87100 Cosenza, Italy", "Geriatria, Accettazione Geriatrica e Centro di Ricerca per l’Invecchiamento, IRCCS INRCA, 60121 Ancona, Italy", "Neurology Unit, IRCCS INRCA, 60124 Ancona, Italy", "Scientific Direction, IRCCS INRCA, 60127 Ancona, Italy" ], "article_type": "research article", "arxiv": null, "author_total": 31, "authors": [ { "affs": [ 0 ], "name": "Gretta Veronica Badillo Pazmay", "orcid": "0000-0002-8108-663X" }, { "affs": [ 1 ], "name": "Patrizia D’Aquila", "orcid": "0000-0001-5740-4733" }, { "affs": [ 0 ], "name": "Carlo Fortunato", "orcid": "0009-0006-9591-7920" }, { "affs": [ 0 ], "name": "Laura Cianfruglia", "orcid": "0000-0002-0322-0282" }, { "affs": [ 2, 3 ], "name": "Dolores Limongi" }, { "affs": [ 2, 3 ], "name": "Carla Prezioso", "orcid": "0000-0002-8377-0742" }, { "affs": [ 4, 5 ], "name": "Federica Novazzi", "orcid": "0000-0002-2741-8840" }, { "affs": [ 6 ], "name": "Pietro Giorgio Spezia", "orcid": "0000-0002-6743-014X" }, { "affs": [ 0 ], "name": "Marta Balietti" }, { "affs": [ 0, 7 ], "name": "Marco Malavolta", "orcid": "0000-0002-8442-1763" }, { "affs": [ 0 ], "name": "Francesco Piacenza", "orcid": "0000-0001-7440-804X" }, { "affs": [ 0 ], "name": "Maurizio Cardelli", "orcid": "0000-0002-4480-2473" }, { "affs": [ 0 ], "name": "Tiziana Casoli" }, { "affs": [ 0 ], "name": "Rosanna Maniscalco" }, { "affs": [ 8 ], "name": "Francesca Marchegiani", "orcid": "0000-0003-4899-6073" }, { "affs": [ 8 ], "name": "Rina Recchioni", "orcid": "0000-0002-7596-3077" }, { "affs": [ 8 ], "name": "Giulia Matacchione", "orcid": "0000-0002-1840-3903" }, { "affs": [ 8 ], "name": "Chiara Giordani", "orcid": "0000-0003-1733-654X" }, { "affs": [ 0 ], "name": "Matilde Sbriscia" }, { "affs": [ 0 ], "name": "Sonia Fantone", "orcid": "0000-0002-5630-5984" }, { "affs": [ 9 ], "name": "Mirko Di Rosa", "orcid": "0000-0002-1862-4159" }, { "affs": [ 7, 10 ], "name": "Antonio Cherubini" }, { "affs": [ 11 ], "name": "Leonardo Biscetti", "orcid": "0000-0002-2878-9432" }, { "affs": [ 11 ], "name": "Giuseppe Pelliccioni", "orcid": "0000-0002-0377-9713" }, { "affs": [ 12 ], "name": "Fabrizia Lattanzio", "orcid": "0000-0003-4051-1289" }, { "affs": [ 12 ], "name": "Anna Rita Bonfigli", "orcid": "0000-0002-9619-0181" }, { "affs": [ 1 ], "name": "Giuseppe Passarino", "orcid": "0000-0003-4701-9748" }, { "affs": [ 0, 7 ], "name": "Fabiola Olivieri", "orcid": "0000-0002-9606-1144" }, { "affs": [ 6 ], "name": "Fabrizio Maggi", "orcid": "0000-0001-7489-5271" }, { "affs": [ 1 ], "name": "Dina Bellizzi", "orcid": "0000-0001-9986-456X" }, { "affs": [ 0 ], "name": "Robertina Giacconi", "orcid": "0000-0002-1468-2140" } ], "bibtex": "https://research.draconitic.com/paper/btw069kkny2zf.bib", "cited_by": 0, "doi": "10.3390/nu18203387", "fulltext_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13708057/?tool=EBI", "id": "btw069kkny2zf", "issns": [ "2072-6643" ], "landing_url": "https://www.mdpi.com/2072-6643/18/20/3387", "language": "eng", "licence": "CC-BY-4.0", "licence_label": "CC BY 4.0", "licence_source": "article", "licence_url": "https://creativecommons.org/licenses/by/4.0/", "metadata_licence": null, "native_subjects": [ [ "openalex", "2737|Nutrition and Health in Aging" ] ], "openalex": "W7222154813", "pdf_url": "https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13708057/pdf/?tool=EBI", "pmcid": "PMC13708057", "pmid": null, "published": "2026-10-01", "publisher": "MDPI AG", "ris": "https://research.draconitic.com/paper/btw069kkny2zf.ris", "sources": [ { "first_seen": "2026-10-30T12:19:56Z", "native_id": "10.3390/nu18203387", "source": "crossref", "url": "https://www.mdpi.com/2072-6643/18/20/3387" }, { "first_seen": "2026-10-30T12:21:49Z", "native_id": "PMC:PMC13708057", "source": "europepmc", "url": "https://europepmc.org/article/PMC/PMC13708057" } ], "subjects": [ { "field": "medicine", "origin": "openalex:2737|Nutrition and Health in Aging", "subfield": "physiology" } ], "title": "Prognostic Nutritional Index, Circulating Bacterial and Viral DNA, and Neurocognitive Vulnerability in Geriatric Inpatients: A Cross-Sectional Study", "title_text": "Prognostic Nutritional Index, Circulating Bacterial and Viral DNA, and Neurocognitive Vulnerability in Geriatric Inpatients: A Cross-Sectional Study", "type": "peer-reviewed", "updated_at": "2026-10-30T12:21:49Z", "url": "https://research.draconitic.com/paper/btw069kkny2zf", "venue": "Nutrients", "versions": [] }