Prognostic Nutritional Index, Circulating Bacterial and Viral DNA, and Neurocognitive Vulnerability in Geriatric Inpatients: A Cross-Sectional Study
13 affiliations
- 1Center of Biogerontology, IRCCS INRCA, 60121 Ancona, Italy
- 2Department of Biology, Ecology and Earth Sciences, University of Calabria, 87036 Rende, Italy
- 3Department for the Promotion of Human Sciences and Quality of Life, San Raffaele University, 00166 Rome, Italy
- 4Laboratory of Microbiology, IRCCS San Raffaele Roma, 00166 Rome, Italy
- 5Department of Medicine and Technological Innovation, University of Insubria, 21100 Varese, Italy
- 6Laboratory of Microbiology, ASST SetteLaghi, 21100 Varese, Italy
- 7Laboratory of Virology and Laboratories of Biosafety, National Institute for Infectious Diseases, Lazzaro Spallanzani-IRCCS, 00149 Rome, Italy
- 8Department of Clinical and Molecular Sciences (DISCLIMO), Università Politecnica delle Marche, 60126 Ancona, Italy
- 9Clinic of Laboratory and Precision Medicine, IRCCS INRCA, 60121 Ancona, Italy
- 10Geriatrics and Clinical Epidemiology, IRCCS INRCA, 87100 Cosenza, Italy
- 11Geriatria, Accettazione Geriatrica e Centro di Ricerca per l’Invecchiamento, IRCCS INRCA, 60121 Ancona, Italy
- 12Neurology Unit, IRCCS INRCA, 60124 Ancona, Italy
- 13Scientific Direction, IRCCS INRCA, 60127 Ancona, Italy
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.
Related
- Circulating and cerebrospinal fluid soluble TREM2 levels and risk of perioperative neurocognitive disorders in surgical patients: a systematic review and meta-analysis
- CT-Derived L3 Skeletal Muscle Index, Handgrip Strength, and Nutritional Behavior as Complementary Dimensions of Frailty in Older Oncology Inpatients: A Cross-Sectional Observational Study
- Joint and interactive associations of nutritional risk and pulmonary infection with tracheostomy decannulation in neurorehabilitation inpatients: a retrospective cohort study.
- Circulating leucine-rich α-2 glycoprotein 1 and its prognostic significance in established heart failure
- Strategies of mechanical adaptations of circulating tumor cells and properties of their cellular microenvironment have predictive and prognostic biomarker value
BibTeX
@article{pazmay2026prognostic,
title = {{Prognostic Nutritional Index, Circulating Bacterial and Viral DNA, and Neurocognitive Vulnerability in Geriatric Inpatients: A Cross-Sectional Study}},
author = {Gretta Veronica Badillo Pazmay and Patrizia D’Aquila and Carlo Fortunato and Laura Cianfruglia and Dolores Limongi and Carla Prezioso and Federica Novazzi and Pietro Giorgio Spezia and Marta Balietti and Marco Malavolta and Francesco Piacenza and Maurizio Cardelli and Tiziana Casoli and Rosanna Maniscalco and Francesca Marchegiani and Rina Recchioni and Giulia Matacchione and Chiara Giordani and Matilde Sbriscia and Sonia Fantone and Mirko Di Rosa and Antonio Cherubini and Leonardo Biscetti and Giuseppe Pelliccioni and Fabrizia Lattanzio and Anna Rita Bonfigli and Giuseppe Passarino and Fabiola Olivieri and Fabrizio Maggi and Dina Bellizzi and Robertina Giacconi},
journal = {Nutrients},
year = {2026},
month = oct,
doi = {10.3390/nu18203387},
url = {https://www.mdpi.com/2072-6643/18/20/3387},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Prognostic Nutritional Index, Circulating Bacterial and Viral DNA, and Neurocognitive Vulnerability in Geriatric Inpatients: A Cross-Sectional Study
AU - Gretta Veronica Badillo Pazmay
AU - Patrizia D’Aquila
AU - Carlo Fortunato
AU - Laura Cianfruglia
AU - Dolores Limongi
AU - Carla Prezioso
AU - Federica Novazzi
AU - Pietro Giorgio Spezia
AU - Marta Balietti
AU - Marco Malavolta
AU - Francesco Piacenza
AU - Maurizio Cardelli
AU - Tiziana Casoli
AU - Rosanna Maniscalco
AU - Francesca Marchegiani
AU - Rina Recchioni
AU - Giulia Matacchione
AU - Chiara Giordani
AU - Matilde Sbriscia
AU - Sonia Fantone
AU - Mirko Di Rosa
AU - Antonio Cherubini
AU - Leonardo Biscetti
AU - Giuseppe Pelliccioni
AU - Fabrizia Lattanzio
AU - Anna Rita Bonfigli
AU - Giuseppe Passarino
AU - Fabiola Olivieri
AU - Fabrizio Maggi
AU - Dina Bellizzi
AU - Robertina Giacconi
PY - 2026
DA - 2026/10/01
JO - Nutrients
DO - 10.3390/nu18203387
UR - https://www.mdpi.com/2072-6643/18/20/3387
AB - 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.
SN - 2072-6643
ER -