Prognostic
Nutritional
Index
PhD-grade dual-formula PNI · 9 oncology indices · Surgical risk stratification · ESPEN 2021 recommendations
PNI Clinical Assessment
Oncology & surgical nutrition · All computations are local & private
PNI = Alb(g/L) + 5×TLC(×10⁹/L) · Onodera 1984 · Buzby 1980 · GPS McMillan 2003 · CONUT Ulibarri 2005 · GNRI Bouillanne 2005 · NLR · PLR · SII Hu 2014 · CAR · PAR · ESPEN 2021
Alb(g/L) + 5×TLC(×10⁹/L)10×Alb(g/dL) + 0.005×TLC(/mm³)158−16.6Alb−0.78TSF−0.2Transf−5.8DHR0: CRP≤10+Alb≥3.5 · 1: either · 2: bothAlb(0–6) + Chol(0–3) + TLC(0–3)1.489×Alb(g/L) + 41.7×(wt/IBW)Plt × Neut / Lymph [all ×10⁹/L]CRP(mg/L) / Alb(g/L) · <1 normal · >3 highOncology Dietitian
Consultation
ESPEN 2021-aligned MNT protocols, ONS optimisation, and serial PNI monitoring from our clinical team.
Book Consultation →This tool is intended exclusively for use by registered dietitians, oncologists, surgeons, and other qualified healthcare professionals. It is not suitable for use by patients, caregivers, or the general public without clinical supervision.
PNI and all associated indices are prognostic tools — they stratify risk and guide clinical decisions. They do not constitute a diagnosis of malnutrition, cancer, or any other condition. All results must be interpreted within the complete clinical, oncological, functional, and biochemical context of the individual patient.
Serum albumin is suppressed by systemic inflammation independently of nutritional status. Low albumin in patients with elevated CRP may reflect disease burden rather than nutritional depletion. PNI may underestimate true nutritional risk in the presence of active inflammation (GPS 1–2). Prealbumin (half-life ~2 days) provides superior sensitivity for acute nutritional change.
PNI thresholds (≥45, 40–44, <40) were originally validated in Japanese gastric cancer surgical patients (Onodera 1984, n=205). External validation has been conducted across multiple cancer types and ethnicities; however, optimal cut-points may vary. GNRI Lorentz IBW equations and grip strength cutoffs are based on European and Asian cohorts — apply with caution in other populations.
No patient data is transmitted, stored, or processed on any external server. All computations run locally in the browser. This tool does not constitute a medical record or clinical document.
Serial PNI measurement, comprehensive nutritional assessment, and individualised medical nutrition therapy should always be conducted by a qualified clinician. This calculator supports — but does not replace — professional clinical judgement.
Frequently Asked Questions — Prognostic Nutritional Index
What is the Prognostic Nutritional Index (PNI)?
The Prognostic Nutritional Index (PNI) is a validated oncology and surgical nutrition risk score developed by Onodera et al. (Jpn J Surg 1984) from gastric cancer surgical patients. PNI = Albumin (g/L) + 5 × Total Lymphocyte Count (×10⁹/L) — mathematically identical to the original publication form 10 × Albumin(g/dL) + 0.005 × TLC(/mm³). A PNI of 45 or above indicates low nutritional risk; below 40 indicates high risk requiring intensive nutritional support.
What's the difference between Onodera PNI and Buzby PNI?
Onodera PNI (1984) is the primary index in this calculator, using albumin and total lymphocyte count, validated across gastric, colorectal, lung, hepatic, oesophageal, pancreatic, and bladder malignancies. Buzby PNI (1980) is a separate surgical-complication-prediction formula requiring transferrin, triceps skinfold, and delayed hypersensitivity reaction testing, expressed as a percentage risk of surgical complications.
What does a PNI score below 40 mean?
A PNI below 40 indicates high nutritional risk. Per Onodera 1984, this is associated with significantly worse 5-year survival and higher perioperative complication rates. Clinical action: delay elective surgery for intensive medical nutrition therapy (MNT), with the goal of raising PNI to 45 or above before proceeding.
Why does albumin need cautious interpretation when CRP is elevated?
Albumin is a negative acute-phase reactant — it falls during systemic inflammation independently of actual nutritional status. The Glasgow Prognostic Score (GPS) flags this: when CRP is elevated and albumin is low (GPS 2), PNI may underestimate true nutritional risk. Prealbumin (half-life ~2 days) is recommended as a more acute-phase-resistant marker in this situation.
Which cancer types is PNI validated in?
PNI was originally validated in gastric cancer (Onodera 1984, n=205) and has since been validated across colorectal, lung, hepatic, oesophageal, pancreatic, bladder, cervical, and breast malignancies, among others. GPS has been prospectively validated across more than 35 solid tumour types (McMillan 2013).
How often should PNI be monitored during cancer treatment?
PNI, albumin, and prealbumin should be checked every 4 weeks during active treatment. CRP, NLR, and CONUT can be checked every 8 weeks or each treatment cycle. An urgent MNT review should be triggered if PNI drops more than 5 points in 4 weeks, weight loss exceeds 2% in 1 month, albumin falls below 3.0 g/dL, or CRP exceeds 50 mg/L.