This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Onodera’s index
The Prognostic Nutritional Index (PNI) was published by Takashi Onodera in 1984 to estimate the risk of complications after gastrointestinal surgery. It combines two simple markers: serum albumin, which reflects protein status and inflammation, and the lymphocyte count, which reflects immune competence.
The formula
PNI = 10 × albumin (g/dL) + 0.005 × total lymphocyte count (per mm³)
If your laboratory reports albumin in g/L, divide by 10; lymphocytes reported in 10⁹/L (or 10³/µL) must be multiplied by 1,000.
Example
Albumin of 3.8 g/dL and 1,500 lymphocytes per mm³: PNI = 38 + 7.5 = 45.5.
| PNI | Usual reading |
|---|---|
| 50 or more | Normal |
| 45 to 50 | Mild risk |
| 40 to 45 | Moderate risk |
| under 40 | Severe risk |
Onodera’s original work found that a PNI of 40 or less was linked to a high rate of complications after resection and anastomosis of the digestive tract, and advised delaying such surgery to improve nutrition first.
Where it is used
The PNI has since been studied in many cancers (colorectal, gastric, pancreatic, lung), in heart failure and in older patients, where a low value is associated with shorter survival. Cut-offs vary between studies, often between 40 and 50, so check the threshold used in the reference that applies to your situation.
Limits
- Albumin and lymphocytes both fall with inflammation, infection, chemotherapy and corticosteroids, so the PNI also measures how sick a person is, not only their nutrition.
- A single value matters less than the trend over time.
- It does not replace a nutritional assessment that includes weight loss, food intake and muscle mass.
The CONUT score adds total cholesterol to the same two markers.