Comparative Prognostic Performance of Nutritional Indices in Acute Myeloid Leukemia

Background/Objectives: Malnutrition adversely affects the clinical course of acute myeloid leukemia (AML), yet comparative data on objective nutritional indices remain limited. Methods: This study evaluated the prognostic performance of four indices—Controlling Nutritional Status (CONUT), Simple CONUT, Prognostic Nutritional Index (PNI), and Nutritional Risk Index (NRI)—on overall survival (OS) alongside the European LeukemiaNet (ELN) 2022 risk classification. Pre-treatment parameters of 236 newly diagnosed AML patients were retrospectively analyzed using Receiver Operating Characteristic (ROC) curves and multivariate Cox regression models. Results: In ROC analysis, only NRI demonstrated significant discriminative performance in predicting OS (Area Under the Curve = 0.637, p < 0.001), whereas CONUT, Simple CONUT, and PNI lacked statistical significance. Patients with low NRI scores had significantly worse survival than the high NRI group (median OS: 16.8 months versus not reached, p = 0.004), particularly within the ELN favorable risk category (2-year OS: 59.6% versus 93.5%, p = 0.022). Multivariate analysis established NRI as an independent predictor of mortality (Hazard Ratio = 0.967, p = 0.009) alongside age and ELN risk. Conclusions: In conclusion, NRI outperforms other nutritional indices and serves as an independent prognostic factor in AML, offering a more holistic and effective approach to clinical risk stratification.