Onodera Prognostic Nutritional Index (PNI) Formula: Albumin & Lymphocyte Surgical Cutoff

Two routine preoperative blood tests—Serum Albumin & Total Lymphocytes—predict anastomotic leak and immunotherapy survival!

Introduced by Japanese gastrointestinal surgeon Tokiro Onodera et al. (1984, Nihon Geka Gakkai Zasshi) to assess perioperative risk before gastrointestinal cancer resection and primary bowel anastomosis, Onodera’s Prognostic Nutritional Index combines visceral protein reserve (Serum Albumin in g/dL, or Albumin_g/L divided by 10) with cell-mediated immunocompetence (Total Lymphocyte Count TLC in cells/uL or cells/mm^3): PNI = 10 * Albumin_g/dL + 0.005 * TLC_per_uL!

Onodera’s landmark surgical thresholds remain standard across GI surgical oncology and checkpoint-inhibitor immuno-oncology: PNI >= 45 indicates Low Perioperative Risk (safe for resection & primary anastomosis), 40 <= PNI < 45 indicates Moderate Risk (prehabilitation & close monitoring), and PNI < 40 flags Severe Immunonutritional Depletion—high risk of anastomotic leakage, sepsis, and postoperative mortality (consider staged procedure / intensive nutrition first)!

Onodera (1984) Prognostic Nutritional Index PNI = 10 * Albumin_gdL + 0.005 * Lymphocytes_uL

Evaluates PNI from Serum Albumin B2 (g/dL; guarded against accidental g/L entry > 10) and Total Lymphocyte Count B3 (cells/uL).

=IF(OR(B2 <= 0, B2 > 8, B3 <= 0), "Invalid Lab Units (Enter Albumin in g/dL <= 8 & TLC in cells/uL)", ROUND(10 * B2 + 0.005 * B3, 2))

Onodera Surgical Anastomosis & Oncology Risk Classifier (< 40 / 40–<45 / >= 45)

Classifies PNI against Onodera’s 40 and 45 surgical cutoffs.

=IF(OR(B2 <= 0, B2 > 8, B3 <= 0), "Invalid Lab Units", IF(10 * B2 + 0.005 * B3 < 40, "Severe Risk (PNI < 40 — High Anastomotic Leak / Post-Op Complication Risk)", IF(10 * B2 + 0.005 * B3 < 45, "Moderate Risk (40 <= PNI < 45 — Prehab Recommended)", "Low Risk (PNI >= 45 — Standard Surgical Clearance)")))

Further reading

• Microsoft Support — IF function