Sagawa Masano, Yoshimatsu Kazuhiko, Yokomizo Hajime, Yano Yuki, Okayama Sachiyo, Usui Takebumi, Yamaguchi Kentaro, Shiozawa Shunichi, Shimakawa Takeshi, Katsube Takao, Kato Hiroyuki, Naritaka Yoshihiko
Department of Surgery, Tokyo Women's Medical University Medical Center East.
Department of Clinical Laboratory, Tokyo Women's Medical University Medical Center East.
J Nippon Med Sch. 2017;84(5):224-230. doi: 10.1272/jnms.84.224.
The modified Glasgow Prognostic Score (mGPS) is an inflammation-based measure of malnutrition that reflects a state of cachexia in cancer patients. We evaluated mGPS as an index to predict surgical site infection (SSI) incidence in patients undergoing colorectal cancer surgery.
We retrospectively analyzed 351 patients who underwent colon cancer resection. Factors correlated with the incidence of SSIs were identified by logistic analysis and stepwise selection.
SSIs were observed in 32 patients, with an incidence of 9.1%. Univariate logistic analysis revealed mGPS (Score 2), laparotomy, resection of other organs, colostomy, excessive blood loss (>423 mL), long duration of surgery (>279 minutes), pulmonary dysfunction, prognostic nutritional index (PNI) ≤40, neutrophil lymphocyte ratio (NLR)(>4), and controlling nutritional status (CONUT) ≥2 to be associated with an increased incidence of SSIs. Multivariate analysis with variables selected by the stepwise procedure also revealed mGPS (Score 2) (Odds ratio (OR) =3.55, 95% Confidence interval (CI) 1.30-9.56; p=0.01), colostomy (OR=6.56, 95%CI 1.60-31.38; p=0.01), excessive blood loss (OR=3.20, 95%CI 1.23-8.42; p=0.02), and NLR (>4)(OR=3.24, 95%CI 1.31-8.17; p=0.01) to be independent risk factors.
mGPS is an independent risk factor for SSIs. Our results suggest that cachexia before surgery in patients with colorectal cancer might predict the incidence of SSIs.
改良格拉斯哥预后评分（mGPS）是一种基于炎症的营养不良指标，反映癌症患者的恶病质状态。我们评估mGPS作为预测接受结直肠癌手术患者手术部位感染（SSI）发生率的指标。
我们回顾性分析了351例行结肠癌切除术的患者。通过逻辑分析和逐步选择确定与SSI发生率相关的因素。
32例患者发生SSI，发生率为9.1%。单因素逻辑分析显示，mGPS（评分2）、剖腹手术、其他器官切除、结肠造口术、失血过多（>423 mL）、手术时间长（>279分钟）、肺功能障碍、预后营养指数（PNI）≤40、中性粒细胞淋巴细胞比值（NLR）（>4）以及控制营养状况（CONUT）≥2与SSI发生率增加相关。通过逐步程序选择变量进行的多因素分析还显示，mGPS（评分2）（比值比（OR）=3.55，95%置信区间（CI）1.30 - 9.56；p = 0.01）、结肠造口术（OR = 6.56，95%CI 1.60 - 31.38；p = 0.01）、失血过多（OR = 3.20，95%CI 1.23 - 8.42；p = 0.02）以及NLR（>4）（OR = 3.24，95%CI 1.31 - 8.17；p = 0.01）是独立危险因素。
mGPS是SSI的独立危险因素。我们的结果表明，结直肠癌患者术前的恶病质可能预测SSI的发生率。
