Division of HPB and Transplant Surgery, Erasmus Medical Center, Rotterdam, The Netherlands,
Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan,
Dig Surg. 2019;36(3):226-232. doi: 10.1159/000488215. Epub 2018 Apr 19.
Preoperative nutritional status is reportedly associated with postoperative outcomes in patients with hepatocellular carcinoma. This study aimed to investigate the significance of the controlling nutritional status (CONUT) score and the prognostic nutritional index (PNI) as predictors of postoperative outcomes.
We retrospectively reviewed data from 331 patients who underwent hepatectomy for hepatocellular carcinoma between January 2007 and December 2015. Patients were divided into 2 groups based on their CONUT score and the PNI. We evaluated the effect of the CONUT score and PNI on perioperative outcomes. Multivariate analysis was performed to identify independent predictors of in-hospital mortality after hepatectomy. -Results: The high CONUT group had a significantly higher -incidence of 30-day mortality (p < 0.001), in-hospital mortality (p = 0.002), ascites (p = 0.006), liver failure (p = 0.02), sepsis (p = 0.01), and enteritis (p < 0.001). The low PNI group was also significantly associated with 30-day mortality (p < 0.001), in-hospital mortality (p = 0.003), liver failure (p < 0.001), sepsis (p = 0.02), enteritis (p = 0.02), and hospital stay (p = 0.01). In multivariate analyses, a high CONUT score was an independent predictor of in-hospital mortality after hepatectomy (hazard ratio [HR] 9.41, p = 0.038), but the PNI was not (HR 5.86, p = 0.08).
Preoperative assessment of the CONUT score is helpful for evaluating patients' nutritional status and mortality risk after liver surgery.
据报道，术前营养状况与肝细胞癌患者的术后结局相关。本研究旨在探讨控制营养状况（CONUT）评分和预后营养指数（PNI）作为预测术后结局的指标的意义。
我们回顾性分析了 2007 年 1 月至 2015 年 12 月期间接受肝细胞癌肝切除术的 331 例患者的数据。根据 CONUT 评分和 PNI 将患者分为 2 组。我们评估了 CONUT 评分和 PNI 对围手术期结局的影响。进行多变量分析以确定肝切除术后住院死亡率的独立预测因素。
高 CONUT 组的 30 天死亡率（p<0.001）、住院死亡率（p=0.002）、腹水（p=0.006）、肝功能衰竭（p=0.02）、脓毒症（p=0.01）和肠炎（p<0.001）发生率显著较高。低 PNI 组也与 30 天死亡率（p<0.001）、住院死亡率（p=0.003）、肝功能衰竭（p<0.001）、脓毒症（p=0.02）、肠炎（p=0.02）和住院时间（p=0.01）显著相关。多变量分析显示，高 CONUT 评分是肝切除术后住院死亡率的独立预测因素（危险比[HR]9.41，p=0.038），而 PNI 则不是（HR 5.86，p=0.08）。
术前评估 CONUT 评分有助于评估患者的营养状况和肝手术后的死亡风险。
