Sim Ji Hoon, Kim Sung-Hoon, Jun In-Gu, Kang Sa-Jin, Kim Bomi, Kim Seonok, Song Jun-Gol
Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
Cancers (Basel). 2021 May 21;13(11):2508. doi: 10.3390/cancers13112508.
PNI is significantly associated with surgical outcomes; however, the association between PNI and intraoperative transfusions is unknown.
This study retrospectively analyzed 1065 patients who underwent hepatectomy. We divided patients into two groups according to the PNI (<44 and >44) and compared their transfusion rates and surgical outcomes. We performed multivariate logistic and Cox regression analysis to determine risk factors for transfusion and the 5-year survival. Additionally, we found the net reclassification index (NRI) to validate the discriminatory power of PNI.
The PNI <44 group had higher transfusion rates (adjusted odds ratio [OR]: 2.20, 95%CI: 1.06-4.60, = 0.035) and poor surgical outcomes, such as post hepatectomy liver failure (adjusted [OR]: 3.02, 95%CI: 1.87-4.87, < 0.001), and low 5-year survival (adjusted OR: 1.68, 95%CI: 1.17-2.24, < 0.001). On multivariate analysis, PNI <44, age, hemoglobin, operation time, synthetic colloid use, and laparoscopic surgery were risk factors for intraoperative transfusion. On Cox regression analysis, PNI <44, MELD score, TNM staging, synthetic colloid use, and transfusion were associated with poorer 5-year survival. NRI analysis showed significant improvement in the predictive power of PNI for transfusion ( = 0.002) and 5-year survival ( = 0.004).
Preoperative PNI <44 was significantly associated with higher transfusion rates and surgical outcomes.
营养预后指数（PNI）与手术结局显著相关；然而，PNI与术中输血之间的关联尚不清楚。
本研究回顾性分析了1065例行肝切除术的患者。我们根据PNI（<44和>44）将患者分为两组，并比较了他们的输血率和手术结局。我们进行了多因素逻辑回归和Cox回归分析，以确定输血和5年生存率的危险因素。此外，我们计算了净重新分类指数（NRI）以验证PNI的鉴别能力。
PNI<44组的输血率更高（调整后的优势比[OR]：2.20，95%置信区间：1.06-4.60，P = 0.035），手术结局较差，如肝切除术后肝功能衰竭（调整后的[OR]：3.02，95%置信区间：1.87-4.87，P < 0.001），以及5年生存率较低（调整后的OR：1.68，95%置信区间：1.17-2.24，P < 0.001）。多因素分析显示，PNI<44、年龄、血红蛋白、手术时间、使用合成胶体和腹腔镜手术是术中输血的危险因素。Cox回归分析显示，PNI<44、终末期肝病模型（MELD）评分、肿瘤-淋巴结-转移（TNM）分期、使用合成胶体和输血与较差的5年生存率相关。NRI分析显示，PNI对输血（P = 0.002）和5年生存率（P = 0.004）的预测能力有显著提高。
术前PNI<44与较高的输血率和手术结局显著相关。
