Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 05505, Korea.
Nutrients. 2021 May 11;13(5):1604. doi: 10.3390/nu13051604.
The prognostic nutritional index (PNI) has been reported to be associated with postoperative complications and prognosis in cancer surgery. However, few studies have evaluated the association between preoperative PNI and postoperative acute kidney injury (AKI) in colorectal cancer patients. This study evaluated association of preoperative PNI and postoperative AKI in patients who underwent colorectal cancer surgery. This study retrospectively analyzed 3543 patients who underwent colorectal cancer surgery between June 2008 and February 2012. The patients were classified into four groups by the quartile of PNI: Q1 (≤43.79), Q2 (43.79-47.79), Q3 (47.79-51.62), and Q4 (≥51.62). Multivariate regression analysis was performed to assess the risk factors for AKI and 1-year mortality. AKI was defined according to Kidney Disease Improving Global Outcomes classification (KDIGO) criteria. Additionally, we assessed surgical outcomes such as hospital stay, ICU admission, and postoperative complications. The incidence of postoperative AKI tended to increase in the Q1 group (13.4%, 9.2%, 9.4%, 8.8%). In the multivariate analysis, high preoperative PNI was significantly associated with low risk of postoperative AKI (adjusted odds ratio [OR]: 0.96, 95% confidence interval [CI]: 0.93-0.99, = 0.003) and low 1-year mortality (OR: 0.92, 95% CI: 0.86-0.98, = 0.011). Male sex, body mass index, diabetes mellitus, and hypertension were risk factors for AKI. The Q1 (≤43.79) group had poor surgical outcomes, such as postoperative AKI (OR: 1.52, 95% CI: 1.18-1.95, = 0.001), higher rates of ICU admission (OR: 3.13, 95% CI: 1.82-5.39, < 0.001) and higher overall mortality (OR: 3.81, 95% CI: 1.86-7.79, < 0.001). In conclusion, low preoperative PNI levels, especially in the Q1 (≤43.79), were significantly associated with postoperative AKI and surgical outcomes, such as hospital stay, postoperative ICU admission, and mortality.
预后营养指数（PNI）已被报道与癌症手术的术后并发症和预后相关。然而，很少有研究评估结直肠癌患者术前 PNI 与术后急性肾损伤（AKI）之间的关系。本研究评估了术前 PNI 与接受结直肠癌手术患者术后 AKI 之间的关系。本研究回顾性分析了 2008 年 6 月至 2012 年 2 月期间接受结直肠癌手术的 3543 名患者。根据 PNI 的四分位数将患者分为四组：Q1（≤43.79）、Q2（43.79-47.79）、Q3（47.79-51.62）和 Q4（≥51.62）。采用多变量回归分析评估 AKI 和 1 年死亡率的危险因素。AKI 根据肾脏病改善全球结果（KDIGO）标准定义。此外，我们评估了住院时间、入住 ICU 和术后并发症等手术结果。术后 AKI 的发生率在 Q1 组呈上升趋势（13.4%、9.2%、9.4%、8.8%）。在多变量分析中，高术前 PNI 与术后 AKI 风险低显著相关（调整优势比[OR]：0.96，95%置信区间[CI]：0.93-0.99， = 0.003）和 1 年死亡率低（OR：0.92，95%CI：0.86-0.98， = 0.011）。男性、体重指数、糖尿病和高血压是 AKI 的危险因素。Q1（≤43.79）组的手术结果较差，如术后 AKI（OR：1.52，95%CI：1.18-1.95， = 0.001）、ICU 入住率较高（OR：3.13，95%CI：1.82-5.39，<0.001）和总死亡率较高（OR：3.81，95%CI：1.86-7.79，<0.001）。总之，低术前 PNI 水平，尤其是 Q1（≤43.79），与术后 AKI 以及手术结果，如住院时间、术后 ICU 入住和死亡率显著相关。
