Nanashima Atsushi, Hiyoshi Masahide, Imamura Naoya, Yano Koichi, Hamada Takeomi, Kai Kengo, Nishida Takahiro, Uchise Yukako, Sakamoto Risa, Inomata Mayu
Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan.
Ann Hepatobiliary Pancreat Surg. 2021 Nov 30;25(4):477-484. doi: 10.14701/ahbps.2021.25.4.477.
BACKGROUNDS/AIMS: It is known that preoperative nutritional status can influence patient outcomes after hepatectomy. Prognostic Nutritional Index (PNI) is a useful parameter to reflect patient outcomes undergoing gastro-intestinal surgery. The aim of this study was to retrospectively evaluate relationships of nutritional parameters, demographics, and surgical records with postoperative outcomes in a cohort study.
Curative hepatectomy was performed for 182 patients at the University of Miyazaki between 2015 and 2018. Each preoperative level of albumin, prealbumin, lymphocyte, total cholesterol, or the comprehensively calculated Onodera's PNI was examined as a nutritional parameter.
The mean PNI was 39.6 ± 5.1, with PNI below 40 observed in 91 (50.0%) patients. Nutritional parameters were not different among patients with various liver diseases. Serum albumin or prealbumin level was significantly correlated with each hepatic parameter ( < 0.01). Prealbumin and total cholesterol levels were significantly correlated with postoperative prothrombin activity ( < 0.05). Albumin or prealbumin levels and PNI were significantly lower in patients with posthepatectomy complications, particularly bile leakage in comparison those without such complications ( < 0.05). Multiple logistic analysis showed that albumin level was an independent risk factor for complications after hepatectomy (risk ratio [RR]: 1.33) and that lymphocyte count was an independent risk factor for bile leakage (RR: 1.28) ( < 0.05). The cut-off level of albumin was approximately 3.8 mg/dL and that of lymphocyte count was 1,320/mm.
Preoperative PNI reflected perioperative liver functional status. It was a predictive parameter for postoperative complications, particularly biliary leakage.
背景/目的：已知术前营养状况会影响肝切除术后的患者预后。预后营养指数（PNI）是反映胃肠手术患者预后的一个有用参数。本研究的目的是在一项队列研究中回顾性评估营养参数、人口统计学和手术记录与术后预后的关系。
2015年至2018年期间，宫崎大学对182例患者进行了根治性肝切除术。将术前白蛋白、前白蛋白、淋巴细胞、总胆固醇的每一个水平或综合计算的小野寺PNI作为营养参数进行检测。
平均PNI为39.6±5.1，91例（50.0%）患者的PNI低于40。不同肝病患者的营养参数无差异。血清白蛋白或前白蛋白水平与各肝脏参数显著相关（<0.01）。前白蛋白和总胆固醇水平与术后凝血酶原活性显著相关（<0.05）。肝切除术后发生并发症的患者，尤其是胆汁漏患者，其白蛋白或前白蛋白水平和PNI显著低于无此类并发症的患者（<0.05）。多因素逻辑分析显示，白蛋白水平是肝切除术后并发症的独立危险因素（风险比[RR]：1.33），淋巴细胞计数是胆汁漏的独立危险因素（RR：1.28）（<0.05）。白蛋白的临界值约为3.8mg/dL，淋巴细胞计数的临界值为1320/mm。
术前PNI反映围手术期肝功能状态。它是术后并发症，尤其是胆漏的预测参数。
