术前预后营养指数可预测远端胆管癌根治性切除术后的短期并发症。

Preoperative prognostic nutritional index predicts short-term complications after radical resection of distal cholangiocarcinoma.

作者信息

He Yulong, Liu Haoran, Ma Yuhu, Li Jianlong, Zhang Jinduo, Ren Yanxian, Dong Chunlu, Bai Bing, Zhang Yong, Lin Yanyan, Yue Ping, Meng Wenbo

机构信息

The First Clinical Medical College, Lanzhou University, Lanzhou, China.

Department of General Surgery, The First Hospital of Lanzhou University, Lanzhou, China.

出版信息

Front Surg. 2023 Jan 10;9:1091534. doi: 10.3389/fsurg.2022.1091534. eCollection 2022.

DOI:10.3389/fsurg.2022.1091534

PMID:36704510

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9872124/

Abstract

BACKGROUND

The occurrence of postoperative complications of distal cholangiocarcinoma (dCCA) is an indicator of poor patient prognosis. This study aimed to determine the immune-nutritional indexes (INIs) that can predict short-term postoperative complications.

METHODS

A retrospective analysis of 148 patients with dCCA who were operated radical pancreaticoduodenectomy at the First Hospital of Lanzhou University from December 2015 to March 2022 was conducted to assess the predictive value of preoperative INIs and preoperative laboratory tests for short-term postoperative complications, and a decision tree model was developed using classification and regression tree (CART) analysis to identify subgroups at risk for overall complications.

RESULTS

In this study, 83 patients (56.08%) experienced overall complications. Clavien-Dindo grade III-V complications occurred in 20 patients (13.51%), and 2 patients died. The areas under curves (AUCs) of the preoperative prognostic nutritional index (PNI), controlling nutritional status (CONUT) score, and neutrophil-to-lymphocyte ratio (NLR) were compared; the PNI provided the maximum discrimination for complications (AUC = 0.685, 95% CI = 0.600-0.770), with an optimal cutoff value of 46.9, and the PNI ≤ 46.9 group had higher incidences of overall complications (70.67% vs. 40.00%, < 0.001) and infectious complications (28.77% vs. 13.33%, = 0.035). Multivariate logistic regression analysis identified PNI (OR = 0.87, 95% CI: 0.80-0.94) and total bilirubin (OR = 1.01, 95% CI: 1.00-1.01) were independent risk factors for overall complications ( < 0.05). According to CART analysis, PNI was the most important parameter, followed by the total bilirubin (TBIL) level. Patients with a PNI lower than the critical value and TBIL higher than the critical value had the highest overall complication rate (90.24%); the risk prediction model had an AUC of 0.714 (95% CI, 0.640-0.789) and could be used to stratify the risk of overall complications and predict grade I-II complications ( < 0.05).

CONCLUSION

The preoperative PNI is a good predictor for short-term complications after the radical resection of dCCA. The decision tree model makes PNI and TBIL easier to use in clinical practice.

摘要

背景

远端胆管癌（dCCA）术后并发症的发生是患者预后不良的一个指标。本研究旨在确定可预测术后短期并发症的免疫营养指标（INIs）。

方法

对2015年12月至2022年3月在兰州大学第一医院接受根治性胰十二指肠切除术的148例dCCA患者进行回顾性分析，以评估术前INIs和术前实验室检查对术后短期并发症的预测价值，并使用分类与回归树（CART）分析建立决策树模型，以识别总体并发症的高危亚组。

结果

在本研究中，83例患者（56.08%）发生了总体并发症。20例患者（13.51%）出现Clavien-Dindo III-V级并发症，2例患者死亡。比较术前预后营养指数（PNI）、控制营养状况（CONUT）评分和中性粒细胞与淋巴细胞比值（NLR）的曲线下面积（AUCs）；PNI对并发症的区分度最大（AUC = 0.685，95%CI = 0.600-0.770），最佳截断值为46.9，PNI≤46.9组的总体并发症发生率（70.67%对40.00%，P<0.001）和感染性并发症发生率（28.77%对13.33%，P = 0.035）更高。多因素逻辑回归分析确定PNI（OR = 0.87，95%CI：0.80-0.94）和总胆红素（OR = 1.01，95%CI：1.00-1.01）是总体并发症的独立危险因素（P<0.05）。根据CART分析，PNI是最重要的参数，其次是总胆红素（TBIL）水平。PNI低于临界值且TBIL高于临界值的患者总体并发症发生率最高（90.24%）；风险预测模型的AUC为0.714（95%CI，0.640-0.789），可用于对总体并发症风险进行分层并预测I-II级并发症（P<0.05）。