Jin Qianwen, Zhang Jun, Jin Jiabin, Zhang Jiaqiang, Fei Si, Liu Yang, Xu Zhiwei, Shi Yongmei
Department of Clinical Nutrition, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Department of General Surgery, Pancreatic Disease Center, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, China.
Nutr Clin Pract. 2025 Feb;40(1):156-166. doi: 10.1002/ncp.11192. Epub 2024 Jul 15.
Postoperative pancreatic fistula (POPF) remains one of the most severe complications after pancreatic surgery. The methods for predicting pancreatic fistula are limited. We aimed to investigate the predictive value of body composition parameters measured by preoperative bioelectrical impedance analysis (BIA) on the development of POPF.
A total of 168 consecutive patients undergoing pancreatic surgery from March 2022 to December 2022 at our institution were included in the study and randomly assigned at a 3:2 ratio to the training group and the validation group. All data, including previously reported risk factors for POPF and parameters measured by BIA, were collected. Risk factors were analyzed by univariable and multivariable logistic regression analysis. A prediction model was established to predict the development of POPF based on these parameters.
POPF occurred in 41 of 168 (24.4%) patients. In the training group of 101 enrolled patients, visceral fat area (VFA) (odds ratio [OR] = 1.077, P = 0.001) and fat mass index (FMI) (OR = 0.628, P = 0.027) were found to be independently associated with POPF according to multivariable analysis. A prediction model including VFA and FMI was established to predict the development of POPF with an area under the receiver operating characteristic curve (AUC) of 0.753. The efficacy of the prediction model was also confirmed in the internal validation group (AUC 0.785, 95% CI 0.659-0.911).
Preoperative assessment of body fat distribution by BIA can predict the risk of POPF after pancreatic surgery.
术后胰瘘（POPF）仍然是胰腺手术后最严重的并发症之一。预测胰瘘的方法有限。我们旨在研究术前生物电阻抗分析（BIA）测量的身体成分参数对POPF发生的预测价值。
本研究纳入了2022年3月至2022年12月在我院连续接受胰腺手术的168例患者，并按3:2的比例随机分为训练组和验证组。收集所有数据，包括先前报道的POPF危险因素和通过BIA测量的参数。通过单变量和多变量逻辑回归分析危险因素。基于这些参数建立了一个预测模型来预测POPF的发生。
168例患者中有41例（24.4%）发生了POPF。在纳入的101例训练组患者中，多变量分析发现内脏脂肪面积（VFA）（比值比[OR]=1.077，P=0.001）和脂肪质量指数（FMI）（OR=0.628，P=0.027）与POPF独立相关。建立了一个包含VFA和FMI的预测模型来预测POPF的发生，受试者工作特征曲线（AUC）下面积为0.753。该预测模型的有效性在内部验证组中也得到了证实（AUC 0.785，95%CI 0.659-0.911）。
通过BIA对术前体脂分布进行评估可以预测胰腺手术后POPF的风险。
