Mullen J L, Buzby G P, Matthews D C, Smale B F, Rosato E F
Ann Surg. 1980 Nov;192(5):604-13. doi: 10.1097/00000658-198019250-00004.
A previously developed and validated predictive nutritional assessment model (Prognostic Nutritional Index) was applied to a heterogenous surgical population. Without knowledge of the then undeveloped PNI, adequate preoperative nutritional repletion (TPN) was provided on clinical indications alone to 50 of 145 patients with the remaining 95 patients receiving no preoperative total parenteral nutrition. Analysis of the two groups found no baseline differences in nutritional status, type and severity of disease and/or operative therapy, and other potentially important variables. In the high-risk stratified group as defined by admission nutritional assessment and calculated PNI (greater than or equal to 50%), adequate preoperative TPN reduced postoperative complications 2.5-fold (p < 0.01), postoperative major sepsis six-fold (p < 0.005) and mortality five-fold (p < 0.01). Clinical "eyeball" evaluation of nutritional status cannot identify high-risk individuals. This nutritional assessment predictive model (PNI) identifies the subset of operative candidates in whom adequate preoperative nutritional support significantly reduces operative morbidity and/or mortality.
一个先前开发并经验证的预测性营养评估模型（预后营养指数）被应用于一个异质性手术人群。在当时尚未开发出PNI的情况下，仅根据临床指征，145例患者中的50例接受了充分的术前营养补充（全胃肠外营养），其余95例患者未接受术前全胃肠外营养。对两组的分析发现，在营养状况、疾病类型和严重程度及/或手术治疗以及其他潜在重要变量方面，两组在基线时没有差异。在根据入院营养评估和计算出的PNI定义的高危分层组（大于或等于50%）中，充分的术前全胃肠外营养使术后并发症减少了2.5倍（p<0.01），术后严重脓毒症减少了6倍（p<0.005），死亡率降低了5倍（p<0.01）。对营养状况进行临床“直观”评估无法识别高危个体。这种营养评估预测模型（PNI）可识别出这样一部分手术候选者，即充分的术前营养支持能显著降低手术发病率和/或死亡率。
