ObjectiveTo study the clinical significance of prognostic nutritional index (PNI) combined with neutrophil to lymphocyte ratio (NLR) in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.MethodsTo retrospectively analyze and collect the clinical data of 517 patients with gastric cancer who were diagnosed at the Third People’s Hospital of Shangqiu City from January 2016 to May 2020, all of the patients received radical gastrectomy. We explored the risk factors that affect the occurrence of postoperative anastomotic leakage, and explored the clinical significance of PNI combined with NLR on the third day after operation in predicting the occurrence of anastomotic leakage.ResultsAmong 517 patients undergoing radical gastrectomy, 61 had anastomotic leakage, and the incidence of anastomotic leakage was 11.8%. The results of multivariate logistic regression analysis showed that patients with preoperative diabetes and intraoperative blood loss ≥400 mL had a higher incidence of anastomotic leakage, and with the increase of NLR value on the 3rd and 5th day after operation, and the decrease of PNI value on the 3rd and 5th day after operation, the incidence of anastomotic leakage increased (P<0.05). The area under the curve of NLR, PNI, and NLR combined with PNI on the 3rd day after operation in predicting the occurrence of anastomotic leakage were 0.849, 0.581, and 0.949, respectively, and the differences were statistically significant (P<0.05), the sensitivity and specificity of NLR combined with PNI were higher than the individual indicator.ConclusionPNI combined with NLR on the 3rd day after operation has important clinical significance in predicting the occurrence of anastomotic leakage after radical gastrectomy for gastric cancer.
ObjectiveTo explore effect of preoperative prognostic nutritional index (PNI) on clinically related postoperative pancreatic fistula (CR-POPF) after distal pancreatectomy (DP) and analyze its influencing factors in order to provide a basis for clinical prediction of CR-POPF. MethodsThe clinicopathologic data of patients who successfully completed DP in the Affiliated Hospital of Xuzhou Medical University and met the inclusion and exclusion criteria of this study from January 1, 2017 to January 31, 2021 were collected retrospectively. The preoperative PNI value was calculated and the optimal cut-off value was obtained according to the receiver operative characteristic (ROC) curve. The patients were divided into low and high PNI based on the optimal cut-off value. The clinicopathologic characteristics were compared between the patients with low and high PNI and CR-POPF or not. At the same time, multivariate logistic regression was used to analyze the influencing factors of CR-POPF. ResultsA total of 143 patients who met the inclusion and exclusion criteria were included in this study. The CR-POPF occurred in 33 cases (23.08%) after DP, and the average preoperative PNI was 52.26 (39.20–65.10), the optimal cut-off value of PNI was 50.55, with 49 cases in the low PNI group and 94 cases in the high PNI group. In patient with low PNI, the proportions of patients aged ≥65 years and with CR-POPF were higher than those with high PNI (P<0.05). In the patients with CR-POPF, the proportions of patients with soft pancreatic texture and with low preoperative PIN were higher than those without CR-POPF (P<0.05). Further, the multivariate logistic regression showed that the the preoperative low PNI (OR=5.417, P<0.001) and soft pancreatic texture (OR=4.126, P=0.002) increased the risk of CR-POPF. ConclusionLow preoperative PNI and soft pancreatic texture increase risk of CR-POPF after DP, and it is necessary to preoperatively evaluate PNI status of patients.
ObjectiveTo discuss the relation between postoperative prognostic nutritional index (PNI) and serious complications (Clavien-Dindo complications classification Ⅲ to Ⅴ) after hepatectomy for patients with hepatocellular carcinoma (HCC). MethodsAccording to the inclusion and exclusion criteria, the HCC patients who underwent hepatectomy in the Sichuan Cancer Hospital from January 2009 to January 2016 were retrospectively collected. The predictive ability of postoperative PNI for postoperative complications was evaluated by receiver operating characteristic (ROC) curve, and the optimal cutoff value was determined. At the same time, the related factors affecting the severe complications and overall survival after hepatectomy in the HCC patients were analyzed by non-conditional logistic regression and Cox proportional hazards regression analysis, respectively. ResultsA total of 779 patients were enrolled, and the postoperative complications occurred in 238 (30.6%) cases, including 68 (8.7%) cases of serious complications. The postoperative PNI of all patients was 35.8±4.9, the ROC curve analysis showed that the area under the ROC curve of postoperative PNI for predicting postoperative severe complications was 0.735, the optimal cutoff value was 35.7, and the sensitivity and specificity were 0.868 and 0.518, respectively. The patients were classified as a lower postoperative PNI (≤35.7, 397 patients) and higher postoperative PNI (>35.7, 382 patients) based on the optimal cutoff value. Compared with patients with higher postoperative PNI, the patients with lower postoperative PNI had later stage of tumor (P<0.001) , worse liver function (P<0.05), and larger volume of excised liver (P<0.001), more blood loss (P<0.001), and higher proportion of intraoperative blood transfusion (P<0.001), higher serious complication (P<0.001) and mortality (P=0.039). The multivariate logistic regression analysis found that the preoperative Child-Pugh score grade B, American Society of Anesthesiologists grade Ⅲ–Ⅳ, intraoperation blood transfusion, preoperative decreased platelet level, and lower postoperative PNI increased the probability of postoperative serious complications in the HCC patients (P<0.05). The overall survival of HCC patients with higher postoperative PNI was better than that of patients with lower postoperative PNI (P=0.007), but there was no statistical difference in tumor-free survival between the two (P=0.073), and it was not fount that the postoperative PNI was associated with the overall survival of HCC patients underwent hepatectomy by the Cox proportional hazards regression multivariate analysis (P=0.276). ConclusionsThe optimal cutoff value of postoperative PNI for predicting postoperative serous complications determined in this study is 35.7, which has a higher predictive value. Patients with higher postoperative PNI and lower postoperative PNI in incidence of postoperative serious complications are obviously different, patients with higher postoperative PNI has a better overall survival than those with lower postoperative PNI.
ObjectiveTo investigate the predictive value of prognostic nutritional index (PNI) in complications after thoracoscopy-assisted radical resection of esophageal cancer.MethodsWe collected the clinical data of patients who underwent thoracoscopy-assisted esophagectomy in the First Affiliated Hospital of Xinjiang Medical University from January 2015 to June 2020. The predictive value of PNI for postoperative complications was evaluated by establishing receiver operating characteristic (ROC) curve and the optimal cut-off point was determined. The patients were divided into a high PNI group and a low PNI group according to the cut-off point. The differences of baseline data and perioperative complications-related indicators between the two groups were compared and analyzed. Univariate and multivariate analyses were used to investigate the influence of PNI and other related indexes on postoperative complications.ResultsA total of 116 patients were enrolled in this study, including 75 males and 41 females, aged 65 (58-69) years. The area under ROC curve was 0.647, and the optimal cut-off point was 51.9. According to the cut-off point, there were 45 patients in the high PNI group and 71 patients in the low PNI group. The overall complication rate (χ2=10.437, P=0.001) and the incidence of postoperative pulmonary infection (χ2=10.811, P=0.001) were statistically different between the two groups. The results of univariate analysis showed that the duration of ventilator use (Z=–3.136, P=0.002), serum albumin value (t=2.961, P=0.004), and PNI value (χ2=10.437, P=0.001) were the possible risk factors for postoperative complications after thoracoscopy-assisted esophagectomy. The results of multivariate analysis suggested that the duration of ventilator use (OR=1.015, P=0.002) and the history of drinking (OR=5.231, P=0.013) were independent risk factors for postoperative complications, and high PNI was the protective factor for postoperative complications (OR=0.243, P=0.047).ConclusionPNI index has a certain value in predicting postoperative complications, which can quantify the preoperative nutritional and immune status of patients. Drinking history and duration of ventilator use are independent risk factors for postoperative complications of thoracoscopy-assisted esophagectomy, and high PNI is a protective factor for postoperative complications.
ObjectiveTo research the association between the prognostic nutritional index (PNI) and the prognosis of patients with malignant obstructive jaundice (MOJ) after interventional treatment. MethodsThe clinicopathologic data of patients with MOJ who were clinically diagnosed and underwent interventional treatment in the Affiliated Hospital of Southwest Medical University, from September 2018 to June 2021, were gathered retrospectively. The X-Tile statistical software was used to determine the optimal critical value of PNI before treatment, then the patients were allocated into the high PNI group (PNI was the optimal critical value or more) and low PNI group (PNI was less than the optimal critical value). The clinicopathologic characteristics of the two groups were compared. The Kaplan-Meier method was used to draw survival curve for survival analysis, and the Cox proportional hazards regression model was used to analyze the risk factors affecting the prognosis of patients with MOJ (the prognostic index was overall survival). ResultsA total of 205 patients were included in this study. The optimal critical value of PNI was 37.5. There were 154 cases in the high PNI group and 51 cases in the low PNI group, respectively. The proportions of the patients with biliary infection, CA19-9 ≥400 kU/L, hemoglobin <120 g/L, albumin <30 g/L, total bilirubin ≥300 μmol/L, and alanine aminotransferase <300 U/L were higher in the low PNI group as compared with the high PNI group (P<0.05). The median overall survival of patients in the high PNI group and low PNI group was 7.1 months and 3.6 months, respectively. The overall survival curve of the former was better than that the latter (χ2=18.514, P<0.001). The median follow-up time of 205 patients was 6.2 months, with a median overall survival of 5.3 months. The multivariate results of Cox proportional hazards regression model analysis showed that the probability of overall survival lengthening was increased for the patients with more times of PTCD, with stent implantation, with treatment for primary tumor, without metastasis, and with preoperative PNI ≥37.5 (P<0.05). ConclusionFrom the results of this study, preoperative peripheral blood PNI has a certain association with the prognosis of patients with MOJ after interventional treatment, and it is expected to be used to predict the prognosis of patients with MOJ in the future.
ObjectiveTo explore the predictive value of preoperative serum heat shock protein 90α (HSP90α) level in combination with the prognostic nutritional index (PNI) for patients with hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE). MethodsThe HCC patients confirmed by histopathological examination and underwent TAC at Guigang People’s Hospital from January 2022 to June 2023 were as the observation group, the healthy individuals who underwent physical examinations during the same period and same hospital as the control group. The blood before treatment and on the day of the physical examination was collected to detected the HSP90α and albumin levels, as well as lymphocyte count. The PNI was calculated [PNI=albumin (g/L)+5×lymphocyte count (×109/L)]. The clinical outcome (tumor progression or death) was observed within one year after TACE treatment, those without tumor progression or death were defined as a good prognosis, while those with tumor progression or death were defined as a poor prognosis. Using the multivariate unconditional logistic regression analysis to identify the risk factors affecting the poor prognosis for HCC patients, and the receive operating characteristic (ROC) curve to evaluate the predictive value of serum HSP90α level in combination with PNI in distinguishing prognosis after TACE treatment. ResultsIn this study, there were 178 cases in the observation group and 100 cases in the control group. The serum HSP90α level (μg/L) in the observation group was higher than that in the control group (96.40±33.57 vs. 52.19±22.13, t=3.191, P<0.001), and the PNI value was lower than that in the control group (43.70±5.24 vs. 56.46±6.86, t=–16.144, P<0.001); Within one year after TACE, there were 70 patients with poor prognosis and 108 patients with good prognosis. The serum HSP90α (μg/L) level in the patients with poor prognosis was higher than that in the patients with good prognosis (117.33±29.48 vs. 82.83±28.84, t=7.726, P<0.001), and the PNI was lower than that in the control group (40.49±4.18 vs. 45.78±4.80, t=–7.548, P<0.001). The multivariate unconditional logistic regression analysis found that the probabilities of incidence of poor prognosis after TACE treatment were higher in the patients with Chinese liver cancer staging Ⅲa–Ⅲb stage [reference: Ⅰ–Ⅱa stage [OR (95%CI)=5.332 (1.058, 26.875), P=0.043] and increased age and HSP90α level [OR (95%CI)=1.100 (1.025, 1.180), P=0.008; OR (95%CI)=1.049 (1.029, 1.070), P<0.001] , as well as decreased PNI value [OR (95%CI)=0.772 (0.686, 0.869), P<0.001]. The area under the ROC curve after TACE in the HCC patients by serum HSP90α level in combination with PNI was 0.878 [95% CI (0.820, 0.922)] in differentiating poor prognosis or not. ConclusionThe analysis results of this study suggest that preoperative serum HSP90α level in combination with PNI has a higher predictive value for prognosis of HCC patients after TACE.