Ann Hepatobiliary Pancreat Surg.  2021 Nov;25(4):477-484. 10.14701/ahbps.2021.25.4.477.

Preoperative Prognostic Nutritional Index is a significant predictive factor for posthepatectomy bile leakage

• Nanashima A
• Hiyoshi M
• Imamura N
• Yano K
• Hamada T
• Kai K
• Nishida T
• Uchise Y
• Sakamoto R
• Inomata M

• KMID: 2523051
• DOI: http://doi.org/10.14701/ahbps.2021.25.4.477

Abstract

Backgrounds/Aims
It is known that preoperative nutritional status can inf luence patient outcomes after hepatectomy. Prognostic Nutritional Index (PNI) is a useful parameter to ref lect 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.
Methods
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.
Results
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 (p < 0.01). Prealbumin and total cholesterol levels were significantly correlated with postoperative prothrombin activity (p < 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 (p < 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) (p < 0.05). The cut-off level of albumin was approximately 3.8 mg/dL and that of lymphocyte count was 1,320/mm^{3,/sup> .
Conclusions
Preoperative PNI ref lected perioperative liver functional status. It was a predictive parameter for postoperative complications, particularly biliary leakage.}

Keyword

Prognostic Nutritional Index; Postoperative nutritional parameters; Hepatectomy; Postoperative complications

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