KMID : 1143920210250040477
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Annals of Hepato-Biliary-Pancreatic Surgery 2021 Volume.25 No. 4 p.477 ~ p.484
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Preoperative Prognostic Nutritional Index is a significant predictive factor for posthepatectomy bile leakage
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Nanashima Atsushi
Hiyoshi Masahide Imamura Naoya Yano Koichi Hamada Takeomi Kai Kengo Nishida Takahiro Uchise Yukako Sakamoto Risa Inomata Mayu
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Abstract
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Backgrounds/Aims: It is known that preoperative nutritional status can influence patient outcomes after hepatectomy. Prognostic Nutritional Index (PNI) is a useful parameter to reflect 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 ¡¾ 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/mm3.
Conclusions: Preoperative PNI reflected perioperative liver functional status. It was a predictive parameter for postoperative complications, particularly biliary leakage.
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KEYWORD
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Prognostic Nutritional Index, Postoperative nutritional parameters, Hepatectomy, Postoperative complications
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