Association Between Nutritional Status, Inflammatory Condition, and Prognostic Indexes with Postoperative Complications and Clinical Outcome of Patients with Gastrointestinal Neoplasia

Abstract

The aim of this study is to describe and relate nutritional and inflammatory status and prognostic indexes with postoperative complications and clinical outcome of patients with gastrointestinal malignancies. Twenty-nine patients were evaluated; nutritional assessment was carried out by subjective and objective parameters; albumin, pre-albumin, C-reactive protein (CRP), and alpha-1-acid glycoprotein (AGP) were determined. To assess prognosis, the Glasgow scale, the Prognostic Inflammatory Nutritional Index (PINI), and CRP/albumin ratio were used; the clinical outcomes considered were hospital discharge and death. A high Subjective Global Assessment (SGA) score was associated with the occurrence of postoperative complications: 73% of the patients with postoperative complications had the highest SGA score, but only 6% of those without postoperative complications had the highest SGA score (P < 0.001). Greater occurrence of death was observed in patients with a high SGA score, low serum albumin, increased CRP, PINI > 1, and Glasgow score 2. There was a positive correlation between weight loss percentage with serum CRP levels (P = 0.002), CRP/albumin (P = 0.002), PINI (P = 0.002), and Glasgow score (P = 0.000). This study provides evidence that the assessment of the nutritional status and the use of prognostic indexes are good tools for predicting postoperative complications and clinical outcome in patients with gastrointestinal neoplasia.

Inflammatory and nutritional statuses of patients submitted to resection of gastrointestinal tumors

“…In our study, several inflammatory markers were altered, especially in patients with high weight loss and malnourished, demonstrating that, as marker values were inadequate, inflammation was worse and %WL was higher. Lima et al 16 and Costa et al 19 , and the association between these markers and nutritional status has been previously assessed 14,22 . A recent Asian study of 64 patients with esophageal cancer found a strong association between nutritional status by PG-SGA and performance scores.…”

“…In our study, the PG-SGA 24 . Some studies found a positive association between altered CRP levels and weight loss in patients with GIT tumors 16,19,25 . .…”

“…We also assessed the CRP/albumin ratio (mPINI), considered an alternative for the simplification of the original formula of the Inflammatory and Nutritional Prognostic Index (PINI) to determine the association between the nutritional status and the systemic inflammatory response in patients with gastrointestinal cancer 16,19 . In our study, the PG-SGA 24 .…”

“…Recently, studies have demonstrated an important association between nutritional depletion and inflammation in cancer patients [4][5][6]14,16,17,[19][20][21][22] , including GIT tumors. Since cancer patients are in a constant state of inflammation, and considering the role of this systemic inflammation in progressive weight loss and muscle mass, cancer cachexia can be identified by the presence and alteration of certain inflammatory markers [5][6][7] .…”

Integrative Assessment of Pretreatment Inflammation-, Nutrition-, and Muscle-Based Prognostic Markers in Patients with Muscle-Invasive Bladder Cancer Undergoing Radical Cystectomy

“…For example, the prognostic markers for urogenital cancer and multiple myeloma include elevated values for C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), and the Glasgow Prognostic Score (GPS) [4,9,13,14] . Moreover, several reports have indicated that systemic inflammation plays a critical role in the pathogenesis of malnutrition, weight loss, and muscle loss in cachexia cases [15][16][17][18] . Abdominal computed tomography (CT) and spirometry are routinely performed during preoperative preparations, which allows researchers to calculate psoas major muscle mass and respiratory muscle strength (i.e., peak expiratory flow [PEF]).…”