Impact of Prognostic Nutritional Index on Postoperative Pulmonary Complications in Radical Cystectomy: A Propensity Score-Matched Analysis

Abstract

Background Radical cystectomy is a standard treatment for muscle-invasive bladder cancer but frequently entails postoperative pulmonary complications (PPCs). Nutrition is closely associated with postoperative outcomes. Therefore, we evaluated the impact of preoperative prognostic nutritional index (PNI) on PPCs in radical cystectomy. Methods PNI was calculated as 10 × (serum albumin) + 0.005 × (total lymphocyte count). The risk factors for PPCs were evaluated using multivariate logistic regression analysis. A receiver operating characteristic curve analysis of PNI was performed, and an optimal cut-off value was identified. Propensity score-matched analysis was used to determine the impact of PNI on PPCs. Postoperative outcomes were also evaluated. Results PPCs occurred in 112 (13.6%) of 822 patients. Multivariate logistic regression analysis identified PNI, age, and serum creatinine level as risk factors. The area under the receiver operating characteristic curve of PNI for predicting PPCs was 0.714 (optimal cut-off value: 45). After propensity score matching, the incidence of PPCs in the PNI ≤ 45 group was significantly higher compared with the PNI > 45 group (20.8% vs. 6.8%; p < 0.001), and PNI ≤ 45 was associated with a higher incidence of PPCs (odds ratio 3.308, 95% confidence interval 1.779–6.151; p < 0.001). The rates of intensive care unit admission and prolonged (> 2 days) stay thereof were higher in patients who developed PPCs. Conclusions Preoperative PNI ≤ 45 was associated with a higher incidence of PPCs in radical cystectomy, suggesting that PNI provides useful information regarding pulmonary complications after radical cystectomy.

The Association between Prognostic Nutritional Index (PNI) and Intraoperative Transfusion in Patients Undergoing Hepatectomy for Hepatocellular Carcinoma: A Retrospective Cohort Study

“…In this study, the incidence of intraoperative transfusion increased significantly in patients with a PNI cut-off value < 44. This is consistent with other previous studies suggesting 44 as the cut-off value for complications [ 32 , 33 ]. Additionally, the clinical model, combined with PNI and known risk factors, improved the predictive power for intraoperative blood transfusion.…”

Association of Preoperative Prognostic Nutritional Index and Postoperative Acute Kidney Injury in Patients with Colorectal Cancer Surgery

“…PNI comprises of assessment of albumin, a major component of plasma protein, and lymphocytes, which are important cells in immunity, indicating patient’s nutritional and immune status [ 21 ]. There have been many studies reporting that low PNI is significantly associated with postoperative complications, including surgical site infection, anastomotic leakage, bleeding, cardiopulmonary failure, and pulmonary embolism [ 22 , 23 , 24 , 25 ]. However, only few studies have reported the association between PNI and AKI in surgical patients.…”

Association of Preoperative Prognostic Nutritional Index and Postoperative Acute Kidney Injury in Patients Who Underwent Hepatectomy for Hepatocellular Carcinoma

“…The PNI, an index calculated using the serum albumin level and lymphocyte count, is another biological marker that indicates a patient’s nutritional and immune status [ 15 ] and is associated with various postoperative complications [ 28 , 29 , 30 , 31 ]. Min et al suggested that the modified PNI predicted postoperative AKI within one week in patients receiving living donor liver transplantation, which is better than the predictive ability of the conventional MELD score [ 32 ].…”