title: Preoperative prognostic nutritional index predicts postoperative surgical site infections in gastrointestinal fistula patients undergoing bowel resections.
abstract: Recent studies have implied a prognostic value of the prognostic nutritional index (PNI) in postoperative septic complications of elective colorectal surgeries. However, the evaluation of PNI in contaminated surgeries for gastrointestinal (GI) fistula patients is lack of investigation. The purpose of this study was to explore the predictive value of PNI in surgical site infections (SSIs) for GI fistula patients undergoing bowel resections.A retrospective review of 290 GI patients who underwent intestinal resections between November 2012 and October 2015 was performed. Univariate and multivariate analyses were conducted to identify risk factors for SSIs, and receiver operating characteristic cure was used to quantify the effectiveness of PNI.SSIs were diagnosed in 99 (34.1%) patients, with incisional infection identified in 54 patients (18.6%), deep incisional infection in 13 (4.5%), and organ/space infection in 32 (11.0%). receiver operating characteristic curve analysis defined a PNI cut-off level of 45 corresponding to postoperative SSIs (area under the curve [AUC] = 0.72, 76% sensitivity, 55% specificity). Furthermore, a multivariate analysis indicated that the PNI < 45 [odd ratio (OR): 2.24, 95% confidence interval (CI): 1.09-4.61, P = 0.029] and leukocytosis (OR: 3.70, 95% CI: 1.02-13.42, P = 0.046) were independently associated with postoperative SSIs.Preoperative PNI is a simple and useful marker to predict SSIs in GI fistula patients after enterectomies. Measurement of PNI is therefore recommended in the routine assessment of patients with GI fistula receiving surgical treatment.
authors.affiliation: Department of Surgery, Jinling Hospital, Medical School of Southeast University, Nanjing, China Medical School of Nanjing University, Nanjing, China.
authors.forename: Qiongyuan
authors.initials: Q
authors.lastname: Hu
authors.forename: Gefei
authors.initials: G
authors.lastname: Wang
authors.forename: Jianan
authors.initials: J
authors.lastname: Ren
authors.forename: Huajian
authors.initials: H
authors.lastname: Ren
authors.forename: Guanwei
authors.initials: G
authors.lastname: Li
authors.forename: Xiuwen
authors.initials: X
authors.lastname: Wu
authors.forename: Guosheng
authors.initials: G
authors.lastname: Gu
authors.forename: Ranran
authors.initials: R
authors.lastname: Li
authors.forename: Kun
authors.initials: K
authors.lastname: Guo
authors.forename: Youming
authors.initials: Y
authors.lastname: Deng
authors.forename: Yuan
authors.initials: Y
authors.lastname: Li
authors.forename: Zhiwu
authors.initials: Z
authors.lastname: Hong
authors.forename: Lei
authors.initials: L
authors.lastname: Wu
authors.forename: Jieshou
authors.initials: J
authors.lastname: Li
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D015897:Comorbidity; D013505:Digestive System Surgical Procedures; D005260:Female; D005747:Gastric Fistula / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015596:Nutrition Assessment; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013530:Surgical Wound Infection / Q000209:etiology*; D016896:Treatment Outcome