ABSTRACT
Objective:To investigate the association between Onodera's prognostic nutritional index (OPNI) and postoperative adverse outcomes in elderly gastrointestinal surgery patients and assess the predictive value.Methods:A total of 230 elderly patients who received gastrointestinal surgery were prospectively enrolled. Clinical data, including age, sex, preoperative laboratory parameters, surgery process and clinical outcomes, were collected. The optimal cut-off value of OPNI was obtained using NRS 2002, a well-recognized nutritional risk screening tool, as the standard. The associations of OPNI, geriatric nutritional risk index (GNRI) and albumin with in-hospital mortality, complication incidence and duration of postoperative hospital stay were evaluated using Chi-square test or nonparametric test as appropriate. Confounders were identified through univariate analysis and logistic and linear regression models were developed to validate the correlation and assess the predictive value of OPNI for postoperative clinical outcomes.Results:The optimal cut-off value for the OPNI was 41.25, which yielded a sensitivity of 72.7% and a specificity of 59.9% with area under the curve (AUC) at 0.682. The incidence of OPNI-based malnutrition (defined as OPNI < 41.25) was 50% (115/230). Univariate analysis indicated that patients with OPNI < 41.25 had a significantly higher mortality (8.70% versus 2.61%, P = 0.046) and complication incidence (20.00% versus 9.57%, P = 0.026) and significantly longer postoperative hospital stay (11.17 d versus 8.49 d, P = 0.009) than patients with OPNI ≥ 41.25. Patients with GNRI < 98 had a longer postoperative hospital stay than those with GNRI ≥ 98 (10.71 d versus 7.55 d, P = 0.001) while there was no significant difference in mortality or complication incidence between the two groups ( P > 0.05). As for subgroups divided according to albumin levels (< 35 g/L or ≥35 g/L), no significant differences in mortality, postoperative complications incidence, or duration of postoperative hospital stay were observed ( P > 0.05). Multivariate analysis verified that OPNI < 41.25 was an independent risk factor for the development of postoperative complications ( OR: 2.660, 95% CI: 1.079-6.557, P = 0.034) and prolonged postoperative hospital stay ( R2 = 0.135, regression coefficient = 2.73, P = 0.047), where the AUC of the regression model for complications was 0.812 (95% CI: 0.741-0.882). GNRI < 98 was the independent risk factor for prolonged postoperative hospital stay ( R2 = 0.134, regression coefficient = 2.797, P = 0.049). Conclusion:OPNI is an independent risk factor for adverse clinical outcomes after gastrointestinal surgery in elderly patients and demonstrates good predictive value with the cut-off value of 41.25.
ABSTRACT
Alanyl-glutamine dipeptide is an important component in parenteral nutrition, which can be decomposed into alanine and L-glutamine in vivo. It plays multiple functions including maintaining intestinal barrier, improving immunity, promoting protein synthesis, and regulating the production and release of inflammatory mediators. Substantial clinical evidences have demonstrated its favorable effectiveness and safety. Rational application of alanyl-glutamine dipeptide can reduce postoperative complications, shorten hospital stay and save medical costs. There are still controversies at home and abroad on the applicable population and dosage of alanyl-glutamine dipeptide. Chinese Society of Parenteral and Enteral Nutrition organized China's experts of related disciplines to compile international standards in accordance with the latest guidelines and consensus, so as to achieve the goal of standardized application and patient benefits.
ABSTRACT
ObjectiveTo determine the prevalence of nutritional risk and application of nutrition support in hospitalized patients in the department of general surgey,and to evaluate the relationship between nutrition support and clinical outcome as well as between nutritional risk and clinical outcome.MethodsHospitalized patients in the department of general surgery were enrolled from September 2009 to April 2010.The patients were screened using Nutritional Risk Screening 2002 ( NRS 2002) on admission.Data were collected on the application of nutrition support within 2 weeks,complication rate,length of stay,and hospital charges.ResultsAltogether 3000 patients were included in the present study.The overall prevalence of nutritional risk was 18.5％,in which gastric cancer patients showed the highest prevalence (48.3％ ).The proportion of patients receiving nutrition support was 44.1％ in those with nutritional risk and 14.3％ in those without nutritional risk.The ratio of parenteral nutrition to enteral nutrition was 1.2:1.The patients with nutritional risk had higher complication rate,longer length of stay,and higher hospital charge [24.1％ vs.14.2％,(11.1 ±4.8) daysvs.(9.6±3.7) days,(12891.5±4831.2) yuan vs.(9982.7 ±3996.4) yuan,all P=0.0000].Among the gastric cancer,colorectal cancer,and hepato-biliopancreatic cancer patients with nutritional risk,the complication rate,length of stay,and hospital charge were significantly lower in the patients receiving nutrition support than those in the patients receiving no nutrition support ( all P ＜ 0.05 ).ConclusionsA number of inpatients in general surgery department are at nutritional risk.The prevalence of nutritional risk is considerably high in gastric cancer patients.Nutritional risk is correlated with the clinical outcome of the patients.Nutrition support may improve the clinical outcome of gastric cancer,colorectal cancer,and hepato-bilio-pancreatic cancer patients.