Value of prognostic nutritional index in predicting the prognosis of patients with hepatic alveolar echinococcosis / 临床肝胆病杂志

ObjectiveTo investigate the value of prognostic nutritional index (PNI) in predicting the prognosis of patients with hepatic alveolar echinococcosis. MethodsA retrospective analysis was performed for the clinical data of 242 patients who were admitted to Department of Hepatopancreatobiliary Surgery, Qinghai University Affiliated Hospital, from January 2015 to December 2018 and underwent surgical treatment of hepatic alveolar echinococcosis. The results of routine blood test and liver function were collected at 1 week before surgery, and PNI was calculated. X-Tile software was used to determine the cut-off value of PNI, and according to this cut-off value, the patients were divided into high PNI group with 216 patients and low PNI group with 26 patients. The chi-square test was used for comparison of categorical data between groups; the Kaplan-Meier method was used to plot survival curves, and the log-rank test was used for comparison between groups; the Cox regression model was used to perform univariate and multivariate analyses, and hazard ratio (HR) and corresponding 95% confidence interval (CI) were calculated. ResultsPNI was associated with treatment modality, intraoperative blood loss, stage of echinococcosis, number of lesions, Child-Pugh class, aspartate aminotransferase, total bilirubin, albumin, alkaline phosphatase (ALP), prothrombin time (PT), and lymphocyte count (all P＜0.05). The low PNI group had 1-, 3-, and 5-year survival rates of 92.1%, 30.5%, and 20.3%, respectively, after surgery, while the high PNI group had 1-, 3-, and 5-year survival rates of 957%, 79.5%, and 56.9%, respectively. The mean survival time was 33.783 (95% CI: 26.450-51.355) months in the low PNI group and 51.355 (95% CI: 49.044-53.666) months in the high PNI group, and there was a significant difference between the two groups (χ2=24.626, P＜0.001). The univariate Cox regression analysis showed that PNI, surgical procedure, intraoperative blood loss, stage of echinococcosis, Child-Pugh class, complication, ALP, PT, neutrophils, and platelets were associated with the prognosis of patients with hepatic alveolar echinococcosis (all P＜0.05), and the multivariate Cox regression analysis showed that treatment modality (HR=1.461, 95%CI: 1.132-1.890, P=0.004), intraoperative blood loss (HR=6.078, 95%CI: 3.412-10.826, P＜0001), PNI(HR=0.367, 95%CI: 0.192-0.701, P=0.002), complications (HR=2.007, 95%CI: 1.204-3.346, P=0.008), and neutrophils (HR=2.772, 95%CI: 1.304-5.891, P=0.008) were independent risk factors for the prognosis of patients with hepatic alveolar echinococcosis. ConclusionPNI can be used to predict the prognosis of patients with hepatic alveolar echinococcosis. The higher the peripheral blood PNI before surgery, the better the prognosis of patients.