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Objective:To investigate the diagnostic value of prognostic nutritional index (PNI) and C-reactive protein to albumin ratio(CAR) in Crohn′s disease complicated with intra-abdominal infection (CD-IAI).Methods:From January 2016 to December 2021, the clinical data of 61 patients with Crohn′s disease (CD) and 61 patients with CD-IAI diagnosed at Nanfang Hospital, Southern Medical University were retrospectively analyzed. Crohn′s disease activity index (CDAI), Crohn′s disease endoscopic index of severity (CDEIS), laboratory parameters(white blood cell count, neutrophil ratio, platelet count, C-reactive protein (CRP), procalcitonin (PCT), D-dimer, prothrombin time (PT), fibrinogen, activated partial thromboplastin time (APTT)), PNI and CAR were compared between CD patients and CD-IAI patients. From January to May in 2022 another 30 patients with CD and 13 patients with CD-IAI diagnosed at Nanfang Hospital, Southern Medical University were selected to verify the accuracy of PNI and CAR in predicting CD-IAI. The optimal cut-off values of PNI and CAR in predicting CD-IAI, area under the curve (AUC), Youden index, sensitivity and specificity were calculated by receiver operating characteristic curve (ROC). Spearman correlation was used to analyze the correlation between PNI, CAR, CDAI, and CDEIS, and logistic regression was performed to analyze the influencing factors of CD-IAI. Independent sample t test and Mann-Whitney U test were used for statistical analysis. Results:CDAI and CDEIS were higher in CD-IAI patients than those of CD patients(256.68±8.50 vs.144.87±7.83; 3.80 (1.80, 5.40) vs. 1.20 (0.20, 2.80)), and the differences were statistically significant( t=-9.67, Z=-4.02, both P<0.001). The white blood cell count, neutrophil ratio, platelet count, CRP, PCT, D-dimer, PT, fibrinogen, and APTT of CD-IAI patients were all higher than those of CD patients (7.81×10 9/L (5.98×10 9/L, 11.39×10 9/L) vs. 5.94×10 9/L (4.86×10 9/L, 7.11×10 9/L); (73.43±10.67)% vs. (62.30±11.03)%; 360.00×10 9/L (266.50×10 9/L, 456.00×10 9/L) vs. 294.00×10 9/L (222.50×10 9/L, 356.00×10 9/L); 44.27 mg/L (16.82 mg/L, 82.65 mg/L) vs. 3.42 mg/L (0.59 mg/L, 18.33 mg/L); 0.07 μg/L (0.04 μg/L, 0.22 μg/L) vs. 0.04 μg/L (0.02 μg/L, 0.05 μg/L); 0.75 mg/L (0.32 mg/L, 2.00 mg/L) vs. 0.26 mg/L (0.15 mg/L, 0.46 mg/L); 11.90 s (11.40 s, 12.90 s) vs. 11.20 s (10.45 s, 11.70 s); 4.58 g/L (3.59 g/L, 5.59 g/L) vs. 2.99 g/L (2.17 g/L, 4.23 g/L); 30.40 s (28.30 s, 32.80 s) vs. 28.00 s (25.45 s, 31.10 s)), and the differences were statistically significant ( Z=-4.48; t=-5.66; Z=-2.71, -6.47, -3.78, -4.87, -4.87, -5.44 and -2.74; all P<0.01). The serum albumin level of CD-IAI patients was lower than that of CD patients (34.10 g/L (31.40 g/L, 36.90 g/L) vs. 39.00 g/L (35.10 g/L, 43.20 g/L)), and the difference was statistically significant( Z=-3.91, P<0.001). The PNI of CD-IAI patients was lower than that of CD patients (41.65, (38.58, 44.58) vs. 47.80 (40.45, 52.98)), while CAR was higher than that of CD patients (1.29 (0.48, 2.67) vs. 0.10 (0.01, 0.46)), and the differences were statistically significant ( Z=-3.83 and -6.44, both P<0.001). The results of Spearman correlation analysis showed that PNI was negatively correlated with CAR, CDAI, and CDEIS ( r=-0.64, -0.53 and -0.50, all P<0.001), and CAR was positively correlated with CDAI and CDEIS ( r=0.63 and 0.52, both P<0.001). The results of logistic regression analysis showed that high level of PNI was a protective factor for CD-IAI ( OR= 0.911, 95% confidence interval 0.864 to 0.961), and high level of CAR was a risk factor for CD-IAI ( OR=2.846, 95% confidence interval 1.745 to 4.644). The results of ROC indicated that the AUC value of combined PNI and CAR in the diagnosis of CD-IAI was 0.829 ( P<0.001), Youden index was 0.541, the sensitivity was 0.934, and the specificity was 0.607. The sensitivity and specificity of optimal cut-off value of the combination of PNI and CAR in predicting CD-IAI were 0.692 and 0.967. Conclusions:PNI and CAR have certain diagnostic value in CD-IAI. The risk of CD-IAI is high when PNI <45.550 and CAR >0.466.
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Objective To investigate the risk factors of abdominal infection after orthotopic liver transplantation. Methods Clinical data of 284 recipients undergoing orthotopic liver transplantation were retrospectively analyzed. All recipients were divided into the infection group (n=51) and non-infection group (n=233) according to the incidence of postoperative abdominal infection. Univariate and multivariate logistic regression analyses were used to identify the risk factors of abdominal infection. Nomogram prediction models were constructed and the prediction efficiency of these models was evaluated. The predictive value of continuous variables for abdominal infection was assessed. Results Among 284 recipients, 51 developed abdominal infection with an incidence of 18.0%. Diabetes mellitus before surgery[odds ratio (OR) 2.66, 95% confidence interval (CI) 1.13-6.14, P=0.013], long operation time (OR 1.98, 95%CI 1.03-3.57, P=0.038), low prognostic nutritional index (PNI) (OR 2.18, 95%CI 1.06-4.44, P=0.023), high systemic immune-inflammation index (SII) (OR 2.21, 95%CI 1.06-4.78, P=0.012) and high C-reactive protein/albumin ratio (CAR) (OR 1.90, 95%CI 1.05-3.49, P=0.029) were independent risk factors for abdominal infection after liver transplantation. The area under curve (AUC) of nomogram model for predicting abdominal infection after liver transplantation was 0.761. The standard model yielded high consistency. CAR, PNI and SII were all predictors of abdominal infection after liver transplantation (all P < 0.05), with AUC of 0.648, 0.611 and 0.648, and cut-off values of 2.75, 43.15 and 564.50, respectively. Conclusions CAR, SII and PNI are predictors of abdominal infection after liver transplantation. The nomogram model based on PNI, SII and CAR may effectively predict the incidence of abdominal infection after liver transplantation.
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Objective@#To investigate the relationship between systemic inflammatory markers such as neutrophil/lymphocyte ratio (NLR) and C-reactive protein/albumin ratio (CAR), and lymph node metastasis in patients with cN0 gastric cancer. To establish a nomogram model to predict the risk of lymph node metastasis in patients with cN0 gastric cancer.@*Methods@#The preoperative systemic inflammatory markers and clinical data of 134 patients with cN0 gastric cancer were retrospectively analyzed, and these markers of patients with negative (pN0) or positive (pN+ ) lymph node metastasis in postoperative pathological diagnosis were compared. The receiver operating characteristic (ROC) curve was used to evaluate the predictive effect of preoperative systemic inflammatory markers on lymph node metastasis. The influencing factors for lymph node metastasis were assessed by univariate analysis and multivariate logistic regression analysis. A nomogram subsequently established by R software was validated by Bootstrap resampling as internal validation.@*Results@#Compared with pN0 group, NE (P=0.022), CRP (P<0.001), NLR (P<0.001), PLR (P=0.003) and CAR (P<0.001) were higher, LY (P=0.003) and Alb (P=0.042) were lower in pN+ group. ROC curve analysis showed that the area under the curve (AUC) of postoperative pathological lymph node metastasis in patients with cN0 gastric cancer diagnosed by NLR, PLR and CAR were 0.687, 0.651 and 0.694, respectively, and the best cutoff values were 2.12, 113.59 and 0.02, respectively. The corresponding sensitivity and specificity were 62.9% and 72.2%, 77.4% and 48.6%, 74.2% and 58.3%, respectively. Univariate analysis showed that tumor size, depth of invasion, NLR, PLR and CAR were associated with lymph node metastasis in cN0 gastric cancer patients (all P<0.05). Multivariate analysis showed that depth of invasion, NLR and CAR were independent influencing factors of lymph node metastasis in patients with cN0 gastric cancer. OR were 8.084, 3.540 and 3.092, respectively (all P<0.05). The C-index of the nomogram model was 0.847 (95% CI: 0.782-0.915). The predicting calibration curve was properly fit with the ideal curve in calibration chart.@*Conclusion@#Combination of NLR and CAR to establish a nomogram model has a good consistency and can accurately predict the risk of lymph node metastasis in patients with cN0 gastric cancer.
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Objective@#To evaluate the clinical significance of C-reactive protein/albumin ratio in predicting the postoperative prognosis of pancreatic cancer patients.@*Methods@#The clinical date of 97 patients with resectable pancreatic cancers who treated at Department of Hepatobiliary and Pancreatic Surgery, the third Affiliated Hospital of Soochow University from January 2005 to December 2015 were analyzed retrospectively. The cut-off value of CRP/Alb ratio was determined by the receiver operating characteristic(ROC) curve. According to the CRP/Alb ratio, patients were respectively divided into two groups: the high group(CRP/Alb ratio≥0.109) and the low group(CRP/Alb<0.109). The relationships between CRP/Alb ratio and clinical characteristics were analyzed by χ2 test. Median survival and 1-year overall survival rate(OS) was calculated by Kaplan-Meier method.The risk factors of patients with poor prognosis were analyzed by univariate and multivariate Cox regression analysis model.@*Results@#Tumor TNM stage(χ2=4.280, P=0.039) and differentiation(χ2=6.635, P=0.010) had significant relationship with CRP/Alb ratio. The median survival of higher CRP/Alb ratio group and lower CRP/Alb ratio group was 15 months and 23 months respectively. Compared with lower CRP/Alb ratio group, the 1-year OS of higher CRP/Alb ratio group decreased remarkablely, and the difference was statistically(χ2=10.207, P=0.001). Moreover, median survival and OS were decreased in patients with advanced age(≥65 years old: χ2 =5.338, P=0.021), high TNM stage(ⅡB-Ⅲ: χ2 =10.529, P=0.001), poor tumor differentiation(χ2=5.380, P=0.020), vascular invasion(χ2 =7.856, P=0.005) and positive surgical margin(χ2=9.059, P=0.003). A high CRP/Alb ratio was identified as an independent risk factor of poor prognosis for patients with pancreatic cancer(HR=1.832, 95% CI: 1.067-3.144, P=0.028). Besides, old age(HR=1.684, P=0.014), high TNM stage(HR=1.666, P=0.031), vascular invasion(HR=1.834, P=0.024) and positive surgical margin(HR=2.205, P=0.023) were also included.@*Conclusion@#Preoperative CRP/Alb ratio can be an important clinical factor for assessing the prognosis of patients with resectable pancreatic cancers, and high CRP/Alb ratio suggests poor prognosis.