预后营养指数在结直肠肿瘤术后手术部位感染的预测作用

Preoperative prognostic nutritional index predicts postoperative surgical site infections in patients with colorectal cancer

目的 :分析预后营养指数(prognostic nutritional index,PNI)与结直肠肿瘤术后发生手术部位感染(SSI)的联系,探讨PNI作为结直肠肿瘤病人预后指标的作用价值。方法 :回顾性收集我院普外科2013年9月至2015年12月行手术治疗的332例经病理确诊结直肠肿瘤病人的临床资料,根据术后是否发生SSI将其分为感染组和对照组,通过单因素和多因素分析评价结直肠肿瘤术后的风险因素,通过ROC曲线评价PNI在SSI的预测价值。结果 :43例病人术后出现SSI,其中浅层或深层手术部位感染36例,器官/腔隙感染7例;ROC曲线分析显示,术前PNI<48对预测术后SSI的发生具有显著价值(曲线下面积=0.782,灵敏度81.1%,特异度65.8%)。多因素分析结果显示,手术时间(OR=3.42,95%CI:1.22-8.78,P=0.04)和PNI<48(OR=2.35,95%CI:1.20-4.53,P=0.03)是预测术后SSI的独立危险因素。结论 :PNI作为简单并有价值的临床指标,对于结直肠肿瘤术后预测SSI的发生具有重要的意义。

Objective： The purpose of this study was to explore the predictive value of PNI in surgical site infections （SSIs） for coloreetal cancer patients undergoing enterectomies. Methods： A retrospective review of 332 colorectal cancer patients who underwent colorectal surgery between 2014 and 2015 was performed. Univariate and multivariate analyses were conducted to identify risk factors for SSIs, and receiver operating characteristic （ROC） cure was used to quantify the effectiveness of PNI. Results： SSIs were diagnosed in 43 （12.1% ） patients, with incisional infection or deep incisional infection in 36 patients and organ/space infection in 7 patients. ROC curve analysis defined a PNI cut-off level of 48 corresponding to postoperative SSIs （area under the curve [AUC] = 0.763, 78.1% sensitivity, 62.7 % specificity）. Furthermore, a multivariate analysis indicated that operation time t〉 3 h （OR=3.42, 95 % CI： 1.22-8.78, P = 0.04） and PNI 〈 48 （OR=2.35, 95% CI： 1.20-4.53, P = 0.03） were independently associated with postoperative SSIs. Conclusion： Preoperative PNI is a simple and useful marker to predict SSIs in colorectal cancer patients after enterectomies.