Clinical Significance of Prognostic Nutrition Index in Patients with Crohn’s Disease after Primary Bowel Resection
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Purpose: Although advancements in medical treatments have been made, approximately half of patients with intestinal Crohn’s disease (CD) require intestinal resections during their lifetime. It is well-known that the nutritional status of CD patients can impact postoperative morbidity. The objective of this study was to evaluate the clinical significance of prognostic nutritional index (PNI) in patients with intestinal CD who underwent primary bowel resection. Materials and Methods: We retrospectively investigated patients who were diagnosed with CD and underwent intestinal surgery at Severance Hospital between January 2005 and October 2018. The patients were divided into two groups: PNI ≤40 (n=150) and PNI >40 (n=77). We assessed the clinical significance of PNI in terms of the incidence of postoperative infectious complications (PICs) and the postoperative recurrence of CD. Results: The low PNI group had significantly higher rates of infectious complications (32.0% vs. 10.4%, p=0.001) compared to the high PNI group. Multivariable analysis identified low PNI (≤40) and longer operation time (>180 min) as independent risk factors associated with PICs [odds ratio (OR)=2.754, 95% confidence interval (CI)=1.140–6.649, p=0.024; OR=2.986, 95% CI=1.451–6.143, p=0.003]. PICs were significantly associated with surgical recurrence (hazard ratio=2.217, 95% CI=1.064–4.617, p=0.034). Conclusion: Preoperative PNI could serve as a predictive factor for PICs in CD patients who undergo intestinal resection. Additionally, PICs are significantly associated with a higher risk of surgical recurrence in CD.
Abstract
Purpose: Although advancements in medical treatments have been made, approximately half of patients with intestinal Crohn’s disease (CD) require intestinal resections during their lifetime. It is well-known that the nutritional status of CD patients can impact postoperative morbidity. The objective of this study was to evaluate the clinical significance of prognostic nutritional index (PNI) in patients with intestinal CD who underwent primary bowel resection. Materials and Methods: We retrospectively investigated patients who were diagnosed with CD and underwent intestinal surgery at Severance Hospital between January 2005 and October 2018. The patients were divided into two groups: PNI ≤40 (n=150) and PNI >40 (n=77). We assessed the clinical significance of PNI in terms of the incidence of postoperative infectious complications (PICs) and the postoperative recurrence of CD. Results: The low PNI group had significantly higher rates of infectious complications (32.0% vs. 10.4%, p=0.001) compared to the high PNI group. Multivariable analysis identified low PNI (≤40) and longer operation time (>180 min) as independent risk factors associated with PICs [odds ratio (OR)=2.754, 95% confidence interval (CI)=1.140–6.649, p=0.024; OR=2.986, 95% CI=1.451–6.143, p=0.003]. PICs were significantly associated with surgical recurrence (hazard ratio=2.217, 95% CI=1.064–4.617, p=0.034). Conclusion: Preoperative PNI could serve as a predictive factor for PICs in CD patients who undergo intestinal resection. Additionally, PICs are significantly associated with a higher risk of surgical recurrence in CD.
참고문헌 (38)
- Torres J, "Crohn’s disease", Lancet, 389, pp.1741~1755 (2017)
- Yang SK, "Epidemiology of inflammatory bowel disease in the Songpa-Kangdong district, Seoul, Korea, 1986-2005 : a KASID study", Inflamm Bowel Dis, 14, pp.542~549 (2008)
- Baek SJ, "Current status and trends in inflammatory bowel disease surgery in Korea : analysis of data in a nationwide registry", Ann Coloproctol, 34, pp.299~305 (2018)
- Freeman HJ, "Natural history and long-term clinical course of Crohn’s disease", World J Gastroenterol, 20, pp.31~36 (2014)
- Bernell O, "Risk factors for surgery and recurrence in 907 patients with primary ileocaecal Crohn’s disease", Br J Surg, 87, pp.1697~1701 (2000)
- Ge X, "Prevalence and predictors of surgical site infections after bowel resection for Crohn’s disease : the role of dual-ring wound protector", Int J Colorectal Dis, 34, pp.879~887 (2019)
- Peyrin-Biroulet L, "The natural history of adult Crohn’s disease in population-based cohorts", Am J Gastroenterol, 105, pp.289~297 (2010)
- Zhou W, "Prognostic nutritional index predicts short-term postoperative outcomes after bowel resection for Crohn’s disease", Nutr Clin Pract, 32, pp.92~97 (2017)
- Galata C, "Risk factors for early postoperative complications in patients with Crohn’s disease after colorectal surgery other than ileocecal resection or right hemicolectomy", Int J Colorectal Dis, 34, pp.293~300 (2019)
- Kang WM, "Application of the Onodera prognostic nutrition index and neutrophil-to-lymphocyte ratio in risk evaluation of postoperative complications in Crohn’s disease", Sci Rep, 7, pp.8481~ (2017)
- Dong X, "Prognostic significance of the controlling nutritional status(CONUT)score in predicting postoperative complications in patients with Crohn’s disease", Sci Rep, 10, pp.19040~ (2020)
- Brennan GT, "Does preoperative enteral or parenteral nutrition reduce postoperative complications in Crohn’s disease patients : a metaanalysis", Eur J Gastroenterol Hepatol, 30, pp.997~1002 (2018)
- Iesalnieks I, "Postoperative morbidity after bowel resections in patients with Crohn’s disease:risk, management strategies, prevention", Z Gastroenterol, 50, pp.595~600 (2012)
- Kanda M, "Nutritional predictors of postoperative outcome in pancreatic cancer", Br J Surg, 98, pp.268~274 (2011)
- Mohri Y, "Prognostic nutritional index predicts postoperative outcome in colorectal cancer", World J Surg, 37, pp.2688~2692 (2013)
- Pinato DJ, "A novel, externally validated inflammation-based prognostic algorithm in hepatocellular carcinoma : the prognostic nutritional index(PNI)", Br J Cancer, 106, pp.1439~1445 (2012)
- Satsangi J, "The Montreal classification of inflammatory bowel disease : controversies, consensus, and implications", Gut, 55, pp.749~753 (2006)
- Onodera T, "Prognostic nutritional index in gastrointestinal surgery of malnourished cancer patients", Nihon Geka Gakkai Zasshi, 85, pp.1001~1005 (1984)
- Gionchetti P, "3rd European evidence-based consensus on the diagnosis and management of Crohn’s disease 2016 : part 2 : surgical management and special situations", J Crohns Colitis, 11, pp.135~149 (2017)
- Na SY, "Korean clinical practice guidelines on biologics and small molecules for moderate-to-severe ulcerative colitis", Intest Res, 21, pp.61~87 (2023)
- Koh SJ, "Korean clinical practice guidelines on biologics for moderate to severe Crohn’s disease", Intest Res, 21, pp.43~60 (2023)
- Soeters PB, "Hypoalbuminemia : pathogenesis and clinical significance", JPEN J Parenter Enteral Nutr, 43, pp.181~193 (2019)
- Zhu Y, "Body mass index is a practical preoperative nutritional index for postoperative infectious complications after intestinal resection in patients with Crohn’s disease", Medicine(Baltimore), 96, pp.e7113~ (2017)
- Galata C, "Skeletal muscle mass index predicts postoperative complications in intestinal surgery for Crohn’s disease", JPEN J Parenter Enteral Nutr, 44, pp.714~721 (2020)
- Ge X, "Preoperative hypoalbuminemia is an independent risk factor for postoperative complications in Crohn’s disease patients with normal BMI : a cohort study", Int J Surg, 79, pp.294~299 (2020)
- Petrie HT, "Inhibition of human cytotoxic T lymphocyte activity in vitro by autologous peripheral blood granulocytes", J Immunol, 134, pp.230~234 (1985)
- Gil-Borras R, "B1a lymphocytes(CD19+CD5+)deficiency in patients with Crohn’s disease and its relation with disease severity", Dig Dis, 36, pp.194~201 (2018)
- Brouquet A, "Anti-TNF therapy is associated with an increased risk of postoperative morbidity after surgery for ileocolonic Crohn disease : results of a prospective nationwide cohort", Ann Surg, 267, pp.221~228 (2018)
- Frolkis A, "Postoperative complications and emergent readmission in children and adults with inflammatory bowel disease who undergo intestinal resection : a population-based study", Inflamm Bowel Dis, 20, pp.1316~1323 (2014)
- Patel SV, "Laparoscopic surgery for Crohn’s disease : a meta-analysis of perioperative complications and long term outcomes compared with open surgery", BMC Surg, 13, pp.14~ (2013)
- Buchs NC, "Incidence, consequences, and risk factors for anastomotic dehiscence after colorectal surgery : a prospective monocentric study", Int J Colorectal Dis, 23, pp.265~270 (2008)
- Konishi T, "Risk factors for anastomotic leakage after surgery for colorectal cancer : results of prospective surveillance", J Am Coll Surg, 202, pp.439~444 (2006)
- Kanazawa A, "Risk factors for postoperative intra-abdominal septic complications after bowel resection in patients with Crohn’s disease", Dis Colon Rectum, 55, pp.957~962 (2012)
- Tang S, "Compare risk factors associated with postoperative infectious complication in Crohn’s disease with and without preoperative infliximab therapy : a cohort study", Int J Colorectal Dis, 35, pp.727~737 (2020)
- Kim SB, "Risk factors for postoperative recurrence in Korean patients with Crohn’s disease", Gut Liver, 14, pp.331~337 (2020)
- Buisson A, "Factors associated with anti-tumor necrosis factor effectiveness to prevent postoperative recurrence in Crohn’s disease", Intest Res, 20, pp.303~312 (2022)
- Singh A, "Use of thiopurines in inflammatory bowel disease : an update", Intest Res, 20, pp.11~30 (2022)
- Poylin VY, "Vedolizumab does not increase perioperative surgical complications in patients with inflammatory bowel disease, cohort study", Intest Res, 20, pp.72~77 (2022)