Associations Between the Prognostic Nutritional Index and Morbidity/Mortality During Intestinal Resection in Patients with Ulcerative Colitis.

Abstract

Onodera's prognostic nutritional index (O-PNI) is a well-known predictor of the prognosis of several surgeries. The aim of this study was to evaluate the association between O-PNI and surgical outcome during surgery for ulcerative colitis (UC). This was a single-institution retrospective cohort study conducted in the Department of Inflammatory Bowel Disease at Hyogo College of Medicine, Japan. The preoperative predictive factors associated with mortality, morbidity, and pouch-related complications (PRCs) were examined separately from surgical procedure. A total of 1151 patients with UC who underwent surgery between January 2000 and December 2015 were included. Total colectomy (TC) alone, ileal pouch-anal anastomosis (IPAA) with ileostomy, and IPAA without ileostomy were performed in 254 patients, 736 patients, and 161 patients, respectively. Mortality and morbidity were found in nine (0.8%) and 320 (27.8%) patients, respectively. The median O-PNI score was 22.6 in patients with mortality and 35.6 in patients without mortality among TC alone (p<0.01). The significant predictive factors for mortality among TC alone were older age [p=0.03, odds ratio (OR) 6.8], higher C-reactive protein (p=0.02, OR 14.5), and O-PNI<24.9 (p=0.04, OR 5.6). Among IPAA with ileostomy, an American Society of Anesthesiologists score ≥3 (p=0.01, OR 2.3), prednisolone (PSL) dosage just before surgery ≥14mg/day (p=0.04, OR 1.8), and O-PNI<35.5 (p<0.01, OR 2.1) were predictors of PRCs. O-PNI did not predict PRCs among IPAA without ileostomy. Lower O-PNI may predict the prognosis in patients with UC. O-PNI may be a useful indicator for decision-making regarding surgical timing and procedure.