P291 Can the prognostic index be a predicting factor for mortality and morbidity in intestinal resection of patients with ulcerative colitis?

Abstract

Ulcerative colitis (UC) is well known as a gut immune disorder and is often treated with immunosuppressive therapies. Significant associations between increasing age, the presence of comorbid disease and mortality were found in a previous study, although disease-specific factors such as the severity or extent of colitis were associated with emergent colectomy but not mortality. Currently, besides the patient’s background information and the above risk factors, which cannot be avoided in the clinical course and especially in urgent/emergent surgery, we have no other predicting factor for mortality and morbidity with a definite index. Onodera’s Prognostic Nutritional Index (O-PNI) is a well-known predictor for 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. This was a single-institutional retrospective cohort study conducted in the Department of inflammatory bowel disease at Hyogo College of Medicine, Japan. All patients who underwent surgery for UC at our institution between January and 2000 December 2015 were included. The pre-operative predictive factors that were associated with mortality, morbidity and pouch-related complications (PRC) were examined distinct from surgical procedure. PRCs were defined as pelvic bleeding or pelvic sepsis, including anastomotic leakage or pelvic abscess. A total of 1,151 patients 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 9 (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 predicting factors for mortality among TC alone were elder patients (p = 0.03, odds ratio (OR) 6.8), higher C-reactive protein (CRP) (p = 0.02, OR14.5), and O-PNI<24.9 (p = 0.04, OR5.6). Among IPAA with ileostomy, American society of anaesthesiologist score ≥3 (p = 0.01, OR = 2.3), PSL dose just before surgery ≥14 mg/day (p = 0.04, OR1.8), and O-PNI <35.5 (p < 0.01, OR = 2.1) were selected as predictors for PRC. O-PNI could not predict the PRC among IPAA without ileostomy. Lower O-PNI may predict the prognosis in patients with UC. O-PNI may be useful indicator for decision making for surgical timing and procedure. In addition, in patients with O-PNI below 35, total colectomy alone without pouch reconstruction may be better for avoiding from PRC.