Predictive Value of the Prognostic Nutrition Index for the Prognosis of Patients With Severe Burns Treated With the Meek Graft.

Abstract

The Meek technique is currently a key method for treating wounds in severely burned patients. The survival rate of skin grafts is an important factor affecting the success rate of treatment. The purpose of this study was to investigate the effect of the preoperative prognostic nutritional index (PNI) on the survival rate of skin grafts in patients treated with the Meek technique in the early stage of severe burns. We retrospectively analyzed the data of severely burned patients who were treated at the burn center between January 2013 and December 2019 and met the inclusion criteria. The albumin (ALB) level and lymphocyte count obtained 1 day before the operation was used to calculate the preoperative PNI (PNI = serum ALB level [g/L] + 5 × total number of peripheral blood lymphocytes [×109/L]). According to the survival rates of skin grafts 14 days after the operation, patients with severe burns were divided into a group with good skin graft survival (survival rate ≥75%, abbreviated as group G) and a group with poor skin graft survival (survival rate <75%, abbreviated as group P). Receiver-operating characteristic (ROC) curves and univariate and multivariate analyses were used to evaluate the predictive value of the preoperative PNI for the prognosis of patients treated with the Meek technique. One hundred and twenty-one patients were enrolled in this study. Groups G (n = 66 cases) and P (n = 55 cases) did not have significant differences in age, sex, and body mass index (P > .05). The total burned surface area, burn index, platelet-to-lymphocyte ratio, preoperative platelet count, operative time, total protein, albumin level, globulin level, and PNI were the risk factors affecting the survival of Meek grafts. The burn index was an independent risk factor for poor skin graft survival (odds ratio [OR]: 1.049, 95% confidence interval [CI]: 1.020-1.079; P < .05). The preoperative PNI was a protective factor against poor skin graft survival (OR: 0.646, 95% CI: 0.547-0.761; P < .05). The ROC curve determined that the optimal cut-off value for the preoperative PNI was 34.98. There were 59 cases with PNI > 34.98 (the high PNI group) and 62 cases with PNI < 34.98 (the low PNI group). The survival rate of skin grafts in patients with a high PNI was generally significantly higher than that of patients with a low preoperative PNI (P < .05). Five (8.47%) patients in the high PNI group died, compared with 16 (25.8%) patients in the low PNI group. The difference in the mortality rate between the two groups was significant (P < .05). Preoperative PNI can be used as a predictor of the survival rate of skin grafts in patients treated with the Meek technique in the early stage of severe burns.