Value of Preoperative Modified Body Mass Index in Predicting Postoperative 1-Year Mortality

Effect of Preoperative Malnutrition Based on Albumin and BMI on Hepatocellular Carcinoma Surgery and Prediction of Risk Factors of Complications

BACKGROUND

To investigate the correlation between preoperative malnutrition and perioperative variables in patients with hepatocellular carcinoma (HCC) and to analyze the risk factors of complications after HCC resection.

METHODS

All patients who underwent hepatectomy because of HCC in the First Affiliated Hospital of Chongqing Medical University from June 1, 2018, to December 1, 2021, were analyzed retrospectively. Preoperative malnutrition was defined as body mass index (BMI) < 18.5 kg/m2 or serum albumin level < 3.5 g/dL within 30 days before operation.

RESULTS

A total of 415 patients with HCC hepatectomy were included, and 75 (18.1%) were classified as malnutrition group. In the malnutrition group, blood loss (662.1 ± 748.1 VS 404.6 ± 681.9, P = 0.002), transfusion rate (36.0% VS 13.5%, P < 0.001), postoperative hospital stays (13.3 ± 9.6 VS 10.1 ± 4.2, P < 0.001), 30-day postoperative mortality (4.0 VS 0.6%, P = 0.043), complications rate (68% VS 34.8%, P < 0.001), and severe complication rate (17.3% VS 2.4%, P < 0.001) were significantly higher than those in the well-nourished group. Multivariate analysis showed that age (HR 1.037, 95% CI 1.015-1.059, P = 0.001), preoperative malnutrition (HR 2.933, 95% CI 1.515-5.679, P = 0.001), simultaneous cholecystectomy (HR 2.004, 95% CI 1.168-3.440, P = 0.012), cirrhosis (HR 4.997, 95% CI 2.864-8.718, P < 0.001), and transfusion (HR 5.166, 95% CI 2.272-11.748, P < 0.001) were independent risk factors for postoperative complications. In addition, preoperative malnutrition (HR 8.209, 95% CI 2.711-24.864, P < 0.001) and operation time (HR 1.088, 95% CI 1.003-1.103, P = 0.004) were independent risk factors for severe complications.

CONCLUSION

Preoperative malnutrition can adversely affect the outcome of HCC resection. For patients with advanced age, cirrhosis, and malnutrition, preoperative planning is very important, and we should be more careful during the operation to avoid transfusion caused by bleeding and not to carry out preventive cholecystectomy, which are helpful to reduce the occurrence of postoperative complications.

The Impact of Modified Body Mass Index on Clinical Prognosis in the Elderly With Acute Ischemic Stroke

OBJECTIVES

The modified body mass index (mBMI) combines the body mass index and serum albumin, accurately reflecting the nutritional status. It remains uncertain whether modified body mass index influences neurological function and clinical prognosis in elderly patients with acute ischemic stroke.

METHODS

We divided the cohort into quartiles of mBMI (1 to 4). The primary outcome was analyzed using the percentage of patients with a 90-day modified Rankin scale (mRS) score of 0 to 1. There were 7 secondary outcomes, including the disability level at 90 days and the National Institute of Health Stroke Scale (NIHSS) score at 14 and 90 days.

RESULTS

mBMI was negatively associated with clinical prognosis at 90-day mRS score in the primary outcome (β=-0.167; 95% CI -0.311 to 0.023, P=0.023). Moreover, mBMI1 (<896.72) and primary outcomes (β=0.438; 95% CI: -0.018 to 0.894) were positively correlated with higher mBMI. Moreover, the number and percentage of patients completing all the duties and activities are also higher. Age-adjusted Charlson comorbidity index (aCCI) and posterior circulation lesion were positively associated with the clinical prognosis 90-day mRS score in the primary outcome (β=2.218; 95% CI: 1.144-4.300, β=2.771; 95% CI: 1.700-4.516). However, BMI and serum albumin were not associated the with clinical prognosis primary outcome. BMI negatively correlates with secondary outcomes (NIHSS at discharge, β=-0.023; 95% CI: -0.102 to 0.057).

CONCLUSIONS

Our study revealed that mBMI and not BMI could be a better primary outcome predictor in the elderly with acute ischemic stroke, and lower mBMI showed a worse prognosis.

Pathophysiology, Functional Assessment and Prognostic Implications of Nutritional Disorders in Systemic Amyloidosis

Gastrointestinal involvement is a common clinical feature of patients with systemic amyloidosis. This condition is responsible for invalidating gastrointestinal symptoms, a significant macro and micronutrient deficit, and is a marker of disease severity. Gastrointestinal involvement should be actively sought in patients with systemic amyloidosis, while its diagnosis is challenging in patients with isolated gastrointestinal symptoms. The nutritional status in systemic amyloidosis plays an essential role in the clinical course and is considered a significant prognostic factor. However, the definition of nutritional status is still challenging due to the lack of internationally accepted thresholds for anthropometric and biochemical variables, especially in specific populations such as those with systemic amyloidosis. This review aims to elucidate the fundamental steps for nutritional assessment by using clinical and instrumental tools for better prognostic stratification and patient management regarding quality of life and outcomes.

Using Routine Laboratory Markers and Immunological Indicators for Predicting Pneumocystis jiroveci Pneumonia in Immunocompromised Patients

Background

Pneumocystis jiroveci pneumonia (PJP) is the most common opportunistic infection in immunocompromised patients. The accurate prediction of PJP development in patients undergoing immunosuppressive therapy remains challenge.

Methods

Patients undergoing immunosuppressive treatment and with confirmed pneumocystis jiroveci infection were enrolled. Another group of matched patients with immunosuppressant treatment but without signs of infectious diseases were enrolled to control group.

Results

A total of 80 (40 PJP, 40 non-PJP) participants were enrolled from Tongji Hospital. None of the patients were HIV positive. The routine laboratory indicators, such as LYM, MON, RBC, TP, and ALB, were significantly lower in PJP patients than in non-PJP patients. Conversely, LDH in PJP patients was significantly higher than in non-PJP controls. For immunological indicators, the numbers of T, B, and NK cells were all remarkably lower in PJP patients than in non-PJP controls, whereas the functional markers such as HLA-DR, CD45RO and CD28 expressed on CD4⁺ or CD8⁺ T cells had no statistical difference between these two groups. Cluster analysis showing that decrease of host immunity markers including CD3⁺, CD4⁺ and CD8⁺ T cells, and increase of tissue damage marker LDH were the most typical characteristics of PJP patients. A further established model based on combination of CD8⁺ T cells and LDH showed prominent value in distinguishing PJP from non-PJP, with AUC of 0.941 (95% CI, 0.892-0.990).

Conclusions

A model based on combination of routine laboratory and immunological indicators shows prominent value for predicting the development of PJP in HIV-negative patients undergoing immunosuppressive therapy.

Impact of preoperative malnutrition, based on albumin level and body mass index, on operative outcomes in patients with pancreatic head cancer

BACKGROUND

To investigate whether preoperative malnutrition in patients who underwent curative pancreaticoduodenectomy (PD) in pancreatic head cancer correlated with short-term outcomes.

METHODS

This study was a retrospective review of medical records from January 2004 to December 2018. Preoperative malnutrition was defined as body mass index (BMI) <18.5 kg/m² , or hypoalbuminemia with serum albumin level < 3.5 g/dL within 30 days before surgery.

RESULTS

Of the 289 eligible patients, 60 patients (20.7%) were classified as the malnutrition group. The estimated blood loss (EBL, mL) (964.1 ± 879.7 vs 597.7 ± 501.7, P = .044) and transfusion rate (51.7% vs 18.8%, P < .001) was significantly higher in the malnutrition group than no-malnutrition group. The hospital stay (days) (20.5 ± 12.2 vs 18.1 ± 13.6, P = .05) was significantly longer in the malnutrition group. The open conversion rate (45.4% vs 6.67%, P < .001) and major complication rate (36.7% vs 21.8%, P = .032) was significantly higher in the malnutrition group. In multivariate analysis, preoperative malnutrition was found to be the predictor of postoperative complication (HR 1.971 95% confidence interval 1.071-3.624, P = .029).

CONCLUSION

Preoperative malnutrition in patients who underwent curative PD for pancreatic head cancer is associated with adverse short-term outcomes.

Perioperative Serum Calcium and Phosphorus Levels are Associated with Hospital Costs and Length of Stay after Major Abdominal Surgery

This study aimed to identify an association between serum calcium (Ca) and phosphate (P) levels, tested during the pre- and postoperative period, with hospital costs and length of hospital stay (LOS) of patients who underwent major abdominal surgery. This retrospective cohort study analyzed the medical records of patients who underwent major abdominal surgery. A total of 3893 patients were included in the analysis, and multivariable linear regression analysis was performed. For a 1 mg/dL increase in preoperative Ca, total hospital costs decreased by 3997.9 dollars (coefficient: −3997.9, 95% confidence interval (CI): −4900.5, −30,953; p-value < 0.01), and for a 1 mg/dL increase in postoperative P, total hospital costs decreased by 702.5 dollars (coefficient: −702.5, 95% CI: −1274.5, −67.3; p-value = 0.03). Furthermore, for a 1 mg/dL increase in preoperative Ca, LOS decreased by 2.9 days (coefficient: −2.9, 95% CI: −3.7, −2.1; p-value < 0.01). For a 1 mg/dL increase in postoperative P, LOS decreased by 3.4 days (coefficient: −3.4, 95% CI: −4.2, −2.6; p-value < 0.01). This study suggested preoperative Ca and postoperative P could be useful indicators for the reduction of hospital costs and decrease in LOS from the perspective of enhanced recovery after surgery.

Association between Modified Body Mass Index and 30-Day and 1-Year Mortality after Intensive Care Unit Admission: A Retrospective Cohort Study

Because conventional body mass index (cBMI) does not reflect fluid accumulation, modified BMI (mBMI, serum albumin multiplied by cBMI) is a more accurate measure of malnutrition status. This study aimed to determine whether mortality after intensive care unit (ICU) admission was associated with cBMI, mBMI, and/or serum albumin levels. The medical records of patients who were admitted to a tertiary hospital ICU between 1 January 2012 and 31 July 2016 were retrospectively reviewed. In total, 6169 ICU-admitted patients were included in the analyses. Multivariate Cox regression analyses revealed that low cBMI, mBMI and albumin level were significantly associated with 30-day and 1-year mortality after ICU admission (hazard ratio < 1.0, p < 0.05). The adjusted area under the curve (AUC) of mBMI for 1-year mortality was significantly higher than that of cBMI (p < 0.001), but not significantly different from that of albumin level (p = 0.098). Low values of mBMI, cBMI and albumin were independently associated with 30-day and 1-year mortality after ICU admission. Combining cBMI and albumin (mBMI) did not increase the validity of the AUC of albumin for 1-year mortality after ICU admission. Our study showed that serum albumin alone, rather than mBMI (combining cBMI), is recommended in predicting mortality among ICU patients.