Zhongguo quanke yixue (Apr 2024)
Comparison of the Predictive Value of Four Nutritional Evaluation Methods for Postoperative Complications of Lumbar Degenerative Diseases
Abstract
Background The occurrence of postoperative complications in lumbar degenerative disease (LDD) is closely related to malnutrition, and currently there is a lack of nutritional evaluation methods that can effectively, objectively, and comprehensively assess the nutritional status of LDD patients and predict the occurrence of postoperative complications. Objective To compare the predictive value of four nutritional evaluation methods of Prognostic Nutritional Index (PNI), Controlling Nutritional Status (CONUT), Naples Prognostic Score (NPS) and High-sensitivity Modified Glasgow Prognostic Score (HS-mGPS) for postoperative complications in patients with LDD, so as to formulate a precise nutritional intervention plan and effectively prevent complications. Methods A total of 201 patients diagnosed with LDD and underwent open surgery in Spine Surgery Department of Xiangya Hospital of Central South University from December 2021 to July 2022 were selected as the study subjects, four nutritional evaluation methods of PNI, CONUT, NPS and HS-mGPS were applied to assess the preoperative nutritional status of the patients, respectively, and occurrence of postoperative complications from postoperative period to hospital discharge were observed. The patients were divided into the complication group and non-complication group according to the occurrence of postoperative complications to analyze and compare the difference in clinical characteristics between the two groups; the optimal cut-off values of different nutritional evaluation methods were calculated by plotting the receiver operating characteristic (ROC) curve, and the prediction efficiency of different evaluation methods was compared, the area under curve (AUC) was compared by using MedCalc software. Multivariate Logistic regression model was used to analyze the correlation between different nutritional evaluation methods and postoperative complications. Results Postoperative complications occurred in 60 patients with an incidence rate of 29.8%. The comparison of clinical characteristics data showed statistically significant differences in age, gender, intraoperative bleeding, surgical segment, PNI, CONUT, and NPS scores between the complication group and non-complication group (P<0.05). The optimal cut-off values of PNI, CONUT, NPS, and HS-mGPS for predicting postoperative complications of LDD were calculated by using ROC curve were 47.5, 2 scores, 1 score, and 1 score, respectively, and the different nutritional evaluation methods were compared within the group based on the cut-off values, showing that low PNI score, high CONUT score, and high NPS score were associated with postoperative complications (P<0.01), while high HS-mGPS score was not associated with postoperative complications (P=0.815). The comparison of AUC showed statistically significant differences between CONUT and HS-mGPS (Z=4.961, P<0.000 1), CONUT and NPS (Z=2.534, P=0.011 3), CONUT and PNI (Z=3.455, P=0.000 6), HS-mGPS and NPS (Z=3.349, P=0.000 8), NPS and PNI (Z=2.025, P=0.042 9) ; there was no statistically significant difference between HS-mGPS and PNI (Z=1.594, P=0.110 9). Multivariate Logistic regression analysis showed that CONUT (OR=2.431, 95%CI=1.376-4.295, P=0.002), surgical segment (OR=11.924, 95%CI=5.491-25.893, P<0.001) were independent influencing factors for postoperative complications after LDD. Conclusion Among the four nutritional evaluation methods used to predict postoperative complications of LDD patients, CONUT score is the most effective and can be used as an independent predictor of postoperative complications of LDD.
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