Retrospective Study
Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jan 6, 2019; 7(1): 28-38
Published online Jan 6, 2019. doi: 10.12998/wjcc.v7.i1.28
Correlation of serum albumin and prognostic nutritional index with outcomes following pancreaticoduodenectomy
Narongsak Rungsakulkij, Pongsatorn Tangtawee, Wikran Suragul, Paramin Muangkaew, Somkit Mingphruedhi, Suraida Aeesoa
Narongsak Rungsakulkij, Pongsatorn Tangtawee, Wikran Suragul, Paramin Muangkaew, Somkit Mingphruedhi, Suraida Aeesoa, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok 10400, Thailand
Author contributions: Rungsakulkij N designed the study, collected and interpreted the data, and wrote the paper; Tangtawee P collected and analyzed the data; Suragul W collected the data; Mingphruedhi S collected the data; Muangkaew P collected the data; and Aeesoa S collected and analyzed the data.
Institutional review board statement: This study was reviewed and approved by the Ramathibodi Hospital Institutional Review Board Committee on Human Rights Related to Research Involving Human Subjects (protocol number ID 07-61-25).
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors declare no conflicts-of-interest related to this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Narongsak Rungsakulkij, FRCS (Gen Surg), MD, Doctor, Lecturer, Surgeon, Department of Surgery, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, 270 Praram VI Road, Ratchathewi, Bangkok 10400, Thailand.
Telephone: +66-2-2011527 Fax: +66-2-2012471
Received: September 6, 2018
Peer-review started: September 6, 2018
First decision: October 19, 2018
Revised: October 26, 2018
Accepted: December 21, 2018
Article in press: December 21, 2018
Published online: January 6, 2019
Research background

Pancreaticoduodenectomy (PD) is an example of major surgery and is a complicated operation to perform for the general surgeon. The perioperative morbidity rate previously reported reaching up to 50%. However, only serious complications are major risk factors for poor long-term surgical outcome. Majority of the serious complications is the infectious complication.

Research motivation

There are several studies have investigated the use of inflammatory markers for prediction of severe postoperative complications following PD. However, the common biomarkers previously reported are C-reactive protein and procalcitonin. These biomarkers are expensive in the limited resource country. Our goal is to find the simple and non-expensive marker for this complicated operation. Prognostic nutritional index (PNI) is one of a simple inexpensive marker. There are previously reported of early postoperative PNI predicted the outcome following surgery.

Research objectives

The objective of our study was to analyze the risk factors and early postoperative PNI for predicting serious complications following PD.

Research methods

From January 2007 to December 2017, 244 consecutive patients underwent PD at the Department of Surgery in Ramathibodi Hospital, Bangkok, Thailand and were retrospectively reviewed. The patients were classified into two groups (grade I-II and III-V complication groups according to Dindo-Clavien classification). Univariate and multivariate analyses were conducted. The cut-off value for high and low PNI was determined by receiver operating characteristic curve analysis

Research results

The independent factors associated with serious postoperative complications following PD were preoperative serum albumin and POD 3 PNI value < 40.5. To the best of our knowledge, we first time reported the early postoperative prognostic index as a predictor of the serious postoperative complication following PD. The hypoalbuminemia is the main factor associated with serious postoperative complications according to previous reports.

Research conclusions

PNI, which is a simple and inexpensive marker, is a good predictor for serious complications. Thus, patients who undergo PD and have early postoperative low PNI should be aware of serious complication especially infectious complications.

Research perspectives

The well designed prospective studies are needed to validate this predictor.