Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2024; 16(1): 143-154
Published online Jan 27, 2024. doi: 10.4240/wjgs.v16.i1.143
Comparison of different preoperative objective nutritional indices for evaluating 30-d mortality and complications after liver transplantation
Chuan Li, Hong-Xia Chen, Yan-Hua Lai
Chuan Li, Yan-Hua Lai, Department of Transplantation, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Hong-Xia Chen, Department of Clinical Pharmacy, People’s Hospital of Guangxi Zhuang Autonomous Region, Nanning 530021, Guangxi Zhuang Autonomous Region, China
Author contributions: Li C conceived the study, collected and analyzed the data and drafted the manuscript; Chen HC assisted with the data collection; Lai YH revised the manuscript; and all the authors read and approved the final version to be published.
Supported by The Self-Funded Research Project of the Health Commission of Guangxi Zhuang Autonomous Region, No. Z-A20230045.
Institutional review board statement: The study was reviewed and approved by the Ethics Committee of Guangxi Zhuang Autonomous Region People's Hospital, No. KY-ZC-2023-056.
Informed consent statement: All patients provided written informed consent for data analysis before transplantation.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (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: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yan-Hua Lai, Doctor, Chief Physician, Director, Professor, Department of Transplantation, People’s Hospital of Guangxi Zhuang Autonomous Region, No. 6 Taoyuan Road, Nanning 530021, Guangxi Zhuang Autonomous Region, China. 1379771812@qq.com
Received: October 29, 2023
Peer-review started: October 29, 2023
First decision: December 6, 2023
Revised: December 17, 2023
Accepted: January 8, 2024
Article in press: January 8, 2024
Published online: January 27, 2024
ARTICLE HIGHLIGHTS
Research background

Nutritional status is closely associated with the prognosis of liver transplantation (LT) patients.

Research motivation

However, few studies have thoroughly investigated the relationship between the preoperative nutritional status of liver transplant recipients and postoperative prognosis. In clinical practice, there is a lack of a simple and effective tool for assessing the nutritional risk of patients during the perioperative period and for predicting the outcomes of LT.

Research objectives

The objective of this study was to compare the value of different preoperative objective nutritional indicators for predicting the 30-d mortality and the incidence of complications following LT.

Research methods

This study conducted a retrospective analysis of clinical data from 162 patients who underwent LT. The present study compared the ability of the serum prealbumin concentration, the controlling nutritional status (CONUT) score, the prognostic nutritional index (PNI), and the nutritional risk index (NRI) to predict the 30-d mortality rate and the incidence of severe complications after LT. This study also aimed to analyze the risk factors associated with the 30-d mortality rate and incidence of severe complications after LT. The area under the receiver operating characteristic curve was used to select the index with the best predictive ability. Patients were then divided into low-risk and high-risk groups based on the optimal cutoff value, and the differences in postoperative complications and mortality rates between the two groups were compared.

Research results

This study identified several independent risk factors associated with 30-d mortality, including blood loss, the PNI, the NRI, and the CONUT. The 30-d mortality rate was 8.6%. Blood loss, the NRI, and the PNI were found to be independent risk factors for the occurrence of severe postoperative complications. The NRI achieved the highest prediction values for 30-d mortality [area under the curve (AUC) = 0.861, P < 0.001] and severe complications (AUC = 0.643, P = 0.011). Compared to those in the high NRI group, the patients in the low NRI group had lower preoperative body mass index and prealbumin and albumin levels, as well as higher alanine aminotransferase and total bilirubin levels, Model for End-stage Liver Disease scores and prothrombin time (P < 0.05). Furthermore, the group with a low NRI exhibited significantly greater incidences of intraabdominal bleeding, primary graft nonfunction, and mortality.

Research conclusions

The NRI has good predictive value for 30-d mortality and severe complications following LT. The NRI could be an effective tool for transplant surgeons to evaluate the perioperative nutritional risk and provide relevant nutritional therapy.

Research perspectives

The purpose of this study was to investigate the predictive value of different objective nutritional indicators before surgery for the outcome of LT.