Nutritional responsiveness affects novel neutrophil parameters and reduces in-hospital mortality and costs in elective cancer oesophagectomy - a single centre, prospective, observational study.
Paweł Kutnik, Michał Borys, Kamil Nurczyk, Weronika Domerecka, Jacek Dziedzic, Grzegorz Buszewicz, Grzegorz Teresiński, Helena Donica, Paweł Piwowarczyk, Mirosław Czuczwar
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引用次数: 0
Abstract
Introduction: Malnutrition in surgical patients remains a common issue affecting the perioperative period. Oesophageal cancer is a disease associated with one of the highest malnutrition rates. Assessment of patient nutritional status remains a challenge due to limited validated tools. Novel parameters to identify malnourished patients and the effectiveness of preoperative nutritional intervention might improve treatment results in the perioperative period.
Material and methods: This was a prospective, observational, single-centre study of patients scheduled for elective oesophagectomy. The primary aim of this study was to establish the correlation between neutrophil reactivity intensity (NEUT-RI) and neutrophil granularity intensity (NEUT-GI) and patients' nutritional status. We divided patients into nutritional responders (R group) and nutritional non-responders (NR group) defined as regaining at least 25% of the maximum preoperative body weight loss during the preoperative period.
Results: The R group had significantly shorter intensive care unit (ICU) stays: 5.5 (4-8) vs. 13 (7-31) days ( P = 0.01). It resulted in a lower cost of ICU stays in the R group: 4775.2 (3938.9-7640.7) vs. 12255.8 (7787.6-49108.7) euro in the NR group ( P = 0.01). Between the R group and the NR group, we observed statistically significant differences in both preoperative NEUT-RI (48.6 vs. 53.4, P = 0.03) and NEUT-GI (154.6 vs. 159.3, P = 0.02). Apart from the T grade, the only preoperative factor associated with reduced mortality was the nutritional responsiveness: 11.1% vs. 71.4% ( P = 0.008).
Conclusions: Preoperative nutritional responsiveness affects neutrophil intensity indexes and reduces in-hospital mortality and costs associated with hospital stay. Further research is required to determine the correlation between novel neutrophil parameters and patients' nutritional status.
导言：手术患者营养不良仍是影响围手术期的常见问题。食道癌是营养不良发生率最高的疾病之一。由于有效工具有限，评估患者营养状况仍是一项挑战。识别营养不良患者的新参数以及术前营养干预的有效性可能会改善围手术期的治疗效果：这是一项前瞻性、观察性、单中心研究，对象是计划进行择期食管切除术的患者。本研究的主要目的是确定中性粒细胞反应强度（NEUT-RI）和中性粒细胞颗粒度强度（NEUT-GI）与患者营养状况之间的相关性。我们将患者分为营养应答者（R 组）和营养无应答者（NR 组），营养无应答者的定义是术前体重至少恢复术前最大体重的 25%：R组的重症监护室（ICU）住院时间明显缩短：5.5（4-8）天对 13（7-31）天（P = 0.01）。R组的重症监护室住院费用更低：4775.2（3938.9-7640.7）欧元，而 NR 组为 12255.8（7787.6-49108.7）欧元（P = 0.01）。在 R 组和 NR 组之间，我们观察到术前 NEUT-RI （48.6 vs. 53.4，P = 0.03）和 NEUT-GI （154.6 vs. 159.3，P = 0.02）的差异具有统计学意义。除T分级外，唯一与死亡率降低相关的术前因素是营养反应性：11.1% vs. 71.4% ( P = 0.008)：结论：术前营养反应性会影响中性粒细胞强度指数，降低院内死亡率和住院相关费用。需要进一步研究确定新型中性粒细胞参数与患者营养状况之间的相关性。
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